Genre et santé des femmes (y compris santé reproductive et sexuelle)
Cette section du profil des systèmes de santé est structuré comme suit:
Le contenu en Français sera bientôt disponible.
Women’s health is broader than reproductive issues only, and should be seen in this wider context. It is best understood in terms of life phases, ranging from infancy to old age. Each phase, due to its specific risks and conditions, has the potential to influence outcomes in the following phase, due to women’s specific roles and bodies.
Very early in life there is a need to avoid parentally transmitted HIV, as this influences health for the rest of an infant’s life. As a child, obtaining adequate nutrition is essential, together with education and appropriate levels of parental support, which in some cultures is not invariably present for girls. Education is a strong predictor of women’s future health. However, many health indicators for girls are poorer in Africa than in other parts of the world.
Sexual activity may start in adolescence, with complication such as early pregnancy or abortion. In adulthood, women who bear children confront the highest maternal mortality figures in the world, with a high fertility rate and often unsafe sex practices. However, many of these problems are avoidable through simple and inexpensive interventions.
Middle-aged and older women become vulnerable to noncommunicable diseases and face social and financial disadvantage if widowed for a prolonged period. Older women may be left with sole responsibility for raising grandchildren orphaned through HIV/AIDS.
More understanding is needed of the interlinked health and social factors that can negatively impact women throughout their lifespan. This could to some extent be achieved through better collection and use of sex-disaggregated data. Regular production, analysis and use of gender statistics is key to finding ways of improving women’s health at all phases.
The girl child
The reproductive future of the girl child starts in utero. Failure to prevent parental transmission of HIV/AIDS is now one of the most significant factors determining her welfare for the rest of her life. In addition, the quality of pregnancy care can influence future reproductive health through fetal programming. It is now known that intrauterine growth restriction can lead to infertility, and to endocrine disorders such as diabetes mellitus.
During childhood, a girl’s health is influenced most strongly by family circumstances. The three critical influences on her health are parental support, nutrition and education. Good parental support is essential for her emotional and intellectual development, while her development in the next life cycle depends on the outcomes of these influences on her health. Future adjustment to adulthood, and the capacity for a normal sexual and reproductive life, depend heavily on a childhood in which both parents are supportive and the family is free from physical and sexual abuse. In some countries, female genital mutilation is a specific risk.
Girls’ education level is one of the most predictive factors regarding future health. In all studies of health utilization and status, education gives women an advantage. In Africa, countries in which girls complete primary school have better health indicators and show superior economic performance.
Good nutrition is essential, as is immunization against the common diseases. Future reproductive performance depends on the availability of adequate nutrients in childhood. Short stature due to childhood undernutrition, and a poor growth spurt, may lead to pregnancy complications such as feto-pelvic disproportion and low birth weight. Chronic anaemia from malaria, parasitic infestations and insufficient food intake can affect girls’ educational performance and put them at risk in future pregnancies. In most African cultures, girl children are treated differently from boys in respect of nutrition, which is one of the factors predisposing them to ill health.
The health indicators for girl children are much poorer in Africa than in developed countries. The leading causes of death in African countries are perinatal conditions, HIV/AIDS, TB and malaria, respiratory infections, and diarrhoeal diseases.
The adolescent period, often bringing the start of sexual activity, can be a time of high risk. This phase brings with it the risk of sexually transmitted diseases, which can lead to future infertility. Unwanted pregnancy, early marriage and pregnancy complications are also significant risks. Others may include behavioural problems, substance abuse, and in some settings, obesity.
The leading causes of morbidity and mortality for adolescent girls in Africa are pregnancy complications, HIV/AIDS, TB and malaria, and mental conditions. Keeping adolescents in school, at least up to the age of 16 years, can minimize the risks. Poor childhood conditions, especially orphanhood, are high risk factors.
There are encouraging success stories, both in Africa and elsewhere, of how strong political leadership has charted a new course for women’s reproductive health in some countries. In the Ugandan government’s fight against HIV/AIDS, broad public acceptance that the disease was indeed a matter of concern led to massive support from both the international community and Ugandan civil society in combating the epidemic. The results of this unique political leadership soon manifested in decreasing HIV/AIDS prevalence rates.
Adult women: the reproductive years
During the reproductive years, adult women can lead a satisfying sexual and reproductive life provided a good basis has been laid down in childhood and adolescence. This includes having the potential to generate independent income.
Unfortunately, due to the high fertility rates and unsafe sex, reproductive mortality and morbidity is high in Africa, with pregnancy complications and HIV/AIDS leading the causes of death. TB and malaria, cardiovascular diseases, diabetes, other communicable diseases, and cervical and uterine cancer become more important in this phase of life. Sexual violence during the reproductive years can cause serious morbidity and even death. In the majority of maternal mortality studies, 70–75% of deaths are shown to be potentially avoidable.
As an example, cervical cancer is the most common cancer among sub-Saharan African women, and it is known that more than 99% of cervical cancer cases are related to genital tract infection with the human papilloma virus (HPV). Studies have shown that although 80% of deaths from cervical cancer can be prevented through a process of timely detection, as many as 50% of cases are not diagnosed until a later stage. Demonstration projects initiated by WHO and conducted at primary health care level have shown visual inspection to be an acceptable, feasible and efficient method of screening to prevent and treat cervical cancer at an early stage.
The continuing high maternal mortality ratio in many African countries can be reduced through the implementation of simple and affordable interventions such as family planning, manual vacuum aspiration for abortions, and the use of oxytocics in the third stage of labour.
Cameroon has developed a strategic plan on reproductive health security, to raise awareness of the need to fund contraception in the national budget. A special budget has been created for the purchase of contraceptives.
During the post-menopausal phase, reductions in the level of female hormones lead to physiological changes. Some women experience minimal morbidity, while others have severe symptoms requiring treatment. Cardiovascular diseases, other non-communicable disorders, cancers, sensory disorders and HIV/AIDS are the main causes of mortality and morbidity at this time. Breast, uterine and ovarian cancers become more prevalent.
Other factors may affect women’s health indirectly. African men, for example, tend to die significantly earlier than in other parts of the world, leaving women with a longer period of widowhood and often fewer resources.
Older African women often face financial hardship as they become unable to work, but rarely have old age benefits. They may have difficulties finding the payments needed for medical expenses, in addition to other essentials for life. Lastly, due to the HIV/AIDS pandemic, they may be left with grandchildren to raise at a time when their own earning power is diminished. Older women in Africa do not, therefore, enjoy a quiet retirement; many face increasing burdens with reduced resources. In response, some countries are starting to establish programmes for the elderly. These include Guinea, Kenya, Mauritius, Seychelles, South Africa, and Togo.
The growth of the mutual health insurance system in Rwanda has been greatly successful in respect of the scope and affordability of the programme. Rwanda is, so far, the only country in sub-Saharan Africa where 85% of the population participates in a mutual health insurance programme.
State of surveillance
There are four barriers to a satisfactorily gender-disaggregated health surveillance system in most African countries. Firstly, despite the core importance of data disaggregated by sex and other variables, these are still not systematically available. Secondly, even where such data are available, there is often unwillingness or a lack of capacity to incorporate them into the frameworks used as a basis for policy-making. Thirdly, in many countries, the producers and users of gender and health statistics, as well as those who work in the health equity domain, often operate in isolation and without any real power to effect change. Fourthly, data on gender, women's health and health equity may not be available in user-friendly formats or may not meet the perceived needs of decision-makers and programme planners.
These deficiencies result in the supplementing of health data with gender statistics from other sectors. Data on education, labour, time use, women's political participation, and related issues do help in providing a critical understanding of the health determinants of women and men respectively. These should, however, complement rather than serving as proxies for gender-disaggregated health data.
WHO is promoting and supporting efforts at country level to strengthen the collection, analysis and use of disaggregated data to inform policy and programme development. This is gaining momentum through strengthening Member States’ capacity for gender analysis and gender mainstreaming in relation to health programmes. However, gaps and challenges persist in respect of the availability, analysis and use of gender statistics.
Endnotes: Sources, methods, abbreviations, etc.
List of tables and figures
Fig 1: Health issues in women’s life (Source: DRH/AFRO annual report 2004 (not referred to in text)
Atlas Figure 98: Percentage of current contraceptive use among married women 15–49 years of age in the African Region, by country, 2000–2008 and 1990–1999.
- ↑ Tim A, Heald S. HIV/AIDS policy in Africa: what has worked in Uganda and what has failed in Botswana. Journal of International Development. 2004.
- ↑ Organisation Mondiale de la santé, 2005. Etude multipays de l’OMS sur la santé des femmes et de la violence domestique à l’égard des femmes. OMS.
- ↑ World Health Organisation Regional Office for Africa, 2010 Baseline Gender Assessment report.
- ↑ World Health Organisation, Regional Office for Africa, Division of Family and Reproductive health DRH/AFRO 2004. Annual DRH report.
References (to be completed)
1. Women’s health: A strategy for the African region, 2005.
2. World Bank, 2006. Women’s Health. Disease Control Priorities Project, World Bank.
3. Tim A, Heald S. HIV/AIDS policy in Africa: what has worked in Uganda and what has failed in Botswana. Journal of International Development. 2004. 4. Organisation Mondiale de la santé, 2005. Etude multipays de l’OMS sur la santé des femmes et de la violence domestique à l’égard des femmes. OMS.
5. World Health Organisation Regional Office for Africa, 2010 Baseline Gender Assessment report.
6. World Health Organisation, Regional Office for Africa, Division of Family and Reproductive health DRH/AFRO 2004. Annual DRH report.