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close this bookAdam and Eve and the Serpent: Breaking the Bonds to Free Africa's Women (Ghana Universities Press, 1995, 141 p.)
View the document(introduction...)
View the documentDATA CARD
View the documentACKNOWLEDGEMENTS
View the documentPREFACE
View the documentINTRODUCTION
View the documentLECTURE 1: Be fruitful and multiply
View the documentLECTURE 2: In sorrow thou shalt bring forth children
View the documentLECTURE 3: Socio-economic development and gender equity
View the documentLECTURE 4: Social, cultural and legal practices and gender equity
View the documentLECTURE 5: Gender, sexual and reproductive rights and equity
View the documentBACK COVER

LECTURE 5: Gender, sexual and reproductive rights and equity

Over the course of this week, we have conducted an examination into human society and its reproduction. Our focus has been on women, who are the primary agents of human reproduction in both a biological and social sense. We have seen the many ways in which the serpent of discrimination has bonded women to this reproductive role, resulting in dangerously high levels of fertility on the one hand, and, a life of physical labour, long hours and drudgery on the other. Eve has been locked in the home while Adam, his needs met and his responsibilities unrecognised, has ruled with impunity. What happened to the mutual companion and helpmate situation in the Garden of Eden?

I would like to relate a small fable, which was composed by Christine Obbo from a number of different tales about women, and which forms the preface of her book African Women: Their Struggle for Economic Independence.

"Once upon a time very long ago, God needed someone to help him with something he wanted done. He turned to the women, who already had their hands full even in those days. Just then they were making milk jugs and water basins and mats to cover the huts. God summoned them: 'Come here: I shall send you out on an important mission.' The women replied: 'Yes, we are coming but wait a moment, we shall finish our work here.' After a while, God summoned them again, and the women responded once more: 'Wait a moment, we are nearly done. Let us finish our mats and jugs.'

"Men at the time did not have to milk the cows, build houses, fetch wood and water as the women did; their only duty was now and again to put up a fence to protect the livestock. So, since at that moment they had nothing else to do, they came running at God's call and said, 'Send us instead, Father.'

"Then God turned to the women and said: 'Hereafter, women, your chores will never be done; when one is completed, the next one will be waiting for you. Hence the men may rest since they came at once when I called, but you, women, will have to work and toil with neither pause nor rest, till the day you die.' And so it has been ever since.

"Time passed. Then one day some strangers came with books, seeds and guns. The men who had been resting embraced the strangers amidst protests from the women that the newcomers were going to harm the land and its people. Certainly their political and economic ideas soon divided the men into two groups - leaders and toilers. The latter had to be taught the dignity of labour by being required to pay taxes. As for the women, they just worked away unnoticed by anyone.

"In the end, the women appealed to the good sense of their sons, brothers and husbands to compensate and reward them for their labour. But the men reminded them that God had condemned them to be the servants of the human species. They claimed that even the books of the strangers confirmed that women's place was indeed under men. Some of the women grumbled that 'the hardest of penalties was to be poor and also a woman.' Others searched around for alternatives that would open up some kind of remedy for them. It was not long before the women realised that society depended upon them for its perpetuation and sustenance, and they became determined to bargain with these discoveries to acquire a share in the decisions regarding their labour and sexuality. The women's strongest assets were their hands - which, in some cases, enabled them to accumulate property in the form of land. But this made the men furious for it was now evident that property represented relationships between people and not between people and things.

"The men accused the women of getting out of control. And the women escaped to the cities determined to support themselves by hard work. Men then accused the women who were demanding an equal share in society's resources and power of weakening the common struggle against the strangers who controlled the world. Men claimed that women were diverting energy from the task of national development.

"The women only smiled, for they had broken the spell of God's condemnation. It was a beginning. Their immediate concern was to lessen the private pains inflicted upon them. And some even dared to hope for a movement whose primary task would be to lessen the institutional pain inflicted upon women by dismantling the structures of male dominance."1

If I could add to this fable, it would be to highlight the role which family planning also plays in helping the women to escape the cycle of endless work and no remuneration. And perhaps to add in a hopeful shift in male attitudes. For slowly but increasingly the world is waking to the needs of women.

Contrary to what many people would like to believe, women's awareness of and struggle to end their oppression and control their own destinies is centuries old. Some people have called this struggle "feminism" in a disparaging manner, and labelled it anti-male and anti-family. Men in particular imagine feminism to mean aggressive and strident radicalism, directed against them. Many of us in Africa have rejected feminism as a western, imperialist construct, foreign to our culture and damaging to our societies, despite our continent's own history of women's autonomy, matrilineal and matrilocal clans, and female farming systems. Despite sharing a strong desire for African women's emancipation, many women and men have been alienated from the "women's movement" because of the "feminist" label. And perhaps because of some very extreme positions some feminists take. But what is feminism, and what effect has it had on women?

Broadly, as I understand it, feminism refers to a process whereby women recognise the structures which have contributed to their oppression in both public and private spheres, and organise with other women and men to eliminate these structures and transform society to reflect more equitable relations between the sexes. There seems to me nothing in this kind of interpretation which is necessarily western, or modern, or middle-class, or anti-male. Feminism of this kind has been instrumental in North America, Europe, Asia, Latin America and even Africa in expanding women's participation in economic, political and social spheres, particularly in this century.

Some of the most significant achievements of modern feminism has been in the field of women's health advocacy, and particularly in expanding women's reproductive rights and choice. Despite the biblical injunction "in sorrow thou shalt bring forth children", which was the focus of my second lecture this week, controlling their fertility has been a preoccupation of women from the beginning of time - whether and when to be able to have, space or stop births. Many of the pioneering women in family planning movement, including those who founded the IPPF, could be described as early feminists: for them, birth control was revolutionary, because it would free women from the burden of unwanted pregnancy and childbirth, thereby contributing to their independence and autonomy.2 Some of these women were jailed, others suffered many indignities and were shunned by society. But they struggled on.

At the turn of the century, women were treated by medical professions in much the same way as by legal professions: namely, as the property of their husbands or fathers, rather than as persons in their own right, incapable of understanding or acting for themselves. Feminism has been a major force challenging this paternalism. One effective strategy has been to "demystify" medicine, through the publication of under-standable guides and health manuals. Groups such as the Boston Women's Health Collective in the US, Peru-Mujer in Peru and the Women's Health Book Collective in Egypt have all published comprehensive, plain-language guides for women to better understand their own health needs.3 Rather than replacing doctors and clinics, these kinds of books enable women to use formal medical services more effectively, and demand better treatment from health professionals. Women activists have also drawn attention to the gender biases of health research and treatment, whereby illnesses more common in men receive greater attention than "women's" diseases.

When the modem health industry is interested in women, it is almost exclusively as reproducers, or "wombs on limbs". Feminists have argued for a new, more holistic interpretation of women's health, spanning their whole lives and incorporating non-biological dimensions of health, such as economic and social factors. A holistic approach to women's health promotion would include reproductive health care, sexuality education, counselling to promote women's emotional and mental health, pre- and post-menopausal care for women, and strategies to promote attitudinal and behaviourial change in both women and men to ensure the elimination of violence against women.

While it has had a limited focus, modem science and medicine has nonetheless tried to improve women's health and well-being through various means, foremost of which has been reproductive technologies. Drugs and procedures to control, prevent, or reverse conception have been developed, as well as new procedures to enable conception in less-fertile women and couples. Millions of women have embraced these new technologies and benefitted from them, accessing the revolutionary potential of birth control as imagined by the early family-planning pioneers. Yet a critical debate has also arisen about the use and control of these technologies, which must be taken seriously by medical, family planning and women's health groups.

Many feminist groups, particularly in the US, Europe, and India have expressed outright rejection of these new technologies, arguing that women's control over their own fertility has been reduced, not enhanced by these technologies, and pointing out the negative side-effects and potential for abuse of drugs like Depo-Provera and Norplant. Developing world feminists have also been vocal about the role of Northern science, and technology in the marginalisation of indigenous knowledge systems. The feminist critique draws our attention to the issues of gender and power relations which exist between men and women, health care providers and patients, population planners and women, and first world and third world. Particularly for non-white people, population policies are easily interpreted as limiting, rather than expanding choice.

Yet these legitimate criticisms of the negative side-effects of contraceptives, drug-experimentation and "drug-dumping" on Southern women, coercive practices and genocide are also arguments used by the extreme right, and right-to-life advocates to carry forward their objectives to end family planning and abortion services altogether and keep women chained to continual childbearing as the servants of male humanity. As the third-world women's coalition DAWN (Development Alternatives with Women for a New Era) points out, what is needed is broader and more holistic reproductive health policies based on a comprehensive understanding of women's needs and responsibilities. They argue that service providers, and women's health advocates should be natural allies in the promotion of women's health and in urging and educating women to take better care of themselves. They recognise, however, that this partnership requires openness and commitment from both sides to exploring new avenues for collaboration.4 The need for collaboration is clear: as I have written elsewhere "it is doubtful if women without education can take advantage fully of contraceptive opportunities, or whether women without contraception will be able to take full advantage of all of the opportunities available to them."5 It must be agreed that some family planning and population policies and programmes have been too insensitive to the many needs of women and not treated them as subjects of their own destiny but as objects for manipulation to achieve some demographic ends. It would be a pity if, for the mistakes of some, the whole population and family planning field gets condemned as iniquitous to women and therefore to be discarded.

Family planning advice is focused on married couples, where it is presumed the couple will either make their own decisions independently or negotiate a compromise on contraceptive use. A study done using information from the Ghana Demographic and Health Survey in 1988 found that, rather than being characterised by mutual compromise and reciprocity, the direction of spousal influence in Ghana was almost exclusively male over female. Alex Chika Ezeh concluded that women's attitudes towards contraceptive use was significantly moulded by their husbands' views, though the reverse was not true.6 The policy conclusions which must be drawn from this research is the importance of targeting family planning information to men as well as to women, and the importance of understanding that gender relations will influence women's ability to utilise family planning services to their fullest. Examples from other African cases such as Zimbabwe have shown that extensive family-planning awareness campaigns directed towards men can significantly increase their acceptance and use of modern methods of contraception, including condoms.7

Men are all too often obstacles to women's emancipation. Yet women can also create their own obstacles. After all, it is likely to be only a small percentage of women who identify themselves as "feminists" concerned with the social transformation of gender relations. Many women appear to have accepted the status quo. It is important to make clear that in discussing the theme of "breaking the bonds to free women", I do not wish to imply that women are helpless to change their own fate. Women themselves play a role in shaping their own futures, so we must ask why have they not yet shaped a different future, a more equitable one for themselves? The reason is, of course, multifaceted and complex, but let us explore some aspects of it.

Yesterday I discussed how culture and tradition contribute to the oppression of women in many societies, and particularly in our own African societies. I also acknowledged that women, in their roles as mothers, play an important role in the transmission of culture from one generation to another. Children learn about distinctions between male and female, both biological and social, from parents, teachers, media sources, books and each other from a very young age. Women have it within their power to change the interpretations of gender roles which are transmitted to their children, at least to some degree. "Masculine" and "feminine" can be defined less rigidly in terms of children's games or toys, chores given to boys and girls, and in how relations between siblings are allowed to develop. Yet how many women consciously try to break the patterns of their own upbringing and develop more equitable gender relations among their own children? Do they value the education and health of their daughters as much as their sons, and not disadvantage one for the benefit of the other in times of economic constraint?

I believe that these things are beginning to happen. One example of change which I referred to earlier in the week is with regard to the tradition of female genital mutilation. For generations women have had their daughters cruelly mutilated despite their own misgivings because of the societal pressures around them - the threat that uncircumcised girls would not be able to find husbands or would be rejected by the community. Now, slowly, women are beginning to reject these arguments and vote to protect the health and sexual well-being of their daughters by saying no to this barbarous tradition. Eventually, these women and their uncircumcised daughters will become a majority in their societies, and the definitions of "culture" and "tradition" will start to change from the bottom up. There are other less traumatising forms of mutilation, such as lower lip and ear lobe expansion, common in some parts of the north of Ghana and Southern Africa. These too must stop.

Women may not always see or believe that they have choices in regard to their acceptance or rejection of tradition. Given women's subordinate status in the family and in society, the social and economic costs of non-conformity may be seen by women to be too high. In addition, as discussed yesterday, many women live under the threat of violence from their husbands or other family members, and they may be particularly wary of doing anything which may incur the wrath of men, even something as simple as requesting male children to participate in household chores.

It is understandably difficult, in societies where so much of women's status is derived from their role as mothers and the size of their families, to make the leap to small family size. Action must be taken at a national and international level to expand the base of women's status, and in particular to value and promote women's education and employment, which can have such a powerful effect on women's well-being and autonomy, and ultimately on their choice to reduce their fertility.

The wake-up call for many at a national and international level on women's rights came during International Women's Year in 1975 and the UN Decade for Women 1976-85. The first World Conference on Women in 1975 in Mexico City raised a banner of women's goals under the headings "Equality, Development and Peace". Despite differences between governments and women from developed, developing and socialist countries, a World Plan of Action was agreed for implementation over the ensuing decade. The objectives of the Plan were mostly straightforward: to improve educational opportunities and employment prospects for women, and to promote their equal participation in political and social arenas. More daringly, the Plan also asked for recognition of women's unpaid work and a reconsideration of rigid gender roles traditionally assigned to both women and men.

That it would be difficult to achieve all the objectives of the 1975 World Plan of Action in a single decade was clear from the start. In fact, while there has been considerable progress in many areas in the ensuing 19 years, many of these same objectives are still being earnestly pursued by women. This fact is testimony not only to the intractable nature of gender-based discrimination, but also, more positively, to the resolve and commitment of both women and men who believe in and promote gender equity. A similar conclusion can be drawn about the implementation of the Forward Looking Strategies, the programme for action to end discrimination against women by the year 2000 which arose from the end of the decade conference in Nairobi in 1985.8

The main contribution of the Women's Decade was in raising awareness of women's subordinate position globally and in giving legitimacy to the demands of women in the South and the North for a more equal role in decision-making about their own futures and the futures of their families, their nations and their planet. The Decade also generated an incredible energy to collect information about the reality of women's lives and their roles in and benefit from development, which before that point had been largely ignored by gender-blind planning and policy. National statistics began to be disaggregated by sex so that base-line data could be collected against which the progress of the Decade could be judged. Unfortunately, at the 1980 Conference in Copenhagen the new statistics provided little cause for celebration: the report from the Copenhagen conference concludes that "stagnation and deterioration describe women's condition in national life in most countries since 1975."9

These same statistics, however, also indicated to women from all over the world that in spite of the differences in culture and levels of economic and industrial development between their countries, the kinds of discrimination and injustice which they faced in family structures, education and employment were disturbingly similar - the difference was one of degree. Women from North and South, East and West saw the value in fostering solidarity in pursuit of their goals of Equality, Development and Peace.

Still, the desire for solidarity in the global women's movement could not mask the real divisions between women from developed, developing and socialist countries, whose different backgrounds and different places in the struggle against oppression led them to favour different strategies for action. In fact the Equality, Development and Peace theme of the Women's Decade was itself a representation of the different priorities of these diverse women. Western 'women from secular, industrial market economies, fired by the feminism of the radical "burn the bra" 60s and early 70s were after legally recognised equality with men, and a fair share of political and economic power. Women in the developing world had a greater need for development. What good was legislation or jobs in the capital to a rural woman who could not feed herself properly or who had watched her own children die of preventable diseases due to lack of clean water and adequate health care? Socialist women, for their part, identified their greatest need as peace, the ending of the militarisation of their societies and the global community due to the Cold War.

In the main conferences and the NGO Forums which accompanied the government meetings, these different needs and strategies often led to acrimonious debate, despite the large degree of agreement over the importance of all three goals to all women. In Copenhagen, for example, conflict developed between Western and African women when the former expressed outrage over certain harmful traditional practices such as bride-wealth, polygamy, and most importantly, female genital mutilation. The northern women argued for immediate legislative bans on these practices for women's protection. The southern women, feeling their cultures and religions were under attack, understandably went on the defensive. While agreeing with the need to eradicate these practices, the African delegates felt that education, not legislation, would be a more appropriate and effective strategy. Educating women and communities about the negative consequences of these practices would have the benefit of empowering them to make their own decisions and changes. Health education could be combined with skill provision enabling women to earn independent income and free themselves from the social pressure to conform to traditional ways. The Western women felt that this was too indirect and long-term, and not a radical enough solution to African women's troubles.10

I believe that it is crucial for all of us in Africa who are concerned with women's well-being and with the fate of our societies to examine the complex relationship between women's status and socio-economic development. I have tried this week to address this issue, but at a national level we still have much work to do. Our women have identified their primary need as development - a goal which would have considerable benefit for all of us both male and female, educated and illiterate.

Soon after the UN Conference on women in 1975 The Ghana National Council on Women and Development was established in 1976 to lead in the implementation of the recommendations. Its functions were the following:

· to advise the Government generally on all matters relating to the full integration of women in development at all levels;

· to serve as the official national body for cooperating and liaising with national and international organisations on matters relating to the status of women;

· to examine and evaluate the contribution of women in the economic, social and cultural fields, and to advise the Government on the specific areas where participation by women can be strengthened or initiated;

· to study the effect of customary beliefs, prejudices and practices on the advancement of women in the educational, political and economic fields, and to report to the Government from time to time;

· to devise a programme for the establishment of a machinery and procedures to make possible the continuous review and evaluation of women's integration in the total development effort at local, regional and national levels;

· to study plans and proposals for the establishment of large-scale non-formal education and training for the purpose of raising living standards in the rural and urban communities and eradicating illiteracy; and

· to perform such other functions as the Government may assign to the Council, or as are incidental or conducive to the exercise by the Council of all or any of the foregoing functions.

No one can fault the array of functions and the mission and mandate of the NCWD. So why has it been so very short on achievement? To me the answer is partly to be found in its unfortunate politicisation and instability of tenure of its chief executives. For this type of council to be truly successful, National should mean National and it should be insulated from partisan politics to enable it fashion relationships with all needed bodies. These will include governmental and non-governmental organisations and research institutions and universities. The revamping of the NCWD and its staffing with really top level and experienced and dedicated staff must be considered a national priority if we want to deal seriously with the emancipation and development of the Ghanaian woman.

The Universities can help. We should establish study centres in our institutions of learning which will be committed to exploring all questions of women and development by listening to women and helping them to meet their short-term and intermediate as well as long term needs on the road to development. All of the Universities may come together to formulate a major multi-facetted women and development programme with funds from both outside and inside the country. Elements of such a programme already exist in the Family and Development and PIP projects at Legon and the Population Agenda exercise at Cape Coast. The new University College for Development Studies is ideally placed to take leadership for such a programme since most of the problems to be researched are more pronounced in the northern parts of the country. Linking such a programme with the activities of the NCWD would make it even more attractive to outside donors and overseas researchers.

There is an international legal framework for promoting women's equal status and the protection of women's rights, extending from childhood to old age. The Universal Declaration of Human Rights, dated 1948, prohibits discrimination on the basis of sex and proclaims that "all human beings are born free and equal in dignity and rights." The UN General Assembly recognised in 1954 that women are often subject to "ancient laws, customs and practices" which are inconsistent with the Declaration, and called upon governments to abolish these. Both the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights contain articles of key relevance to women's rights, such as rights to security of the person and freedom of movement, to recognition as a person before the law, freedom to seek and impart information, freedom to marry, to vote and stand for election, rights to reasonable conditions of employment and, adequate standards of living, and a right to health and to education. These rights apply equally to male and female persons. The Covenant on Civil and Political Rights is particularly powerful as its rights are immediately enforceable and it is deemed able to overrule domestic law where contradictions may arise in countries which sign.

The most comprehensive statement of women's legal rights is found in the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which was adopted by the General Assembly in 1979 and entered into force in 1981. States who ratify CEDAW agree to eliminate discrimination against women and promote gender equality on three levels:

· First, they agree to embody the principle of the equality of men and women in legislation, including their Constitutions if appropriate; to eliminate all discriminatory legislation, and to establish institutions to ensure the protection of women's legal rights.

· Second, states agree to adopt "temporary special measures aimed at accelerating de facto equality between men and women", which measures would be removed when the objectives of equality of opportunity and treatment have been achieved.

· The third level for action is undoubtedly the most difficult. Its strength and relevance to today's topic make Article 5 worth quoting:

"States parties shall take all appropriate measures (a) to modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and all other practices which are based on the idea of the inferiority or superiority of either of the sexes or on stereotyped roles for men and women; (b) to ensure that family education includes a proper understanding of maternity as a social function and the recognition of the common responsibility of men and women in the upbringing and development of their children..."

Clearly, CEDAW is a powerful convention with wide-ranging implications for women's status, providing there is sufficient political will to implement its provisions. Ghana is one of several African countries and 117 countries globally which have signed and ratified the Convention. But traditional attitudes are difficult to transform, particularly in rural areas where conditions of life have changed less for many people than has been the case in urban areas. The serpent of discrimination is well camouflaged in his natural habitat of culture - and once spotted difficult to capture. Governments are not always willing to challenge fundamental cultural or religious discrimination against women, and many countries which have signed the Convention have done so with reservations. CEDAW has more reservations placed against its various articles than any other international Convention, and some of them can be construed as incompatible with the purpose of the convention itself. However, even if legislation is put into place in accordance with CEDAW, the problem of turning de jure equality into de facto equality will remain.

The Convention on the Rights of the Child (CRC) was adopted a decade after CEDAW, in November 1989, and is regarded as the most complete statement of the rights of children ever made, and the first instrument to make states legally accountable for their actions towards children. It is also significant as the first Convention to use inclusive language, using both "he" and "she" and "his" and "hers" throughout. This explicit recognition of girls as well as boys leaves no excuse for not correcting the terrible forms of discrimination and exploitation of girl children from infancy to the age of majority. Given the youthful demographic structure of African countries, the CRC actually applies to a very large number of females, and could protect girls from early abuses like forced early marriage and genital mutilation. Combined with CEDAW, it could set young women off into adulthood with better chances.11

The UN Declaration on the Elimination of Violence Against Women is the newest member of the family of international women's rights instruments.

Members of the Organisation of African Unity (including Ghana) are also bound to the African Charter on Peoples and Human Rights. Article 18.3 of this Charter states that: "The State shall ensure the elimination of every discrimination against women and also ensure the protection of the rights of the woman and the child as stipulated in international declarations."12

What has been the impact of these wide-ranging international conventions on women within individual countries? Unfortunately it is often very little, as their articles are rarely enforced in support of women. Noted economist Marilyn Waring accuses the international community of "unquestionable hypocrisy" over its neglect of human rights abuses against women. She notes that the international community has actively fought racial discrimination and apartheid, while turning a blind eye to gender discrimination and sexual segregation within states. The United Nations, the Commonwealth, and various states have, at different times, called for the reduction of aid or military assistance to countries where gross violations of human rights are taking place, but there is rarely any specific consideration of women's rights in these contexts. She laments that the excuses are always the same. Despite all the instruments and conventions, women's rights are still considered "social" rather than "civil or political, conditional on custom and religion rather than universal, and abuses of women's rights are "private" concerns rather than "public" matters for state intervention.13

The fact that virtually all the human rights Conventions were written using the masculine gender, except CEDAW which uses the feminine and the Convention on the Rights of the Child which uses both, may also affect the recognition of women's rights. Georgina Ashworth, prominent women's rights activist suggests that many people find it easy to dismiss the importance of terminology, especially people in positions of power who do not wish to understand the many ingredients of powerlessness, of which language is one. She suggests that is very possible that, "had the articles of the human rights conventions explicitly stated men/women, he/she, his/her, the realisation of women's human rights would have been far greater," and furthermore:

"there would have been less separation of social and economic rights from the civil and political, because the linkages between social vulnerability, political marginalisation, economic exploitation and physical abuse are very much more conspicuous when examined through women's lives."14

It can be suggested that the focus of legal activism for women's rights should be less about the development of new laws and conventions, and rather more on education and creating a familiarity with and regular use of already existing instruments in the every-day situations of women's lives. The widespread failure of top-down legal change over the past 15 years suggests that a more bottom-up strategy may be appropriate.

What else can be done by and with Africa's Eve to promote her equal status in society? There is little doubt that one of the most important keys to solving these difficulties and increasing gender equity in social, cultural and legal spheres is education. Here I would include several kinds of learning.

FORMAL PRIMARY AND SECONDARY SCHOOL EDUCATION

Priority must be given to decreasing the gender gap that exists through most of the world - for example in Ghana only 31 percent of secondary-school aged girls are still enroled, and there are only 64 girls per hundred boys at that level. Population Action International estimates the cost of eliminating the gender gap in education globally by 2005 at $18 billion, (using 1990 constant US dollars). For Ghana, they estimate the cost to be US $53 million.15 A substantial sum, unquestionably, but I have tried to show that the opportunity cost of not educating girls will ultimately be much higher. I will quote Dr. Agnes Akosua Aidoo of UNICEF from a presentation given at an International Council of Voluntary Agencies Development Forum in Senegal in 1991: "Women are a strategic human resource and one of the most crucial tools for their efficiency and effectiveness is education. Therefore, a society that fails to educate its girls and women creates its own fundamental obstacles to undermine its progress towards development."16

It has been said elsewhere, and some have attributed it to Aggrey, "educate a man and you educate an individual - educate a woman and you educate a nation." I challenge this University, through all of you here today, to play a leading role in the promotion of universal primary education for girls as well as boys, and for expanded and equitable participation of girls in secondary school, thus eliminating the gender gap. Aggrey, Fraser and Guggisberg themselves could ask or expect no less from us today.

HEALTH EDUCATION

Awareness of the basic elements of health maintenance is necessary in order for individuals to exercise their human right to health. In all communities, health education needs to be delivered in a culturally sensitive manner, so that both women and men understand the dangers of practices such as female genital mutilation and the benefits of birth spacing and family planning. Services and information intended to improve women's health or the health of their families can only be effective to the extent that women are aware of them, understand the pros and cons of various services and how to use them, and then choose freely to do so, all of which is best accomplished through education.

LEGAL LITERACY

Women need to become aware of the rights which their governments have promised them through CEDAW and a wide range of other international conventions and declarations, and thus become prepared to demand them. The work being done by the local chapter of FIDA (International Federation of Woman Lawyers) should be recognised and supported by the NCWD and the Government.

NON-FORMAL EDUCATION

Innovative non-formal education programmes need to be designed to increase basic literacy among adult women and school-leavers and reduce the gender gap which exists here as well. Such programmes should include the development of appropriate literature. Only 50% of Ghanaian women are literate compared to 70% of men. Community literacy programmes can be combined with health education and provision of income-generating skills to address women's needs in a more comprehensive way, and lower the opportunity costs of women's attendance at such programmes.

SENSITISATION FOR MEN

Education for women will raise their awareness about their disadvantaged position in society, and probably increase the pressure for change. But we will also need education for men in order to affect lasting social transformation. Male attitudes against women's education, family planning, sharing household tasks and family responsibilities must be explored through research to determine where the barriers to increasing gender equity are situated, and how strong is men's resistance to change. But I do not for a moment think that we men are incapable of change: both men and women have adapted to changing conditions through history by taking on new roles and responsibilities.

In particular, men need to be counselled about taking on more active roles in relation to family and household maintenance. With their traditional breadwinner role disappearing due to global economic change, and men are now in a position to have a significant impact on reducing women's double burden of productive and reproductive work. Women do not need men's sympathy as much as their empathy and cooperation. At a very basic level, we need to promote the understanding that just as men and women are both active in the creation of children, so they should both be active in caring for those children.

The fruit of the tree of knowledge, which Eve has been taught was what led to her downfall, provides her best chance to regain her position as Adam's equal. Education develops women's critical and analytical capacities so that they are able to question the cultural, religious and physiological bases of their supposed inferiority and expose the fallacies behind oppressive beliefs and practices. Furthermore, studies have shown that the greater the similarity in educational and occupational levels between spouses, the more likely they are to share parental responsibility and household tasks, and to negotiate the changes necessary for both to make in times of increased financial constraint. The burden of adaptation therefore is no longer weighted against the woman. Without strong basic education this is unlikely to happen.

In addition to education, I believe that there are other, urgent reforms and new directions which can help us in our pursuit of gender equity.

HEALTH CARE REFORM

When many people think about the right to health, they tend to associate this with a rights to medical treatment or other health services. But being healthy is not primarily a medical matter, it is more an issue of social justice. Health services have rarely prioritised women's needs, although in many places they rely on a predominantly female workforce.17

As a medical practitioner, I am all too aware of how my profession has tended to pathologize the human condition and treat health as merely the absence of disease. While there have been considerable advances in medical technology which can be of tremendous benefit for women, we have often tried to extend new technologies without any clear understanding of the social, political or economic environment in which potential users operate. While the idea of appropriate technology is taking hold in development planning, health services have tended to see themselves as exempt from the same considerations.

There is a real need to expand the links between biomedical research and social science research, to make these two halves into one whole. This will enable us to improve the quality, efficiency, and cultural appropriateness of existing programmes for men and women, particularly in the area of reproductive health, and also to develop innovative approaches to strengthening women's capacity to protect and promote their own health.18

EARLY SEXUAL EDUCATION

A central part of reforming health care services and reproductive health programmes is an acknowledgement of human sexuality, and most importantly that this sexuality is natural, is not conditional on age or marital status, and is understood physically and emotionally in different ways by women and men. Sexuality education must begin before puberty in primary school and be continued throughout adolescence both in schools and youth centres which can reach out-of-school teenagers. I firmly believe that if we wait to address the issues of reproduction and sexuality until we are talking to mothers and fathers we will be too late to change the patterns of fertility and population growth which I have tried to show have such a negative impact on women now and cast such a shadow over the future of our planet in the longer term.

I regard the failure to address the needs of adolescents around the world for sexuality and reproductive health education, and access to family planning services, as one of the greatest inadequacies of the planned parenthood movement, which has disastrous consequences for the lives and health of millions of adolescents, and for the success of national development strategies. We can no longer continue to threaten the well-being of our teenagers by denying their sexuality, withholding crucial information and services, and ignoring the statistics on unwanted teenage pregnancies out of some warped sense of moral duty. In the age of HIV and AIDS in particular, our reticence shows a. peculiar interpretation of morality indeed. Let us examine the facts in our own country and then determine where our moral duty should be.

According to the Demographic and Health Survey data collected in Ghana in 1988, annual births among teenage girls aged 15-19 in Ghana have been around 123 to 155 births per thousand consistently since the early 1970s. Twenty-three percent of girls aged 15-19 were either pregnant with their first child or had already had one child at the time of the survey. Of those girls who were unmarried at the time of their pregnancy, 58% had not intended to get pregnant, and even 38% of pregnancies occurring in marriage were unintended. The survey suggests that 55% of unmarried and 48% of married Ghanaian teenagers had an unmet need for family planning services. The unmet need for information and understanding about fertility and reproduction is surely even higher. Only 16% of girls aged 15-19 could correctly identify the fertile period of their monthly cycle, and only 57% knew about modern forms of contraception. I imagine the percentage would be even lower for boys of the same age. Misunderstandings about the effects of contraceptive methods are also widespread - with many women and men believing that, for example, the pill causes infertility or stomach cancer in the long run. While some of these teenagers will not be sexually active, and so will not suffer directly from their lack of knowledge, the roughly 50% of sexually active teenagers may be heading for an unfairly and unnecessarily rude awakening.19

The effects of an unwanted pregnancy on an individual adolescent girl can range from death or life-long health problems to social ostracism or forced marriage, with additional physical mental and emotional health consequences. In addition, she is unlikely to finish her education or hold a responsible job outside the home. The effects of lack of action on the part of family planners, health providers, parents and legislators on whole generations of future teenage girls will be to perpetuate the cycle of women's subordination. Action can help to free the bonds holding Africa's Eve, and enable her to become a full partner in national life through the development of her own unique potential.

POLITICAL PARTICIPATION AND DECISION-MAKING

My final recommendation is a call to broaden the whole range of the democratic process to accept women as equal players from the smallest democratic unit - the family - to the largest - the state. Almost every aspect of women's struggle to break their bonds of oppression can be fought more strongly in the political arena. Decisions about new laws, the enforcement of good laws already in existence, the implementation of programmes directed towards women, as well as decisions affecting wage discrimination, occupational segregation, and the provision of reproductive services including abortion - all of these flow from actions taken by the legislature. And at the moment, almost every legislature is the reflection of political and social attitudes of its overwhelmingly male majority.20

I would like to end these series by sharing with you two ideas I got from Achimota. The first relates to the school crest, the black and white keys of the piano. I was told, "You can play some kind of music on the white keys alone, and you can do equally well on the black keys too, but for true harmonious music you need to combine both keys". At the time this was meant to represent black-white race relations. Should we not today use the same to represent male-female relations? The second comes from Dr. Aggrey. He is alleged to have gazed at the map of Africa for a long time and then turned to those around him and said, "Gentlemen the map of Africa is a question mark. Africa is asking a question, indeed many questions. 'Why my backwardness? Why am I marginalised, why are my children in bondage" etc. Today I say the women of Ghana and Africa are asking questions. "Why are we so poor? why are we kept in the dark? Why are we so oppressed, kept constantly pregnant to bear children only to see so many of them die? When and from where will deliverance come?

Deliverance will come from all of us working together. I call upon women to participate in breaking their own bonds of servitude by standing for election and by voting for women. Equally, I call upon men to see the immediate and long-term benefits to sharing power with our sisters and wives. In Africa we have not had a history of the so-called "war of the sexes" which has so affected gender relations in the industrialised West. Let us draw upon our rich cultural tradition of mutual autonomy and cooperation between women and men, which dates long before colonialism and the enslavement of African economies to Northern markets, and on this basis reconstruct equitable gender relations and pursue our own mutual development.

REFERENCES

1 Christine Obbo (1980) African Women: Their Struggle for Independence London: Zed Press pp. ix-x.

2 Sandra Whitworth (1991) "Planned Parenthood and the New Right: onslaught and opportunity?", Studies in Political Economy Number 35, Summer.

3 Population Council (1992) "By and for women: involving women in the development of reproductive health care materials", Quality/Calidad/Qualit/I>Number 4.

4 DAWN Informs, 1993

5 Fred T. Sai (1993) "Political and Economic factors influencing contraceptive uptake", British Medical Journal, 40(1), p.208.

6 Alex Chika Ezeh (1993) "The Influence of spouses over each other's contraceptive attitudes in Ghana" Studies in Family Planning Volume 24 Number 3 May/June.

7 Phyllis T. Piotrow et al. (1992), "Changing men's attitudes and behaviour: the Zimbabwe male motivation project", Studies in Family Planning 23(6), November/December.

8 United Nations (1985) Nairobi Forward Looking Strategies for the Advancement of Women to the Year 2000, New York: United Nations

9 Report of the 1980 World Conference of the UN Decade for Women: Equality, Development, Peace (Copenhagen), quoted in Kate Young (1993) Planning Development with Women: Making a World of Difference, London: Macmillan.

10 Florence Abena Dolphyne (1991) The Emancipation of Women: An African Perspective, Accra: Ghana Universities Press.

11 Georgina Ashworth (1993) "Women and Human Rights", a paper prepared for the Fourth Meeting of Commonwealth Ministers Responsible for Women's Affairs, Nicosia, Cyprus, 5-9 July 1993.

12 Quoted in Ashworth (1993).

13 Marilyn Waring (1993) "Do you know where your human rights are?", Women's Health Journal, 2/93.

14 Ashworth (1993).

15 Population Action International (1993) "Closing the Gender Gap: Educating Girls", the 1993 report on progress towards world population stabilization. Washington: PAI.

16 Dr. Agnes Akosua Aidoo (1991) "The girl child - her present, her future", Women as Partners in Development - Proceedings of an ICVA Development Forum held in Sally, Senegal, 10-11 March 1991, Geneva: International Council of Voluntary Agencies,

17 Diana Smith, editor (1993) "Why women's health?", Contact, No. 131, June.

18 Joanne Leslie (1992), Women's Lives and Women's Health: Using Social Science Research to Promote Better Health for Women, New York and Washington: The Population Council and the International Centre for Research on Women.

19 Population Reference Bureau (1992) Adolescent Women in Sub-Saharan Africa: A Chartbook on Marriage and Childbearing, Columbia and Washington: Demographic and Health Surveys and the Population Reference Bureau.

20 Dr. Riffat Sardar (1991), "Women and human rights", Women as Partners in Development: Proceedings of an ICVA Development Forum held in Sally, Senegal, on 10-11 March 1991, Geneva: International Council of Voluntary Agencies.