Towards a woman-friendly healthcare system (2009)
An Indian poet, Anasuya Sengupta, once wrote: “Too many women in too many countries speak the same language of silence.” This is no longer the case. Women are now speaking up, and the profession should listen.
When women of the world gathered at the International Conference in Beijing in 1995, the Platform for Action which they adopted devoted a special section to women’s health, and highlighted specific areas of concern about the healthcare system.
I submit for your consideration nine propositions on how we can make our healthcare system friendly to women. These propositions are partly about what the system has to learn, but also what the system has to unlearn.
1) Women are ends and not means
Contraception is meant to be used by women to empower themselves by maximising their choices, and controlling their fertility, their sexuality, their health and thus their lives. Family planning, however, can be used and has been used by governments and others to control rather than to empower women.
At the 1994 Cairo International Conference on Population and Development (ICPD), I proposed ten principles for a woman-friendly family planning service:
- Uphold the principle that family planning is a dignified behaviour based on voluntary informed choice.
- Be open at times of women’s convenience. Provide an outreach service.
- Excel in counselling.
- Offer a broad choice of contraceptive methods.
- Do not promote contraceptive methods for their demographic effectiveness. Do not subscribe to demographic targets or quotas.
- Include in your inventory only methods that your service can deliver, ensuring women’s safety and free informed choice.
- Promote men’s participation and responsibility in family planning.
- Offer sympathetic care and help if a woman has an unwanted pregnancy.
- Care as much about protecting women from reproductive tract infections as about protecting them from unwanted pregnancy.
- Do not miss an opportunity to help you with other reproductive health needs or problems.
When women are given a real choice, and the information and means to implement their choice, they will make the most rational decisions for themselves, for their communities and ultimately for the world at large.
2) A woman is not a womb; a woman has a womb
One attitude to dismantle in the profession of women’s health is to see the health of women only or mainly through their reproductive function and reproductive system. The health of women is more than the health of mothers and more than the absence of gynaecological disease.
3) Maternity is not a disease
Pregnancy should not be lumped with other causes of the burden of disease in the competition for allocation of resources.
Maternity is a privileged function of women, essential for the survival of our species. If women go on strike, and withdraw their “labour”, our human species will become extinct. Women risk their life to give us life.
4) Do not over-medicalise
“In some countries, over-medicating of women's life events is common, leading to unnecessary surgical interventions and inappropriate medication." Beijing Platform for Action, paragraph 103.
One example of this over-medicalisation is the rise of Caesarean sections around the world.
5) Medicine should re-discover its social roots
While social consciousness is important in all the practice of medicine, it is highly important in the field of women’s health: “Women’s health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology.” Beijing Platform for Action, paragraph 89.
6) The profession should be gender conscious
Research data and service statistics should be disaggregated not only by age, but also by sex, and appropriate conclusions should be drawn for the improvement of gender-sensitive health services.
7) Women are an integral part of the healthcare system
Women are not only beneficiaries of the health system. They are part of it, as caregivers, nurses, and doctors.
Home is where somewhere between 70 percent and 90 percent of all sickness is managed. Cost-cutting efforts in health care reform often involve early release from hospital without adequate medical, nursing and home support services in the community. This penalises middle-aged and older women who are left to care for people who are acutely or chronically ill, with little or no professional support.
In many countries, the knowledge and skills of nurses and midwives are still not acknowledged, and often under-utilised. The medical workforce in many countries includes increasing numbers of women doctors. But are they getting the recognition they deserve? Not yet.
8) Care versus cure
Throughout human history, medicine has been recognised as a profession for both care and cure. Unfortunately, the pride in the application of scientific knowledge and biomedical technology is now creating an "emotional" gap in the care of patients.
Women increasingly resent being objectified in their fundamental physiological roles. When they feel that what they need is care, they sometimes get what they perceive as a depersonalised, mechanised, mystery-clouded medical service.
9) Equity please!
A major barrier for women to the achievement of the highest attainable standard of health is inequality, both between men and women and among women in different geographic regions, social classes and indigenous and ethnic groups.
New public health interventions and programs initially reach those of higher socio-economic status, and only later affect the poor. And where people are poor, women are the poorest of the poor.
This article is an edited version of a speech delivered by Prof. Mahmoud F. Fathalla, FIGO Past President (1994 – 1997) at the Egon and Ann Diczfalusy Foundation Meeting in Szeged, Hungary, November 10, 2009