Gender Equality and Women's Health in the Caribbean

• Author: Denise Noel-DeBique
• Pages: 146-177

146 Denise Noel-DeBique

INTRODUCTION

Enjoyment of the highest attainable standard of health is recognised as a

fundamental right for every human being.1 Conscious that the realisation

of this right eludes the majority of women, governments with unstinting

support from women from regions around the world, affirmed commitments

to women’s health and empowerment throughout the life cycle at major

international conferences held during the decade of the nineties.

The consensus documents of the International Conference on Population

and Development (ICPD 1994) held in Cairo and the Fourth World

Conference on Women (FWCW 1995) held in Beijing were therefore

significant in their embodiment of empowerment approaches to women’s

health, based on women’s capacity to challenge and change oppressive

situations and/or ideologies in the systems and relationships in their lives.

Having proclaimed that ‘Women have the right to the enjoyment of the

highest attainable standard of physical and mental health’ (UN 1996: 56)

and that ‘Women’s health involves their emotional, social and physical

well-being and is determined by the social, political and economic context

of their lives, as well as by biology’ (UN 1996: 56), the Beijing Declaration

and Platform for Action (PFA) proceeded to articulate the key requirements

and point to the main pillars upon which the attainment of this right

would hinge. In so doing, the Declaration and PFA positioned concerns

Gender Equality and Women’s Health

in the Caribbean

Denise Noel-DeBique

FIVE

Gender Equality and Women’s Health 147

about women’s health within broader development goals of equality,

development and peace.

The concern with health as a development issue emerges from early

recognition of the special characteristics of health in exerting a positive

impact on productivity. Health had been considered an enabling, capability-

enhancing attribute with empowerment flows being derived through the

channels of welfare and productivity (Grossman 1972, Sindelar 1982, Over

1991, Kindig 1997). However, given that it is subject to depreciation,

any threat to an individual’s capacity to maintain or improve his/her health

status could be reasonably interpreted as a threat to his/her welfare.

Health development in the nineties was characterised by themes of equity,

participation and sustainability. The emphasis on these principles led the

Presidents and Heads of State at the Summit of the Americas in Miami in

1994, to adopt the Resolution on Equitable Access to Basic Health Services,

and include among their principles the following ‘It is politically intolerable

and morally unacceptable that some segments of our population are

marginalized and do not share fully the benefits of growth’.

Notwithstanding, the decade witnessed accelerated and complex changes

that have had gender differentiated effects on women’s health. Available

evidence shows rising mortality and morbidity rates among women from a

wide range of causes, among them growing demands on women’s

productivity, their multiple reproductive roles and their lack of control

over their time, labour and sexuality. The precariousness of women’s

livelihoods, as evidenced by the large numbers of them in low income jobs

with hazardous working conditions, created occupational health burdens

such as physical stress, and reproductive disorders. Analysis of data on

domestic injuries showed that women were more vulnerable to violence in

the home when they were in situations of extreme economic dependence

associated with poverty.

A crucial finding of the FWCW 1995 was that ‘Women have different

and unequal access to and use of basic health services . . . Women also have

different and unequal opportunities for the protection, promotion and

maintenance of their health’. (UN 1996: 56-57). In effect, therefore, women

were increasingly in relatively weak positions to address their health needs

and maintain and/or improve their productive capacity.

This chapter examines the critical developments with respect to women’s

health and the progress of CARICOM countries in addressing the health

148 Denise Noel-DeBique

issues raised in the PFA which were identified as priorities for the region.

In so doing, special emphasis is placed on issues of inequalities in health

and access to health care, in keeping with the underlying concerns of the

PFA that ‘A major barrier for women to the achievement of the highest

attainable standard of health is inequality, both between men and women

and among women in different geographical regions, social classes and

indigenous and ethnic groups’ (UN 1996: 56).

The chapter calls attention to the implications of health policies and

programmes for gender equality goals in respect of health status, access to

care and priority setting for financing. It argues that the strategic shift

from Women in Development (WID) to Gender and Development (GAD)

in health, has barely taken place, as provided by an assessment of approaches

in areas of noted gender inequalities in health in CARICOM countries,

and concludes that the shift required is both ideological and political, and

within and outside health institutions.

The chapter includes a review of strategies used in the CARICOM region

in implementing the strategic objectives of the Beijing POA in respect of

health. It draws on government reports and insights gained through women’s

perspectives. Undoubtedly the nature and priorities for women’s health are

shaped by historical, political, social and economic conditions specific to

the region. This assessment of achievements of the goals of Beijing in the

region must be placed against the backdrop of globalisation and the region’s

thrust towards a single market and economy. As one prominent feminist

scholar notes, these shifting macroeconomic imperatives have had significant

policy implications for the health and well-being of the women of the

region (Antrobus 1993).

EQUITY, GENDER AND EMPOWERMENT

The development approaches to women’s health in the nineties were

underpinned by the following three concepts: equity, gender and

empowerment.

The concept of equity in health accepted by WHO is defined as

recognisable change from that which is considered unnecessary, avoidable,

and, moreover, unjust2 to that in which there is minimisation of avoidable

disparities in health – including but not limited to health care – between

groups of people with different levels of social privilege.3 Equity in the

broad area of health implies a concern with resource distribution at all

levels of the health system – with emphasis on the health of the

disadvantaged in society, among whom women predominate. In health