Panel 1. “Women, newborn and child health: Social protection in health and the Millennium Development Goals.”

Social Protection in Health Forum

Elsa Gómez Gómez

Tegucigalpa, November 8, 2006

Themes for reflection

1. Gender as a structural determinant of health inequity

2. MDG 3, “Gender equality and empowerment of women,” as an end in itself, from a rights and citizenship focus

3. Centrality of MDG 3 for achieving the health objectives of women, mothers and children

4. Challenges the health sector faces in contributing to progress in MDG 3, accelerating the achievement of the health goals

1. Cultural definitions of differential roles, rights and responsibilities for W(omen) and M(en) determine inequalities in:

Health risks and problems for W and M Allocation of social resources for meeting the

specific needs of each sex Access for W and M to appropriate resources

and services Contributions of W and M to the financing of

care Distribution by sex of the responsibilities,

compensations and power in the social production of health

0

10

20

30

40

50

60

70

Nica

ragu

a

Hond

uras

Jam

aica

Gua

tem

ala

Rep.

Dom

.

Ecua

dor

Bras

il

Cost

a Ri

ca

Colo

mbi

a

Pana

ma

Méx

ico

Ven

ezue

la

Chile

(%)

0

10

20

30

40

50

60

70

Nic

arag

ua

Hon

dura

s

Jam

aica

Gua

tem

ala

Rep

. Dom

.

Ecua

dor

Bra

sil

Cos

ta R

ica

Col

ombi

a

Pana

ma

Méx

ico

Ven

ezue

la

Chi

le

Gender and poverty: Poverty affects differently the survival opportunities of men and women

Probability of dying (per 1,000) between 15 and 59 years of age, according to sex and poverty condition

Source: WHO - The World Health Report, 1999

MenWomen

Non-Poor Poor

Dom

. Rep

.

Dom

. Rep

.

Braz

il

Braz

il

Mex

ico

Mex

ico

2. Emphasis on W responds to the ethical imperative to rectify unjust inequalities that limit the exercise of the right to health

W have a greater need for services than M tend to use services more than M

must pay more than M to protect their health

have lower economic capacity

constitute the majority of providers of formal care and the primary providers of family health

are more affected by reductions in public services, as users and caretakers

have less power and representation

W and M get sick and die due to different causes

Percentage distribution of years of life lost due to premature death and disabilities, by groups of causes.

Latin America and the Caribbean

Groups of causes Man   Woman

Transmissible, maternal, perinatal, nutritional 33 39

Non-transmissible 45 52

Accidents and violence 22   10

Source: Hanson, Kara. Measuring Up: Gender, Burden Disease, and Priority Setting, 2002.

% of years lost due to premature death and disability due to illnesses of the reproductive system in the 15-44 year old group, according to sex. Latin America and the Caribbean.

Source: Abou Zahr, C. and P. Vaughan 2000. Assessing the burden & sexual reproductive ill-health.

Causes  Women   Men

STIs, excluding HIV 3.97 0.60

HIV 1.06 3.63

Maternal Conditions 9.64  

Cancers of the Repro. System 2.14 0.02

Total 16.80   4.25

Source: National Household Surveys 1997-2000.

Percentage of people with health problems that seek care, by sex, in selected countries of Latin America,

1997-2000.

0

20

40

60

80

Chile Colombia Peru Ecuador

(%) Men

Women

W have greater needs for services, tend to use them with greater frequency and pay more for them

– In BRA, ECU, PER, PAR and the DOM REP, out-of-pocket spending on health was 15.45% higher for W than M.

– In the USA, out-of-pocket spending on health during the reproductive years was 68% higher for W than M.

– In Chile, private insurance premiums during the reproductive years are 3 times higher for W than M.

Health care costs more for W

W have lower economic capacity

• 50% of W are outside of the remunerated labor market• Unremunerated domestic labor is not eligible for social

services• Unemployment is consistently higher for W• W are the majority in occupations in the informal and

part-time sectors, with lower social protection• The remuneration of W is 30% lower than that of M• Less W than M are entitled to rights:19% of W and 32%

of M contribute to social security in LAC• W’s work history, since interrupted by family roles, limits

access to and amount of social protection in old age.

73

85

77

79

81

83

79

74

79

81

83

80

73

78

72

72

77

73

79

60

58

57

57

57

56

54

54

53

53

52

51

51

50

50

46

46

45

45

0 10 20 30 40 50 60 70 80 90

USA*

Guatemala

Bolivia

Colombia

Uruguay

Venezuela*

Panama

Peru

Brasil

Ecuador

Nicaragua

Dominican Republic

El Salvador

Honduras

Uruguay

Argentina

Costa Rica

Chile

México

Men Women

Percentage of men and women in the urban labor force. 2000/2003

Source: PAHO/GE Gender, Health and Development in the Americas, Basic indicators

Urban unemployment rate (%) by sex. 2003

27

24

21

20

20

20

14

13

13

12

8

8

8

8

7

13

9

4

12

4

3

12

17

13

14

15

19

6

9

9

11

5

7

6

7

5

0 5 10 15 20 25 30

Dominican Republic

Panama

Uruguay

Venezuela***

Colombia

Argentina*

Ecuador

Brazil

Chile

Paraguay**

Nicaragua

Bolivia

Honduras

Costa Rica

Peru

Guatemala

El Salvador

Mexico

Women Men

Women Men

Source: PAHO/GE Gender, Health and Development in the Americas, Basic indicators

Average weekly hours worked by women and men in the urban labor market.

# horas

52.8

45.5

50.6

48.0

49.1

49.6

46.2

49.2

46.0

46.3

43.6

44.8

44.3

45.2

40.0

43.2

43.7

27.4

50.6

43.9

43.3

41.3

41.0

40.4

40.4

40.3

39.6

39.5

39.0

38.7

37.0

36.3

35.0

35.0

32.0

23.0

0 10 20 30 40 50 60

Chile (2003)

El Salvador (2004)

Nicaragua (2002)

Bolivia (2002)

Colombia (2002)

Costa Rica (2004)

P erú (2003)

México (2004)

Ecuador (2004)

Honduras (2003)

P anamá (2004)

Rep. Dominicana (2004)

Brasil (2003)

Guatemala (2004)

P araguay (2002)

Uruguay (2004)

Argentina (2004)

Venezuela (2003)

Hombres Mujeres # hoursMen Women

Dominican Republic (2004)

Percentage of women and men employed in low-productivity sectors

%

7773 72

68 66 65 63 62

51 51 50

4240 38

42

58

46

59 58 56 55 56 55

48

58

41 42 4237 36

28

42

59

50

0

30

60

90

Mujeres Hombres

Dom

inic

an R

ep. (

2004

)

Women Men

58

59

61

63

64

66

67

67

68

69

70

72

73

74

75

76

76

76

77

0 30 60 90

Guatemala

Argentina*

Bolivia

Mexico

Chile

Brazil

Ecuador

P eru

Dominican Republic

Nicaragua

P araguay**

Uruguay

El Salvador

USA

Costa Rica

Honduras

P anama

Venezuela***

Colombia

Average female income as a percentage of average male income. 2000/2003

*Buenos Aires. **Asuncion. *** National

Source: PAHO/GE Gender, Health and Development in the Americas, Basic indicators (CEPAL data)HRSA, Women’s Health USA 2002.

3. MDG 3 and MDGs for maternal and child health

Education, reproductive autonomy, W’s access to resources, and a life free of violence are decisive factors for child and maternal health.

1-3 years of maternal education reduce child mortality by 15%. 1-3 years of paternal education reduce it by 6% (BM, 2003)

Control over their own fertility is critical for the health of women, mothers and children. Numerous, closely-spaced, very early or very late pregnancies put women’s and children’s lives at risk.

Violence against women is the cause of physical and mental pathologies, is a risk for perinatal health and negatively affects self-care during pregnancy and, subsequently, childcare

Child mortality (per 1,000 live births), in the 10 years prior to the surveys, by maternal education level, selected countries of LA, 2000.

113

93

73

56 54

88

4954

47

3528

77

41

23 212014

42

302830

nd nd

16

0

20

40

60

80

100

120

Bolivia Brasil Perú Guatemala Nicaragua Colombia

Sin educación Primaria Secundaria Superior

1 Demographic and Health SurveysSource: IADB: Los Objetivos de Desarrollo del Milenio en América Latina y el Caribe. Retos, acciones y compromisos. 2004.

No education Primary Secondary Superior

Child mortality (per 1,000 live births) according to duration of birth interval, LAC

Source: DHS. Taken from: The Alan Guttmacher Institute, 2002 Series, No.2

mortalidad infantil

83

48

35

0

20

40

60

80

100

< 2 años 2-3 años >= 4 años

Interval

CMR

< 2 years 2-3 years >= 4 years

Maternal and child mortality rates in selected countries of the Americas, as multiples of the MM and CM rates in Chile.

0 5 10 15 20 25 30

Haiti

Bolivia

Nicaragua

Honduras

Ecuador

Jamaica

Guatemala

Peru

Paraguay

El Salvador

Venezuela

Panama

Dominican Republic

Colombia

Brazil

Mexico

Costa Rica

Argentina

Cuba

CMR/CMR Chile

MMR/MMR Chile

PAHO, Basic Indicators, 2005

Unmet need for contraception in 2 neglected groups: adolescent women and women without education

%

58.3

25.433

19.8

2923.6

16.2

40.7

28.8 31.323.2

12.716.5

12.2

39.6

23.1 22.714.6

10.9 10.25.8

0

1020

30

40

5060

70H

aití

(2000)

Guate

mala

(1998/9

9)

Boliv

ia (

2003)

Nic

ara

gua (

2001)

Repúblic

a

Dom

inic

ana(2

002)

Perú

(2000)

Colo

mbia

(2005)

15-19 años Sin educación Total nacional

Source: OCR Macro. DHS

Do

min

ican

R

epu

blic

(20

02)

Do

min

ican

R

epu

blic

(20

02)15-19 yrs No education Natl. Total

Domestic Violence

% of women 15-49 years of age in union, that have ever experienced physical or sexual violence by their partner

or companion. Around 2000

Source: Measure ORC Macro, Demographic Health Surveys carried out in each country between 1997 and 2002.

44 42

30 29

22

11

Notavailable

10

17

6

0

10

20

30

40

50

Colombia (2000) Peru (2000) Nicaragua (1997-98)

Haiti (2000) Dominican Rep. (2002)

Physical Sexual

4. Challenges for the sector in contributing to advances toward MDG 3, accelerating the achievement of the health MDGs

Provide integral and integrated sexual and reproductive health services to W and M in the framework of strengthening PHC, emphasizing adolescents, and including care for domestic and sexual violence against W

Separate the labor situation from access to social protection in health, promoting universality and overcoming exclusion and segmentation

Promote solidarity in financing in reproduction to ensure that its costs do not fall mainly on W

Strengthen inclusion and citizen participation of W within the power structures of the local and national health systems