| Boiling Point No. 27 - April 1992 |
by J Sims, Prevention of Environmental Pollution, Division of Environmental Health, World Health Organisation, CH-1211, Geneva 27, Switzerland
The constraints on women's time arising from an excessive workload contribute significantly to their ill-health. Finding individual solutions for each time-consuming task, however, is difficult; a preferable approach is to introduce methods of addressing a number of areas simultaneously. This article will point to some of the effects of fuel shortage and smoke pollution on women's health and nutrition levels. On these grounds, an improved stove has a role to play as one such broadbased, general solution to the problems facing poor and rural women.
Reducing smoke levels in the home will certainly benefit all members of the family, particularly women who are normally exposed to higher emission levels over longer periods. However, smoke is not the only problem connected with biomass cookstoves. The crux of the problem with biomass supply and use lies in women's triple role as household manager, income provider and reproducer.
Apart from cooking meals, the stove or hearth is used for boiling water, preparing animal feed, food-drying and smoking activities, and brewing beer etc.; it also often serves space heating, lighting, ritual and entertainment functions. Many of these activities cannot be "speeded up" and some require women's presence at the stove as well as additional supplies of fuel. Fuel efficiency and reduced smoke emissions can therefore provide benefits in a number of spheres of household activity, not simply the preparation of family meals.
In many societies, seasonal or perpetual food shortages in lower income populations influence frequency of food preparation. Fuel shortages exert similar effects in regulating food intake and in areas where both food and fuel are short the effects on nutrition can be severe.
Fuel availability can therefore be seen as a determinant of women's health, not only through its direct relationship to food intake, but also due to the energy dissipated in extended gathering and carrying. Women's nutritional requirements rise with additional expenditure of energy, but in conditions of general shortage are unlikely to be met. More hours spent searching for fuel are increasingly likely to be compensated by fewer hours spent in the labour-intensive preparation of nutritious traditional foods. A greater trend towards purchased, processed foods is often the only answer to fuel shortages, particularly in urban or pert-urban surroundings where such substitutes are easily found. The scarce cash resources of low income families, invested in processed or semi-processed foods, or on the fuel itself, is then unavailable for school fees, adequate clothing, health care and other family essentials.
These basic problems of fuel shortage and domestic cooking practices can create further negative impacts by conflicting with health and development efforts. For example, low-income families cannot respond to health education programmes encouraging them to maintain higher standards of personal and home hygiene, if fuel is too scarce to permit an adequate supply of hot water. Messages concerning food safety may also remain unapplied or unabsorbed if re-heating leftovers, or reducing optimal cooking time, is the only way a housewife perceives of eking out the fuel supply.
Medical Supplies in Nepal
Energy expenditure in connection with shortage of fuel also affects women's nutritional status. Rural women bear the brunt of the physical work of gathering food, water and animal fodder, working in the fields, caring for animals, running the home, as well as regular childbearing. This burden adds up to the requirement for a significant nutritional intake. A study on air pollution levels in the Bombay region found women to be in the lowest protein-intake groups of communities studied for pollution effects (Kamat,1984). This suggests that more attention should be paid to poor women's food intake versus energy expenditure patterns. It is unlikely that the extra energy expended by women in fuel shortage situations will be made up by the necessary quantities of additional food (Agarwal,1986).
Kamat (1984) has suggested that nutritional status plays a role in the effects on health morbidity of combinations of air pollutants. The position of women in the lower protein and calorie intake groups therefore threatens their overall health status and increases their vulnerability to the negative effects of biomass smoke. As the energy cost of both overwork and pregnancy are clearly very high, the consequences for women and their fetuses are serious. Maternal morbidity and mortality statistics for example, show that more than half of all women of reproductive age in the developing world are anaemic, with lowered resistance to infection and disease (WHO,1991a). As they generally have less hemoglobin in reserve than men, women are naturally more prone to anaemia which in turn renders them more susceptible to carbon monoxide toxicity. When pregnant, a woman's endogenous production of CO may be 50% higher, leading to higher natural carboxyhemoglobin (HbCO) levels (Smith,1987). Further exposure of mothers to CO while cooking on traditional biomass stoves increases the risk of low birth weight infants who succumb more easily to potentially fatal diseases such as diarrhoea and acute respiratory infection.
Figure 1 shows the relative importance of different health factors which contribute to low birth weight in rural developing areas (WHO,1991b). Many of these factors can be linked with women's work burden and to general nutritional insufficiency - namely low pre-pregnancy weight, maternal short stature (stunting), low calorie intake or low weight gain during pregnancy, female primiparity (giving birth for the first time) and general morbidity. Significantly, there are also associations between low birth rate and exposure of women during pregnancy to indoor air pollution from biomass smoke. The early age of onset of chronic bronchitis and cor pulmonale in women in some areas of Nepal has been attributed to hours of proximity to the household stove (Pandoy,1988).
Women's and girls' low social value in traditional societies is reflected not only in the massive work burdens they are required to assume, but in the basic quality and quantity of food they consume in this process of "working their passage". Gender discrimination acts on the health of women and girls in a variety of ways: for example, through differential feeding which allocates a superior quality and quantity of food to males, through an often disproportionate burden of work inside and outside the home and through the absence of provision for health needs, particularly in reproductive health (WHO, l991b). Given women's particular vulnerability on account of such discrimination, the links between food and fuel shortage represent a threat to their health on several levels.
Biomass use, poverty and women's nutritional status are thus closely bound together and provide an excellent example of how social, economic and cultural factors combine to impair women's health. Although it is not easy to pinpoint one specific health or economic factor which can be solved through the improved stoves, there is little doubt that introducing a more fuel-effcient, smokeless stove in the home will help to address a whole constellation of poverty-related household problems by improving comfort, health, safety and hygiene, and saving time and resources. A well planned and targeted improved stove programme, in other words, is a positive step towards the goal of releasing large numbers of women from the vicious circle of poverty, malnutrition and overwork in which they are trapped.
Agawal, B. Cold Hearths and Barren Slopes: the Woodfuel Crisis in the Third World. Zed Books, London 1986.
Kamat, S.R. Bombay Air Pollution: A Study of Urban Effect on Citizens' Health in a Developing World. Bombay Municipal Corporation, /984.
Pandey, M R. at al Chronic Bronchitis and Cor Pulmonale in Nepal - A Scientific Epidemiological Study. Mrigendra Medical Trust, Kathmandu, 1988.
Smith, K.R. Biofuels, Air Pollution and Health - A Global Review. Plenum Press, 1987.
Word Health Organisation. Maternal Mortality - A Global Factbook. WHO, Geneva, 19911a).
World Health Organisation. Women, Health and Development. Document WHO/WHD/90.11, WHO Geneva, 1991(b).