“The Health of Women: A Global Perspective”

(1993) Edited by Marge Koblinsky, Judith Timyan and Jill Gay, published by Westview Press. 291 pages.

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The Health of Women: A Global Perspective is essential reading for topics to include in a women's health agenda in developing countries. The strength of this book is the depth of its perspective. Much more is included than the medical aspects of maternal morbidity and mortality. As the titles of the chapters indicate, the health of women in developing countries is placed in a comprehensive context:

1. Women's Health: The Price of Poverty.

2. Mother and More: A Broader Perspective on Women's Health.

3. Women's Nutrition through the Life Cycle: Social and Biological Vulnerabilities.

4. Infection: Social and Medical Realities.

5. Family Planning: A Base to Build on for Women's Reproductive Health Services.

6. Abortion.

7. Women's Mortality: A Legacy of Neglect.

8. Violence against Women: The Missing Agenda.

9. Women's Mental Health: A Global Perspective.

10. Access to Care: More than a Problem of Distance.

11. Quality of Care: A Neglected Dimension.

12. Health Women's Way: Learning to Listen.

Each chapter justifies inclusion of its topic in a women's health agenda for developing countries. The reasons for each topic's inclusion are clearly and strongly presented, supported by relevant statistics. Each chapter provides a fresh perspective. Either the topic of the chapter itself is fresh (e.g., violence, mental health) or the approach towards it is fresh (infection, family planning). Each chapter also includes thoughtful and practical recommendations, often categorized for policy, program, and research.

The audience for this book is broad. It includes people who have not yet considered women's health in developing countries, and would benefit from seeing a comprehensive agenda; people who are convinced of the need to address women's health concerns, but need information and new approaches with which to convince others; and people who need suggestions on how to design health services to better meet women's needs.

Chapter 1 makes the case that poverty is a major factor in women's poor health. Poverty limits women's access to health care and reduces women's decisions to seek care, yet increases women's chances of suffering ill health. Chapter 2, “Mother and More” reviews existing information on the levels of morbidity for those conditions that most frequently cause maternal mortality: ill health consequences of hemorrhage, obstructed labor, infection, gestational hypertension, and septic abortion. Other topics reviewed are what is known about the menstrual cycle, ill health consequences of women's work, and the health 'isues of aging women.

Chapter 3 discusses women's nutrition, first in terms of social vulnerability, due to women's low status, in each of four life cycle stages (preference for males in infancy/childhood, early reproductive role in adolescence, multiple roles in the reproductive years, and marginalization in the later years), and second in terms of biological vulnerability, due to women's reproductive role. Chapter 4 on infections (reproductive tract infections, sexually transmitted diseases, and HIV) has useful sections on existing interventions and considerations for designing them.

Chapter 5 presents family planning as one of the basic and most important preventative health care services for women. To play this role effectively, family planning “services must be available to women in a way that incorporates and satisfies their other primary of reproductive health care needs and is simultaneously responsive to the various stages of their reproductive lives,” and the chapter outlines ways in which this can be done. Chapter 6 on abortion addresses ways to reduce the poor health outcomes of unsafely performed abortions, chief among which is promotion of family planning services to prevent unwanted pregnancies. Other strategies for tackling the problem of ill health effects of unsafe abortions are safe technologies and access to safe care.

Chapter 7 on women's mortality discusses both mortality due to the low status of women, and maternal mortality (deaths due to complications of pregnancy, childbirth, and the early postpartum months). Specific priorities are outlined for reducing maternal mortality. Chapter 8 on violence presents a compilation of available statistics on domestic violence, dowry deaths, rape and sexual assault, violence against refugee women, female circumcision, and discrimination against girl children. Following the grim statistics, the author gives examples of ways women are fighting against violence in their lives, and makes action-oriented recommendations for reducing this problem.

In Chapter 9 on mental health, the author starts by challenging the myth that mental health is a luxury item. She then describes the most prevalent types of mental illness in women of different age groups, and ends by outlining an effective mental health policy. Chapter 10 on access to care discusses thoroughly the many factors that constrain women's access to health care services. On the service side are factors such as service organisation, service location, characteristics of personnel, structural adjustment, cost and quality of services. On the user side are factors such as informational barriers, decision-making dynamics, and cultural barriers. Specific recommendations are made to reduce each of these constraints to women's access to health care.

Chapter 11 on quality of care outlines characteristics of the delivery of health services to ensure quality, and thus use, of services. The original audience for the quality-of-care arguments was the family planning community, but applies to a variety of health services that could be serving women's health concerns. Chapter 12 describes the importance of listening to women in order to design health services to meet their needs. Programs that meet women's needs are more likely to be sustained and to be more effective. Perhaps more importantly, the authors describe eloquently effective methods for listening to women to discern these needs.

The Safe Motherhood Initiative was launched six years ago after the high rates of maternal mortality became apparent. It focused on mortality of women during pregnancy, childbirth, and the early postpartum months. While the Initiative has brought long overdue attention and programmatic action to a problem of enormous proportion, it is gratifying to see that the specific focus of the Initiative is now being complemented by a broader focus of women's health in developing countries.

For order and other information, please write to: Westview Press, 5500 Central Avenue, Boulder, Colorado 80301-2877 or 36 Lonsdale Road, Summertown, Oxford OX2 7EW.

Kathleen Kurz International
Center for Research on Women