Although healthy women throughout the developing world shares a common health problem, a major concern varies from region to region. So, too, do the priorities for action.
Sub - Saharan Africa
Sub - Saharan Africa has the world's highest fertility and maternal mortality. Maternal health problems exacerbated by poor prenatal and delivery care and by unsafe abortions, which accounts for 20 to 40 percent of all maternal deaths in the region. African countries also have some of the highest teenage pregnancy rate in the world. At age 18, more than 40 percent of women in Cote d 'Ivoire, Mali, Senegal and has spawned (Population Reference Bureau 1992).
STDs and HIV / AIDS is the leading cause of disability and death among African women and accounts for more than half the burden of STDs among women in developing countries. Infertility and cervical cancer, often caused by a sexually transmitted disease, which is common in some countries. Genital mutilation is practiced in several countries in the region.
Priorities for improving the health of women in Africa, including improving access to maternity care, family planning, safe services for the management of abortion, and STD services, and prevent genital mutilation, HIV infection, and violence against women. To provide clinical and preventive services are needed - and especially to extend services to rural areas - many countries need to strengthen their health care infrastructure. Special initiatives for adolescents is needed because a large number of young women at risk and great potential for improving health through delay sexual activity and childbearing, safe sex practices, and good nutrition.
South Asia
Throughout most of South Asia, women of all ages suffer from the effects of gender discrimination. Discrimination and neglect is estimated to cause the deaths of six babies of women in Bangladesh, India, and Pakistan. In some areas of gender-specific abuse is common, including sex selection through abortion, female infanticide, and the injuries and deaths associated with wife abuse and dowry demands Other forms of discrimination, such as giving a little food for female household members, limiting their access to health services, and impose more physical work in girls and women, are also common. The status of women is also seen lower school enrollment and retention is lower.
Many women do not have access to health care, especially maternity care, contraception, and safe services for the management of abortion. South Asia has a higher proportion of stunting the growth of girls and anemia in pregnant women compared to other regions. Only one of the three women receiving prenatal care or have trained personnel during childbirth. As a result, the rate of death and disability related to pregnancy and childbirth are high. STDs are widespread, and HIV infection continues to increase.
The key component of the agenda for women's health in South Asia is for health care providers to address the impact of discrimination by expanding access to health care through measures such as training of female health providers, conduct public education and outreach programs, and publicize the importance of protecting women's health. Expanding and improving the quality of women's health services are also important health programs need to give greater attention to the nutritional status of young girls and teens, as well as detection and rapid referral of complications related to pregnancy. Cross-sectoral initiative is needed to address the issue of early marriage and violence against women.
East and Southeast Asia
In certain countries, such as Laos and Cambodia, similar to women's health conditions in South Asia or Africa. In other parts of East and Southeast Asia, women reach the level of health girl , education, and social status of the typical middle-income countries. In East Asia 95 percent of women benefit from a trained assistance during delivery, although less than half of all births take place in institutions. There are regional differences and urban-rural large enough, however, reflecting the influence of lifestyle and economic status on the pattern of the disease. For rural women, infectious diseases are the main cause of death, while urban women have higher rates of cardiovascular and cerebrovascular disease and cervical and breast cancer. East Asia has the highest incidence of cervical cancer in the developing world.
Maternal morbidity and mortality remain high in some countries in the region have adequate maternity care is not widespread (WHO 1991a). Contraceptive prevalence is relatively high in Indonesia, the Republic of Korea, Malaysia, and Thailand, but in some countries, like the Philippines, various methods of contraception are not available. HIV / AIDS is growing faster in East Asia than in other parts of the world (USAID 1991). Increasingly, their early teenage girls into prostitution, often because of economic hardship or force.
Smoking and alcohol abuse among women is growing concern in some parts of East Asia, because the multinational tobacco companies are increasingly targeting advertising to women. The health status of women is also influenced by the discriminatory practices, such as sex selection in China and the Republic of Korea and female genital mutilation in parts of Indonesia and Malaysia.
Priorities for women's health services in the region tend to vary, depending on the existing health infrastructure and policies. In countries with limited services, health agencies will need to concentrate on the expansion and improvement to ensure access to maternity care, family planning, and safe abortion services. Most countries in the region need to give extra attention to early prevention of disease among young girls and teenagers, especially by emphasizing the dangers of unprotected sex, tobacco use, and substance abuse. Where resources allow, cancer screening and treatment should be provided.
Middle East and North Africa
Fertility rates in the Middle East and North Africa are among the highest in the world, almost the same as those of Sub-Saharan Africa. High fertility and early childbirth contribute to poor health among women. Low contraceptive prevalence rates, and poor access to health care. Cultural norms prevent women using the existing health services. Genital mutilation is practiced in some areas. Women's low status and low literacy levels, as well as lack of information and data on women's health issues, the main obstacle to improving women's health.
The main priority in this area is to increase women's access to better health care by meeting their needs for women's health care providers, convenient locations, and information about healthy behaviors. Better maternity care is another pressing need in most countries. Women can also benefit substantially from increased access to contraception and a wider choice of methods.
Latin America and the Caribbean
In many Latin American countries, non-communicable diseases cause more death and disability for women than communicable diseases and maternal and perinatal causes combined. However, the maternal mortality ratio in the region is higher than in other areas with similar levels of income, due in large part to unsafe abortion. Fertility is quite high in most countries. The service is often inefficient and poor quality. Tertiary health facilities and higher levels used in excess for maternity care, and some states have abnormally high rates of caesarean section delivery, which adds to the risk of women's health.
Unwanted pregnancies, especially among teenagers, is a serious problem. Although abortion is illegal in most countries in the region, the abortion rate in some areas is one of the highest in the world. PMS is also a concern. Although aids epidemic is at an early stage, the number of cases among women is projected to rise sharply in 2000 (PAHO 1993). Violence against women is increasingly recognized as a source of mental and physical health of the poor.
As the proportion of older people increases, problems such as heart disease and cerebrovascular become more significant among women. Breast cancer is increasingly common, especially in high-income countries. Cervical cancer is also increased. Women's risk of disease invaded by factors such as high levels of smoking, obesity, and anemia, nearly one in three women in this region of anemia (PAHO 1993).
Agenda to improve the health of women in Latin America, including ensuring that low-income women have access to health care services, especially pregnant care and family planning, develop strategies to meet the needs of adolescent sexual and reproductive health, to overcome the problem of unwanted pregnancies and healthy behaviors and promote , such as good nutrition, safe sex practices, and avoiding smoking and obesity, unsafe abortion. Some countries need to give more attention to local issues such as overuse of tertiary health care facilities, unnecessary medical procedures, HIV / AIDS, violence against women, and adequate support for women after the age of reproduction, including the management of cervical and breast cancer.
Eastern Europe and Central Asia
The health status of women in Eastern Europe and Central Asia are lower than expected, given the high level of women's education and health infrastructure is quite well developed. Shortages of drugs and supplies are common, such as health care practices that are not always effectively obsolete. Although almost all women receiving prenatal care, the excessive emphasis placed on diagnostic tests and not enough on counseling and prevention. Abortion, which is legal in many countries in the region, is the most common method of fertility regulation largely because contraception is not available, even, there are more abortions than live births. Needs of divorced women, widows, and the elderly in need of greater attention. In some countries the status of women's health deteriorated, and their access to services such as legal, state-subsidized abortions are being threatened.
Key initiatives in women's health agenda for the region include making information and services more widely available to reduce reliance on abortion family planning, provide more training to improve clinical practice, ensuring that medicines and adequate supplies are available, increasing the emphasis on preventive health care (especially avoidance of tobacco, the value of exercise, and good nutrition), and addressing the needs of women after the age of reproduction.
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