Women – farmers, workers, tradeswomen, producers of goods and wealth, healthcare providers, mothers, educators… – are the “considerable topics” of a global history whose economic and ideological tensions are often directly written in their bodies in inflicted violence and imposed choices. Everywhere, gender differences typically mean inequality: in education, decisional autonomy, water pumping and transportation, wood carrying, or payment.
Such inequalities are particularly intolerable in the field of health, which combines social and economic dimensions. Despite some progress, 358 000 women die every year for reasons linked to pregnancy or childbirth, including 204 000 in Sub-Saharan Africa where maternal, infant and neonatal death rates are the highest in the world (respectively 1 100 in 100 000 live births, 92°/°° and 45°/°°). To such data should be added pain and the many stigmatizations that surround abortion, and notably the tragedies women endure from fistula.
These deaths and pathologies – whose direct medical causes are dystocia, haemorrhage, eclampsia and infections –pertain, should one adopt a more encompassing perspective, to three wide health and social dimensions. The first relates to fertility. While a European woman has an average of 1.6 children, an African woman has 5.2, and obviously this multiplies by as many times her risk of dying from being pregnant. However, despite major differences between the countries, there are only 9% of African women on average who use modern contraceptive methods.
The second dimension is the effectiveness of childbirth management and infants/young children care. Although effective measures have been identified to reduce the deaths of all these patients, different reasons combining technical, ethical and organizational dimensions cause in-hospital mortality to decrease only very slowly.
Lastly, health programmes are, in a historical scale, but one component of the very fast social changes through which, globally, many norms of behaviour and conflicting values meet. Hence the necessity to consider how health proposals fit into wider societal transformations.
Ahead of “risks”, health and education are linked; and, in very concrete terms, knowledge should be developed and disseminated, in accordance with the social and linguistic contexts, to enable women and men to better understand the functioning of their bodies and control their fertility.
Improvements in gender relations should also be boosted, in order for conception to be thoughtful, negotiated and included by the concerned populations into a life and education plan taking into account the new situations and socio-economic changes.
Finally, the populations should be helped in getting knowledge of and access to the contraceptive methods in order to avoid abortion and unintended pregnancies.
To address the problems related to pregnancy, to childbirth and to child management, access to healthcare should be improved as well as its quality, by combining a whole set of dimensions which connect cure and care, the recognition of women patients and management quality, healthcare organization and cooperation among wards (obstetric wards, neonatology, blood banks,…) .
Next to these technical management issues, “social health” should finally be monitored to ensure proper compliance with treatments and recommended lifestyles, as well as the seamless reinstatement of women in their social environments.