Poverty, Development, and Women: Why Should We Care?

© 2007, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses JOGNN 523

Healthy, prosperous nations require healthy women and newborns. Young girls and women in resource-poor nations suffer the greatest ill-health consequences from low status, denial of basic human rights, and poverty. Poverty and poor health result in poor economic development. The Millennium Devel-opment Goals call for immediate efforts to reduce poverty, improve health, especially of girls and women, and foster development in the world ’ s poor-est nations. JOGNN, 36, 523-530; 2007. DOI: 10.1111/J.1552-6909.2007.00184.x

Keywords : Development — Poverty — Women ’ s health

Accepted: May 2007

The Millennium Development Goals, particularly the eradication of poverty and hunger, cannot be achieved if questions of population and reproduc-tive health are not squarely addressed. And that means stronger efforts to promote women ’ s rights, and greater investment in education and health, in-cluding reproductive health and family planning.

Kofi Annan, UN Secretary General, 2002

In August 1995 at the Fourth World Congress on Women in Beijing, the theme of the preconference in Huairou was, “ Look at the World through Wom-en ’ s Eyes. ” Those present heard and witnessed women ’ s stories of torture and beatings for speaking out publicly in Miramar, the loss of young lives from unsafe abortions and female circumcision in Africa, the untimely deaths of one ’ s sisters and young children in South Asia, and the suffocation of newborns in India who were female. For many

individuals from resource-rich countries, this “ look ” and stories were uncomfortable and seemingly un-real. However, for the women from resource-poor nations and the vulnerable groups in rich nations, this look was and continues to be their daily reality. This reality gives rise to the question, “ How can we, the privileged, continue to ignore the fact that well over one-half of the world ’ s women live in abject poverty, ravaged by disease and infi rmity, devoid of status and basic human rights, and valued only for their ability to procreate, even if it kills them (which it often does)? ”

Poverty, economic development, and the poor health of women are a deadly combination of ele-ments that, if left as is, will result in continued poor health of families, continued high rates of maternal and neonatal mortality and morbidity, and limited national development in most resource-poor nations of the world. It is a well-known fact, reported in many publications since 1980s with increasing em-phasis in the 21st century, that the health of women determines the health and socioeconomic deve-lopment of any country ( The Partnership, 2006; Thompson, 2005; United Nations, 2000; World Health Organization [WHO], 2005 ). A simple explanation is that healthy women beget healthy children who be-come healthy adults and productive members/leaders of any society. Part of the support for this statement comes from the dual roles of women in any society — society maintaining through growing, birthing, and caring for the next generation and society enhancing through their leadership and contributions to the economic and social development of villages, com-munities, and nations.

Resource-poor nations are plagued with lack of support for the important roles of women in society

THOUGHTS & OPINIONS

Poverty, Development, and Women: Why Should We Care? Joyce E. (Beebe) Thompson

524 JOGNN Volume 36, Number 6

that begins when a baby is born female . This paper will explore the lives of girls and women in resource-poor na-tions, beginning with factors that contribute to poor health and then exploring links between the poor health of young girls and women, poverty, and a nation ’ s level of socioeco-nomic development.

Determinants of Health

What is health and how do we promote, maintain, or regain our personal health? In this paper, “ health ” is much more than the absence of disease. As noted in the Consti-tution of the WHO when it was established on April 7, 1948, health is defi ned as a “ state of complete physical, mental and social well-being ” ( www.who.int/about/ ) that allows a person to perform their daily work and achieve their life goals. In order to attain this state of health, one needs to understand what contributes to personal health and well-being. This understanding, with special reference to young girls and women, allows one to more clearly vi-sualize the links between the cultural, social, and economic status of women that results in their lack of development and poor health.

Years ago, Blum (1974) noted that there were several main elements that determined how healthy one could be or was. The primary determinants of how healthy an indi-vidual is, in decreasing order of infl uence, are as follows: (a) environmental factors including the fetal and physical environment, (b) socioeconomic status, culture, and level of education, (c) personal habits of daily living, (d) genet-ics, and (e) the availability of health professionals. These remain pertinent today.

Several years ago, Thompson (1999 ) added another de-terminant of women ’ s health — personal status — after wit-nessing fi rsthand in Latin America and sub-Saharan Africa the key link between health and human rights — especially for women. She observed that women in resource-poor na-tions were prevented from attaining their fullest potential in health and well-being because they were viewed by those in power as “ objects, ” not as persons. More on this later.

The connection of these determinants of health to the health of girls and women is important. For example, the fetal environment begins the level of health for all human beings and is largely dependent on the health of the preg-nant woman prior to and during pregnancy. Though ge-netics can play a role in individual health over a lifetime, fetal and newborn health is largely dependent on the health of the mother, including her health over a lifetime as she cares for the children, the family, and often her parents as they age. The physical environment is also important to everyone ’ s health, especially the need for safe drinking wa-ter and safe working environments. The low status of women, beginning with the birth of a girl child, is directly connected with how healthy that girl child will be as she grows into adulthood ( Cook, 1994 ). Likewise, her choices

(or lack of them) of personal health habits related to diet, exercise, alcohol, drug use/abuse, and so forth as well as sexual behaviors (unsafe sex, unplanned pregnancies, un-safe abortion) have a direct link to the health of young girls and women.

Health of girls and women is affected by low status, denial of human rights, and poverty.

Although a minor input into one ’ s health overall, in resource-poor nations, the availability, accessibility, accept-ability, and affordability of health services provided by culturally sensitive, up-to-date health workers are vital. Global emphasis on having a professional birth attendant with midwifery competencies has reinforced the impor-tance of health services for childbearing women in resource-poor nations ( Task Force on Maternal Survival , 2006; UN Millennium Project Task Force on Child Health and Maternal Health, 2005; WHO, 2004 , 2005 ). Recent evidence ( Family Care International [FCI], 2002; WHO, 2004 ) has demonstrated the need for having an enabling environment for providing health services that include suffi cient equipment and essential drugs for use when needed. Otherwise, even the most competent and caring midwife or nurse or physician may not be able to provide needed services for women or even save the lives of mother or child in an emergency.

Health of Women and Newborns

A quick overview of the current health status of women and newborns is shocking as well as devastating — not only to the families of these women and newborns but also to those who spend their lives trying to prevent such trage-dies and to the societies where these women and newborns lived. As noted in many recent publications ( Bellagio Child Survival Study Group, 2003 ; Lancet , 2006; The Partner-ship, 2006; Population Reference Bureau [PRB], 2006; Save the Children, 2006; UNFPA, 2006; WHO, 2005 ), a picture of ill health includes the fact that:

• Every year, 60 million women give birth at home without a skilled birth attendant ( Lancet , 2005).

• Every year, nearly 600,000 women die during the childbearing cycle with about 68,000 of those deaths resulting from unsafe abortion ( WHO, 2005 ).

• Every year, about 4 million newborns die within the fi rst 28 days of birth, more than 3 million die as stillbirths, and 10 million children die before their fi fth birthday ( Sines, Tinker, & Ruben, 2006 ).

November/December 2007 JOGNN 525

• 120 million women who would like to space or limit their births are unable to do so because they lack ac-cess to information, education, and counseling on family planning, cannot access contraceptives, or face other social, economic, or cultural barriers ( FCI, 2005 ).

• 39.4 million people are living with HIV/AIDS and almost half of them are women ( FCI, 2005 ).

A more striking portrayal of these numbers is that every minute of every day, at least one woman dies from pregnancy-related causes, 7 newborns die, and 20 children between the ages of 1 and 5 die.

Poverty and ill health lead to poor economic development.

An even more sobering fact is that 99% of newborn deaths and 98% of maternal deaths occur in resource-poor nations from mostly preventable causes ( Save the Children, 2006 ). There is no excuse for these preventable deaths to continue, but they do. This fact has led to the view that poor women and children are not important — that they are discardable objects to be mourned, yes, but not important enough to politicians, policy makers, and husbands/fathers to have received enough attention to have prevented their needless deaths. Cook (1994) noted that “ the collective failure to stem the rising tide of mater-nal mortality is evidence of societal views that the lives of women are expendable and that women do not matter! ” Maternal mortality is one of the greatest social injustices of the modern era. While many proven, cost-effective in-terventions are known that can save the lives of women and children, they do not reach the most vulnerable groups for a variety of political, economic, social, cultural, and low-status reasons.

The health of women and newborns in any society is affected by many factors as noted earlier. One only needs to read current health statistics by area of the world to see that women and girl children fare much better in resource-rich countries than in resource-poor nations. The 1998 data on women in the world ( PRB, 1998 ) noted that women in less developed nations had a life expectancy of 60 years compared to 71 years in more developed nations, a maternal mortality ratio of 580 per 100,000 live births compared to 10 in Western Europe and the United States, along with lower levels of literacy and lower wages when compared to men. In addition, levels of domestic violence and AIDS were on the increase for women (PRB, 1998). The infant mortality ratio (deaths per 1,000 live births

during fi rst year of life) was 61 in less developed nations compared to 6 in more developed nations ( PRB, 2006 ), and neonatal mortality ratio (deaths per 1,000 live births during fi rst 28 days of life) was 34 compared to 5 in more developed regions of the world ( Save the Children, 2004 ).

The 2006 reported data on newborns, girls, and women demonstrated that little has changed for the better in resource-poor nations and many areas where progress for women has halted or reversed ( PRB, 2006; WHO, 2005 ). These data also included the fact that adolescent preg-nancy (15-19 years old) accounts for more than 25% of all births in some resource-poor nations, such as Bangladesh, Chad, and Mozambique ( PRB, 2006 ). Early childbearing can limit a young girl ’ s education and reduce her potential earnings, contributing less/little to development of the nation. Contraceptive use in many resource-poor nations is also limited (overall rate of 50%, with a low of 4% and high of 57% in countries in Africa), leading to unwanted pregnancies, increased demand for abortions, and poor health of young girls and women.

If one were to examine specifi c regions of the world that account for the great majority of these statistics re-lated to the poor health of women and newborns, they would include sub-Saharan Africa and South Asia. How-ever, within regions individual country differences are noted as well as within country disparities ( PRB, 2006 ). Why is this so? One explanation relates to the urban ver-sus rural paradigm, with less access to economic develop-ment, health services, and education in remote or rural areas. Another reason that maternal mortality is so high in sub-Saharan Africa, South Asia, and some countries in Latin America is the low status of women that leads to lack of basic human rights.

Status in Society The dominant view of women in any society is a com-

bination of value biases, cultural traditions, and sex role stereotyping. Unfortunately, this view often treats women as chattel, property to be owned and bartered, as the spoils of war, or as reproductive machines. Many of the world ’ s women suffer from dominant societal views that too often relegate the girl child or woman to being an object — rather than a person. This objectifi cation of women leads to the persistent denial of the basic human rights available to most men ( Thompson, 2004 ).

Examples of what happens to the girl child or woman when viewed as an object are rampant throughout the world. These include cultures that prefer men, resulting in selective termination of female fetuses or, worse, suffoca-tion of girl babies at birth (infanticide). Another health con-sequence is related to cultures that value women only for their procreative ability — the number of children they pro-duce that “ feeds ” the men ’ s sense of importance. Thus, beginning in early teens, women have too many children too close together so that their bodies cannot recover health


(if they ever had it), often leading to maternal disability or death, or both. Choices about when and whether to conceive a child or seek medical attention when needed are not made by the women themselves — leading to further deterioration of their health ( Thompson, 2004, 2005 ). Even more striking during the author ’ s work in East Africa was the realization that women could not refuse sex, increasing the likelihood of HIV transmission from a wandering husband, nor could they decide to seek medical attention if a complication arose during pregnancy or birth. These decisions were the prov-ince of the men in the family and often left the women mal-nourished, poor, and, too often, disabled or dead.

There is a global call to action to address the importance of women in health and

development of nations.

Lack of Human Rights When women are treated as objects and not as fully hu-

man, they have few or no rights and their health suffers. Human rights are justifi ed claims that individuals and groups make upon others or society based on the ethical concept of justice. Human rights help societies defi ne what it means to be a person including how one should be treated by others and how one should treat other human beings. Basic human rights generally include a right to: (a) respect as a person of value or worth, (b) security of person (safety), (c) privacy/confi dentiality, (d) food, nutrition, and housing, (e) freedom from any form of discrimination, (f) information and educa-tion, (g) benefi ts of scientifi c progress, (h) freely informed consent, (i) reproductive choices, and (j) equitable access to health services of good quality ( Thompson, 2004 ).

Many authors ( Cook, Dickens, & Fathalla, 2003; Thompson, 2004; WHO, 2002 ) agree that the violation of basic human rights leads to poor health, especially for girls and women. Women denied their basic right to safety are prime candidates for domestic violence, maternal death, and HIV/AIDS. Women denied their right to information and education are experimented on without their fully in-formed consent, including the overuse of elective cesarean surgery in rich nations and lack of access to cesarean deliv-ery when needed in poor nations. Those with limited educa-tion or who are illiterate cannot read basic health promotion information or how to take prescribed medications. As noted earlier, when women are denied an active role in making decisions about their work, their lives, or when to seek medical attention, even in emergencies, the health con-sequences include disability and even premature death.

The health consequences of discrimination against young girls and women may exist in every country and culture but are more pronounced in resource-poor na-tions. There is a global call to action in both health and development sectors to view girls and women as fully hu-man with full human rights so that nations can prosper ( Lancet , 2003, 2006; Save the Children, 2006; WHO, 2005 ). In a recent article ( Public Health at a Glance, 2006 ), the author noted that one of the benefi ts of reducing ma-ternal deaths and improving maternal health is improve-ment in the labor supply and productive capacity of women, resulting in improved household income and economic well-being of families and communities. Once again, the link between health and development is reinforced.

Poverty and Development

Socioeconomic status and level of education contribute to personal health or the lack thereof, especially for young girls and women. In resource-poor nations, girls/women eat least and last, if anything is left, and are discriminated against when it comes to primary, secondary, and tertiary education access ( Cook, 1994 ; PRB, 2006; WHO, 2005 ). Recently, the WHO published a foundational module on poverty and gender ( Western Pacifi c Regional Offi ce/WHO, 2006 ), in which it was noted that the current un-derstanding of poverty indicators includes multidimen-sional aspects beyond income and consumption, such as education, health, social and political participation, per-sonal security, and powerlessness (p. viii). This validates prior understandings of how poverty interacts with the health of women.

A conservative estimate is that 70% of the world ’ s women live in poverty and that poverty signifi cantly af-fects their ability to access health services, read health pro-motion literature (584 million women illiterate), or make nutritious choices in food, especially if they do not have enough money to purchase healthy foods. Currently, one third of deaths in the world (18 million people or 50,000 deaths a day) are due to poverty-related causes with a ma-jority of these deaths in women and children ( UNFPA, 2006 ). Far too many women lack access to family plan-ning, and deaths of women during pregnancy and child-birth show no signs of improvement — especially in sub-Saharan Africa and South Asia ( Ashford, 2005 ). The World Health Report (WHO, 2005) noted that poorer women have more children at an earlier age and that chil-dren of the poorest women are three times more likely to have stunted growth. The report also noted that the wealthiest women (high economic development) were half as likely to be malnourished, four times more likely to use mod-ern contraceptives, and fi ve times more likely to give birth with a skilled attendant, leading to positive health outcomes for both mother and newborn ( Campbell & Graham , 2006).


Poor, barefoot, and pregnant are a reality for many women living in resource-poor nations, and each of these factors contributes to early death or disability for young girls and women.

The population of the 50 poorest countries is projected to more than double by 2050 and to at least triple in 12 of them. This population increase is notable in those areas and environments of the world that can least sustain such growth. At the same time that the net increase in popula-tion is occurring in developing countries, the number of women and children living in poverty is also rising ( www.unfpa.org/pds/facts.htm ). As Ashford (2005) noted, the gap between the health of women and children is widening between wealthy and poor countries. More than 1 billion people live on less than $1 per day with nearly 2.8 billion living on less than $2 a day. The income per person in Africa fell 25% over the past 20 years ( www.millennium-campaign.org ).

It is widely recognized that population dynamics and trends are closely linked to economic progress, highlight-ing the importance of access to sexual and reproductive health information and services. Birdsall and Sinding (2004) analyzed demographic trends and four decades of debate about the relationship of population growth to economics. They concluded that economists at the end of the 1990s fi nally reached the conclusion that “ rapid popu-lation growth generally hinders economic growth ” (p. 29). However, they also noted that economists have yet to ap-preciate that reducing high fertility rates is a critical ele-ment in the global effort to reduce poverty. Jeffrey Sachs ( Crossette, 2004 ) noted that not only is the world popula-tion growing rapidly but also in the poorest countries of the world, it is a hindrance to national economic develop-ment. Thus, it is time to reinvest in child spacing/family planning, especially in low-income countries.

Access to family planning counseling and services is dif-fi cult in many poor countries for a variety of reasons — cul-tural, personal, and fi nancial. FCI ’ s (2005) Briefi ng Cards summarize some important facts related to sexual and re-productive health that highlight the important connection between access/use of contraception and the health of communities (development). For example, 201 million women in developing countries would like to space their pregnancies or terminate childbearing but cannot access or are not allowed to choose modern methods. If this “ un-met need ” were met, 52 million unintended pregnancies would be averted in 1 year, which would prevent 142,000 pregnancy-related deaths and 1.4 million infant deaths. The brief also noted that “ sexual and reproductive ill health is both a consequence and cause of poverty and hunger ” (p. 5). One example is that when young girls be-gin their childbearing too soon, they often cannot com-plete their schooling, leading to fewer employment opportunities and increasing the poverty burden on the family, community, and nation.

Financing health services, especially modern contracep-tion methods, remains a problem in the developing world. The increase in conservative religious perspectives in ma-jor donor countries has limited these funds in recent years so that the $18.5 billion promised during the 1994 Cairo International Conference on Population and Development has not been forthcoming, with slightly more than 50% actually received ( www.unfpa.org/pds/facts.htm ). Meet-ing the Cairo challenge by 2015 is doubtful unless imme-diate action is taken to make acceptable reproductive health information and services available in the low-resource nations ( Catino, 1999; PAI, FCI, IPPF, 2005). Stated bluntly, now is the time for the wealthy nations to reverse the deadly results of promoting debt and unrealistic economic policies, as well as imposing personal values, in developing countries and begin to support sector-wide approaches that include quality health services for young girls and women, including access to family planning services, especially in rural and remote areas.

Responses of the Global Community

The Safe Motherhood Initiative (1987 to Present) The sad reality of ill health in young girls and women,

especially those who are poor, requires an immediate re-sponse. The global Safe Motherhood Initiative begun in 1987 in response to high rates of maternal death and disability in resource-poor nations did not generate the large-scale effect that was envisioned for a variety of reasons, not the least of which was minimal economic investment ( Starrs, 2006 ). Many lessons were learned, however, and today there is greater clarity and consen-sus on what needs to be done, what interventions are effective, and governmental recognition of the value of investing in maternal health. The recent Maternal Survival series ( Task Force on Maternal Survival , 2006) notes that one of the most important interventions is having births attended by midwives in a health facility closest to the women, with reliable access to emergency care when needed ( Campbell & Graham, 2006 ). The World Health Report (WHO, 2005) , with its emphasis on “ Make every woman and child count, ” along with United Nations Population Fund (UNFPA) projected that an additional 334,000 midwives were needed immediately, recognizing that it will take time for countries to produce the needed midwifery teachers and clinicians ( Koblinsky et al., 2006 ). UNFPA and the International Confederation of Midwives (ICM) are working together to make this need a reality.

At the fi rst international forum on “ Midwifery in the Community ” held in Hammamet, Tunisia, December 11 to 15, 2006, a call to action was agreed. This document calls on governments, regulatory bodies, professional


health care organizations, educators, and communities to establish or improve the following key areas:

• Policies to ensure equitable access to midwifery services.

• Policies and regulatory systems to improve the num-ber, deployment, status, and conditions of work of midwives and others with midwifery skills.

• Competency-based education and training in mid-wifery skills.

• Peer and supportive supervision of providers in the fi eld.

• An enabling environment to support effective health care delivery, including infrastructure, communica-tion, emergency transportation, adequate funding, equipment, and supplies.

• Permanent monitoring and periodic evaluation.

Another strategy to improve the health of women and children includes a focus on the continuum of care from adolescence through childbearing, newborn, and young child years ( Lancet , 2003). The new global Partnership for Maternal, Newborn, and Child Health (PMNCH) has ad-opted this continuum of care along with a second dimen-sion as one of its guiding principles. The second is the continuum of care from the household to the health facil-ity and hospital as needed (Partnership, 2005). This global partnership ’ s focus on strengthening health systems and capacities is essential to address access, availability, and acceptability of health services for girls and women. This continuum of care requires effective interventions as well as national policies that support the investment in Safe Motherhood ( Thompson, 2005 ).

The Millennium Development Goals (2000) Another global effort to improve the health of popula-

tions, especially in resource-poor nations, is the agreement of the Millennium Development Goals (MDGs) in 2000. Each of the previously described determinants of individual health can be seen as an integral part of the eight MDGs, endorsed by 189 member states of the United Nations. Each MDG has specifi c outcome indicators for improved health by 2015. The MDGs recognize that poverty, health, and development are tightly interlinked and must be addressed together. The goals begin with the reduction of poverty, illustrating again the key link between poverty and health, and rest on the platform of women as persons and political action by men and women in order to improve the health of nations.

The eight goals are as follows:

1. Eradicate extreme poverty and hunger. 2. Achieve universal primary education. 3. Promote gender equality and empower women. 4. Reduce child mortality. 5. Improve maternal health. 6. Combat HIVAIDS, malaria, and other diseases.

7. Ensure environmental sustainability. 8. Develop a global partnership for development.

Looking closely at each of these MDGs, one can note that success in achieving each depends in large measure on the health and well-being of women. For example, the face of poverty is more often female (MDG 1), limited primary education often disadvantages girls more than boys (MDG 2), and healthy newborns and children depend on healthy women (MDGs 4 and 5). Likewise, HIV/AIDS and ma-laria are more devastating to women with AIDS deaths in women rising much faster than for men (MDG 6). MDG 3 clearly targets girls and women, and MDG 7 speaks to sustainable development, safe drinking water, and individuals living in the slums (more often women and children). The fi nal MDG is often characterized as the developed world ’ s chance to redeem itself from past poli-cies that kept poor nations poor and unable to sustain strong, basic health systems and to share its resources and provide needed assistance to resource-poor nations.

One can check the web ( www.millenniumgaols.org ) to see that limited progress has been made on the MDGs, especially in sub-Saharan Africa and countries in South Asia. In fact, maternal death rates have worsened since 2000 in countries like Malawi where it is conservatively estimated that every hour a pregnant woman dies during childbirth ( Agence France Press, 2007 ). There are other resource-poor nations that have made signifi cant progress, such as Bolivia, Indonesia, and Sri Lanka, and we must learn from these successes ( Koblinsky, 2003; Pathmana-than et al., 2003 ). Thus, the MDGs provide an important framework for political and economic action targeted to reducing poverty and improving the health of all the world ’ s citizens.

Summary and Way Forward

The promotion of health, alleviation of poverty, and advances in economic development will only occur when women are viewed as fully human, are equally valued as persons, and are healthy. The global community has awak-ened to these facts and is committed to taking the actions needed so that health can become a reality for all, includ-ing women and children. There is much to do, but the in-vestment is well worth the effort! Economic growth and healthy nations can be a reality for all. This will require individual and group commitments to advocacy, political action, and fi nancing.

The WHO 11th General Programme of Work medium-term strategic plan 2008 to 2013 was proposed to the Ex-ecutive Board in January 2007. Of the 16 objectives, 6 target the relationship of gender, socioeconomic status, and the health of women. The seventh objective is most important for addressing this relationship and reads, “ To address the underlying social and economic determinants


of health through policies and programmes that enhance health equity and integrate pro-poor, gender responsive, and human rights approaches ” ( WHO, 2006 , p. vii). Activities that will be promoted by WHO at country level include helping policy makers across sectors (ministries) to work together and share responsibility for the health of its citizens. This global body for health will also support pol-icy action focusing on the underlying causes of the poor health of women, in particular, by looking at social exclu-sion, lack of education for girls and work opportunities for women, gender-based violence, and high rates of maternal and neonatal mortality.

The White Ribbon Alliance and other nongovernmen-tal organizations such as FCI, Saving Newborn Lives, and international health professional organizations such as the ICM, the International Council of Nurses, the Interna-tional Federation of Gynecologists and Obstetricians, the International Pediatric Association, and the Council on International Neonatal Nurses are committed to working in partnership to advocate for healthy adolescents, women, and children throughout the world. The PMNCH advo-cacy campaign is targeting the empowerment of women so that newborns, children, and families will be healthy ( The Partnership, 2006 ).

Mobilizing international donors to improve the health of people has been quite successful in the recent past as demonstrated by the Global Fund for HIV/AIDS. On February 14, 2007, the Agence France Presse News Report highlighted the new fi nancial collaboration of the WHO and European Union targeting $2 million for Malawi to reduce preventable maternal and newborn deaths. While this amount is a drop in the bucket, it is a beginning. Governments such as Norway, the United Kingdom, Sweden, Canada, and the United States and the Gates Foundation have committed signifi cant resources to save the lives of women, newborns, and children in resource-poor nations ( Borghi, Ensor, Somanathan, Lissner, & Mills, 2006 ). It is hoped that other major government interna-tional aid agencies and foundations will come to the aid of poor women and children throughout the world, so they can truly have a good chance to not only survive but also live to be healthy, productive members of their societies.

In summary, building partnerships with communities, men and women, politicians, donors, and governments is the way forward to improving health and development. Above all, women must be encouraged to recognize and speak out about their health care needs. Empowerment of women for health and development is the key to successful nations. This requires that all stakeholders:

• Listen to women ’ s concerns and needs. • Treat women with respect and dignity at all times. • Promote self-care, knowledge, and understanding of

how to be and stay healthy.

• Recognize and change discriminatory practices against women and girls.

• Take political action needed to eliminate gender dis-crimination.

• Give women voices and well as choices in their lives and their health.

• Promote basic human rights for all.

We must remember that healthy women lead to healthy children who contribute to healthy nations. As Horton (2006) noted in the Lancet Maternal Survival issue, “ There can be no safe future for our species without healthy moth-erhood. ” (p. 1). Together, we can make the world a better and healthier place for each person and especially for women and children.

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Sines , E. , Tinker , A. , & Ruben , J . ( 2006 ). The maternal-newborn-child health continuum of care: A collective effort to save lives. Policy perspectives on newborn health . Washington, DC: Save the Children & Population Reference Bureau .

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Task Force on Maternal Survival . ( 2006 ). Maternal survival [ Special issue ]. Lancet, Special Series, pp. 1-66 .

Thompson , J. E. ( 1999 ). Nurse-midwifery and primary health care for women ( Chapter 14 ). In Mezey , M. D. & McGivern , D. O. ( Eds .), Nurses, nurse practitioners: Evolution to advanced practice ( 3rd ed. , pp . 219 - 232 ). New York : Springer .

Thompson , J. B. ( 2004 ). A human rights framework for mid-wifery care . Journal of Midwifery & Women ’ s Health , 49 , 175 - 181 .

Thompson , J. B. ( 2005 ). International policies for achieving Safe Motherhood: Women ’ s lives in the balance . Health Care for Women International , 26 , 472 - 483 .

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Web Sites for further information:

www.SafeMotherhood.org www.PMNCH.org www.millenniumcampaign.org www.savethechildren.org www.familycareintl.org www.who.int

Joyce E. (Beebe) Thompson, DrPH, RN, CNM, FAAN, FACNM, is a Lacey Professor of Community Health Nursing in Bronson School of Nursing, Western Michigan University at Kalamazoo, Michigan, MI 49008-5345.

Address for correspondence: Joyce E. (Beebe) Thompson, DrPH, RN, CNM, FAAN, FACNM, Bronson School of Nursing, Western Michigan University, Kalamazoo, MI. E-mail: [email protected]

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Poverty, Development, and Women: Why Should We Care?