safe womanhood in a challenging world afaf i. meleis, phd, faan professor and margaret bond simon...

SAFE WOMANHOOD SAFE WOMANHOOD IN A CHALLENGING IN A CHALLENGING

WORLDWORLDAfaf I. Meleis, PhD, FAAN

Professor and Margaret Bond Simon Dean

School of NursingUniversity of Pennsylvania

Philadelphia, PA

Global Health SeminarUniversity of North Carolina – February 3, 2006

Is The World Unsafe?

♀Violence: wars, terrorism

♀ Infections: new and reemerging

♀Environment: accidents, pollution, lack of caring and support

♀Unhealthy life styles: eating, sleeping, activity, smoking

Is the World Unsafe for Women for other

reasons?

What Makes the World Unsafe

for Women?♀Violence♀ Infections

♀Lifestyles – cardiovascular♀Wars

I could easily discuss any of these, and I do agree that these are compelling reasons that make the world unsafe for women, but I believe there are added risks for women that magnify each of these to a

higher proportion.

What Makes the World Unsafe for Women?

♀ The Gender Divide

♀ It makes women socially, culturally, and biologically at higher risk for morbidity and

mortality

A Framework for Discussion: an Unsafe World for Women and

Their Health♀The context for my comments:

Research to uncover the lived experiences of low- or no-income women

Women From:♀Brazil

♀Columbia

♀Egypt

♀Kuwait

♀Mexico

♀USA

We Studied(Total N of research participants=1161):

♀Per diem maids in Columbia♀Per diem maids in Egypt♀Fishermen’s wives in Brazil♀Women in clerical jobs in Southern Brazil♀Women in clerical jobs in the USA♀Women in clerical jobs in Egypt♀Farm workers in Egypt♀Auxiliary nurses in Mexico

♀ In addition to the many years of researching women’s situations, my practice as a nurse, my life experience as a woman, though privileged rich with educational opportunities, I will never claim to know through first-hand experience what it is like to be abused, harassed or violated, I can look at these experiences from an outsider’s perspective and, somewhat, an insider’s position and understand and relate to these experiences.

The Context for My Comments

♀ I am also an immigrant who lived in the center and on the margins, and know how different are the experiences and the responses at both the center and the margins

The context of my comments is profoundly

influenced by my own lived personal, academic, and clinical experiences:

•A nurse

•A medical sociologist

•An immigrant

•A feminist

•A researcher

What Makes the World Unsafe

for Women?♀The burden of women’s work

Women’s work is veiled, voluminous,

and devalued

In developing countries women produce 75% of food

In sub-Saharan Africa and the Caribbean, they provide 80% of staple

food

In Asia women

carry 90% of the rice

field

An African Proverb:“Without Women

We Would All Go Hungry”

Housework

At home women cook, clean, carry water,

sew, bake, and care

for families

Nationally and Internationally

♀Women’s work underreported and underestimated

♀However, there is a beginning recognition of how vital women are for the hunger and economic crises

♀Economic and labor statistics do not reflect women’s work outside of the context of the formal labor force

Women’s Work

♀Women are self-employed or in unpaid labor

♀Much of work is not remunerated and not factored into economic productivity as the gross national product

♀Women considered unproductive by economists and development experts

Women create and maintain community life and provide emotional work and labor

“I am a poor, nonworking person. I am just a housewife.”

Crisis in Care-Giving♀We are facing a crisis in care-giving in

health care systems that is impacting national and global health policy

♀The crisis is reduced to:Shortages and numbers of nursesAging nursing populationImmigration of nurses

♀It is due to misinformed patriarchal policy makers that we do not yet have effective solutions

“I grew up seeing my mother and the rest of the women in the family do a lot of work from sunrise to sunset”

Women’s WorkWhen women’s work is unacknowledged and

devalued

♀Limited studies of employment, hazards, and health

♀Almost non-existent studies of work, risks, and health

Risks for Women

♀Nature and definition of work

♀Overload

♀Burden of double and triple shifts

Vicious Cycle

♀Even when women try to use their culture-imposed types of work to earn a better living, they become:MaidsNannies to well-to-do families in high-income

societies.

♀They are:• Exploited• Abused• Driven to suicide (maybe!)

Women-Workers in Other Countries

♀Domestic workers who work in other countries, Filipinas in Hong Kong, Indians in Saudi Arabia, Thai in Korea are at a higher risk because of:Limited policies to protect them,Lack of access to health care,Demands of family in countries of origin,Marginalization in host family,Lack of support

Messias, D.K.H., Im, E., Page, A., Regev, H., Spiers, J., Yoder, L., & Meleis, A.I. (1997). Defining and redefining work: Implications for women’s health. Gender and Society, 11 (3), 296-323.

Messias, D.H., Regev, H., Im., E., Spiers, J., Van, P., & Meleis, A.I., (1997). Expanding the visibility of women’s work: Policy implications. Nursing Outlook, 45, 258-264.

Meleis, A.I., & Lindgren, T. (2001) Show Me a Woman Who Does Not Work! Journal of Nursing Scholarship, Third quarter, 33 (3), 209-210.

Meleis, A.I. (2001). Women’s Work, Health, and Quality of Life: It is Time We Redefine Women’s Work. Women and Health. 33, Numbers 1 / 2, xv–xviii (note: preface to book printed as article).

Meleis, A.I., and Lindgren, T. (2002). Man works from sun to sun, but woman’s work is never done: Insights on research and policy. Health Care for Women International, 23 (6-7), 742–753.

What Makes the World Unsafe

for Women:

♀The burden of work (producing)

♀Marriage

It is a worldwide phenomenon that

women are defined by marriage and are always

under enormous pressure to “be found”

by a husband.

MARRIAGE: A Risk Factor

Women are violated and killed because marriage brings:

• Bridal burning in India• Abuse and battering by

husband and in-laws• Burden of caring for

in-laws

CHILD LABOR

CHILD LABOR

What Makes the World Unsafe

for Women:♀The burden of work (producing)

♀Marriage

♀Violence

♀Laws that condone and support domestic violence under the pretence that this is a family matter

♀Social pressure that forbids women from disclosing/reporting violence

What Makes the World Unsafe

for Women:

• Disclosing rape is not accepted

• It is newsworthy when a father allows a daughter to disclose being raped

Laws that violate

women ― stoning for having a baby out

of wedlock

Let us look at what happened in the Soviet

Union −

♀Some may say changes in political regimes may bring more safety for women. . .

Issues Uzbek Women Face:♀Domestic Violence: police

underreporting, failure of state and families to correct the problem

♀Limited knowledge of the options available to women facing domestic violence

♀Forensic evidence centers are few and located in big cities, far from reach of rural women

♀Victims often hesitate to report violence to the police out of fear to shame the family and of futility of their attempts as well as economic impact of police fines and jail time on the family budget

Issues Uzbek Women Face:♀Families often do not support the

victims♀“Beating is always a woman’s fault.

Men never beat for nothing”♀Rape of married women♀Limited access to higher education♀Stigmatization of divorced women♀Polygamy♀Poverty and limited employment

opportunities due to gender discrimination

Issues Facing Ukrainian Women:

♀Domestic violence♀Medical service to women,

especially pregnant, is often inadequate

♀High rates of infant mortality, miscarriages, and STDs

♀High cost of contraceptives and lack of basic knowledge of family planning leading to high abortion rates

Issues Facing Ukrainian Women:

♀Gender-based employment discrimination that is also based on age and appearance

♀Marital status-based employment discrimination

♀Women trafficking into forced labor and sex industry

Examples from Eastern Europe:

♀Since the fall of the Soviet Union:Laws do not prohibit discrimination

against womenHigher HIV infection rate for womenProstitution to support drug habits

or to feed familyPolice detain prostitutes but rape

them in lieu of money or release

Violence♀Wars♀Terrorism♀For women these mean:

RapeTraffickingSex industryInfectionsBurden of more workLoss of work as men come back from warReligious revival

Rape: Violence and Children

How about Afghanistan and

Iraq post-war liberation?

Publications on the Issue

♀In times of economic turmoil, women suffer the most for their families:

Women are fired first

When rations are given, usually to men, women may be forced to prostitute themselves to feed their families

There are hidden

consequences of 9/11

“Domestic violence is a

taboo exacerbated

by terrorism”

Different Types of Violence

♀Young women and girls are two and a half times more likely to be infected by HIV/AIDS than their male counterparts.”

♀ In Sub-Saharan Africa, women ages 15-24 account for 75% of all young people infected with HIV/AIDS.

♀ In South and Southeast Asia, 30% of all those infected with HIV are women, and this percentage is rising rapidly.

Peter Bell, CARE 2005

What Makes the World Unsafe

for Women:♀The burden of work

(producing)♀Marriage♀Violence♀Pregnancy, birthing,

motherhood (reproducing)

Reproductive Roles as Risks

♀ 1 in 7 women in parts of Africa will die in child birth. (In Sweden: 1 in 6000)

♀ In Iraq, a woman is 3.5 times more likely to see her child die in 1st year than in Sweden

♀ 200 million women become pregnant around the world, one third is unintended and unwanted

♀ Nigerian women face 1 in 13 lifetime risk of maternal mortality

♀ Women living in Sub-Saharan Africa face the greatest risk of mortality due to unsafe abortion

♀ Gender-based violence is associated with higher mortality rates

“A son gave her security in the marriage, and was going to be a man,

a breadwinner”

With increasing

technology to determine the sex of a baby

♀Women who choose to give birth to a daughter suffer prejudice

Another Kind of Violence Associated with

Reproductive Function♀Female vaginal mutilation/female

circumcision/female purification♀Different types posing different risks

♀Increased risk of infections♀Increased risks to reproductive

system♀Increased risks for psycho trauma

Another kind of Another kind of violence is violence is

preventing women preventing women from having safe from having safe

abortionsabortions

What Makes the World Unsafe

for Women:♀Burden of Women’s work

(producing)♀Marriage♀Violence

♀Pregnancy, birthing, motherhood (reproducing)♀Resources

Health Care is a Major Problem♀Distance

♀Transportation♀Length of wait

♀Availability of personnel♀Cost of medicine

♀Cost of transportation♀Many responsibilities

Their Health Care

♀A source of overload

♀Fragmented

♀Inaccessible economically

♀Relied more on illness care

What Makes the World Unsafe

for Women:♀Burden of Women’s work (producing)

♀Marriage♀Violence

♀Pregnancy, birthing, motherhood (reproducing)♀Resources

♀Theoretical and conceptual frameworks

Theoretical/Conceptual Frameworks

♀Biomedical Model

♀Reproductive Maternal Model

♀Morality Model

Theoretical/Conceptual Frameworks

♀Biomedical ModelDisease focusGender is not front and centerSociopolitical/cultural context minimizedFosters dependency

♀Reproductive and Maternal ModelFocus on pregnancy and birthingLacks context of women’s lifeAttention is on reproductive years

Theoretical/Conceptual Frameworks

♀Morality ModelAdherence to moral standards buys careCommercial sex workers stigmatizedPreservation of virginity is paramountRitual killing goes unpunishedBride burning ignoredTrafficked women stereotyped

What Makes the World Unsafe

for Women:♀Burden of Women’s work (producing)♀Marriage♀Violence

♀Pregnancy, birthing, motherhood (reproducing)♀Resources

♀Theoretical and conceptual framework♀Policies

An Example of Policy that Makes the World

Unsafe“. . . any organization receiving USAID assistance must declare

that it does not promote, support, or advocate the

legalization of prostitution.”U.S. Senate

Reaction by Governments

The Government of Brazil rejected $40M from USAID because the United States wanted to impose controls on countries that receive

the funds.

“Our feeling was that the manner in which the USAID funds were consigned would bring harm to our program from the point of view of its scientific credibility, its ethical values, and its social commitment. We must remain faithful to the established principles of the scientific method and not allow the theological beliefs and dogma to interfere.”

Pedro Chequer, DirectorBrazilian AIDS Program

Themes in the Lives of Women♀Exploitation♀Overload

♀Worry♀Social insecurity

♀Economic insecurity♀Inaccessible health care♀Inaccessible education

Marginalization

♀Intermediacy♀Differentiation

♀Power♀Secrecy

♀Reflectiveness♀Voice

♀Liminality

The single best predictor of perceived wellbeing was role integration, balance between stressors, and

satisfaction in all combined roles.

Level of Education(2005 Carnegie Challenge)

♀Gain of 4 years of education; fertility drops by one birth (Klasen 1999)

♀One additional year of education decreases infant mortality rate by 5-10% (Schultz 1993)

♀Primary and secondary education protects women and their children against HIV/AIDS and violence (Herz and Sperling 2004)

♀Women’s education increases ability to resist violence in India (Sen, Amartya 2000)

Level of Education(2005 Carnegie Challenge)

♀Educated women are less likely to be circumcised and oppose it more often for their daughters and granddaughters in Africa (ORC Macro International 1995)

♀Mother’s education associated with less intent to circumcise daughters, less risks and greater use of medical personnel (when circumcized), in Egypt (Malhotra and others 2003)

Lack of education Lack of education makes the world makes the world

unsafe for womenunsafe for women

Coping Strategies and Resources

♀Turning to self

♀Problem solving

♀Reaching out

Women’s Health as a Foreign Policy

♀Change conceptual framework

♀Develop explicit policies♀Redefine work

Change Conceptual Framework

♀Stereotyping, morality, reproductive, stigma, and

exploitive♀Vulnerable, gendered, equity and empowering

What Will Make the World Safe

for Women?

♀Women’s health on the agenda

♀Equity

♀Opportunities

♀Paradigm change - gender

Explicit Policies♀Develop health programs that

acknowledge women’s perspectives, experiences, and context

♀The daily situations of women, need to be described and integrated in health programs

♀Identifying women who are most vulnerable to risks

♀Provide resources and structure to support and protect women

Messias, D.K.H., Regev, H., Im, E., Spiers, J., Van, P. & Meleis, A.I. (1997). Expanding the Visibility of Women’s Work: Policy Implications. Nursing Outlook, 45, 258-264.

Messias, D.K. H., Im., E., Page, A., Regev, H., Spiers, J., Yoder, L., & Meleis, A.I., (1997). Defining and Redefining Work Implications for Women’s Health. Gender and Society, 11(3) 296-323.

Work Redefined

♀Energy expenditures♀Activity♀Space♀Time

♀Resources♀Results♀Values

♀MeaningsMessias et al. 1997Meleis et al. 2001

Keeping Women’s Health as a Top

Priority on National and International

Agenda♀Education

♀Development

♀Research

♀Services

WomeWomen n

in a in a Safe Safe

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