Health Has a Gender

on the Eighth International Conference “ WOMEN AND HEALTH”

Women's bodies and women’s health has for some twenty years now been one of the trigger topics of feminist activism. Women's health, the ways it is impaired and cured, is a part of the patriarchal in­stitutions that continue to follow the stand­ards which men have set. Every woman has had experiences which lead to that con­clusion—starting with poverty, that af­flicts primarily women, then to abortion and contraception, and to the population policies in many countries run by government ideologies rather than the needs of women. That is why feminists started associating on a global scale in 1975, ex­changing experiences and encouraging action. The Eighth International Con­ference “Women and Health” was held in Brazil on March 16-21, 1997. Upwards of 400 female health experts from governmental and non-governmental organizations, theoreticians, and activists from 72 countries gathered in Rio de Janeiro to convey various experiences from their respective communities. The five day conference in­cluded some 150 discussion workshops and panels. There were four repre­sentatives from the region of former Yugoslavia. Three came from Bosnia-Herzegovina (from the NGO Medica Zenica) and I represented Women in Black.

Women's health was discussed from the perspective of the needs and wishes of women from different parts of the world, and from the position of feminist criticism of the ruling ideologies that produce current health policies.

Women's health, poverty and quality of living

This was the official title of the con­ference, which was organized, like the previous ones, by women from the NGO sector (alter­native, feminist, non-governmental organizations). Gatherings such as this are not opened by female state officials who deliver empty speeches on behalf of women. This is done by women, speak­ing for themselves. Brazilian feminists opened the conference with a perfor­mance-story about women's resistance.

The co-ordination network, com­prised of ten feminist NGOs, worked for two years to prepare the conference. These groups cover all of Brazil: the Brazilian Feminist Network, the Feminist Association of Sexuality and Health, Lilit (women's house), Women's Infotheque (CIM), the In­stitute of Afro-Brazilians, etc.

The conference closed with the adoption of the Declaration of Gloria, titled after the place in Rio where the conference was held.

Women's health, reproductive rights, and sexual rights—as the central issues in feminist theory and practice—must be in­cluded in universal human rights. Woman's health cannot be reduced to a biological category, to physical health. Patriarchal, sexist and fragmentary models finds that adequate, but women do not. There is an interdependency of gender, class, race, and ethnicity. "Women's health must be observed in its historical, economic, political and cultural reality" (Frida Akhter, Bangladesh).

Discussions during this intensive, creative conference, marked by a feeling of solidarity, can be divided into four basic issues: obstacles to women's health, reproductive and women's rights, problems hampering the estab­lishment of a policy to benefit women, and positive contributions over the last few years and strategies aimed at improving the status of women and especially women's health.

GITA SEN, a feminist and economist from Bangalore, India, the author of numerous books, essays, and research in population policies, described the globalization of the production and financial system as the new king of fun­damentalism—MARKET FUN­DAMENTALISM. Although the term was not accepted in the final document, but rather replaced with the term “inter­national capital,” Gita Sen explained: "All forms of fundamentalism have three basic characteristics: they believe and wish others to believe in a general, ex­clusive truth, that truth that is beyond all others, and they trust in an authority who knows everything and should be trusted without question. After all, market has become that faith, truth, and authority beyond all others."

In what way does that affect women's health? Gita says that health is no longer a right, but a disposable commodity—capital. That results in discrimination. Those who have the possibility (money) have more right to health than others do not have money. The policies of economic restructuring, the growing economic crisis, have in most states resulted in cuts to health budgets and public health services and the privatization of health services. As these services are for pay, they are available to fewer and fewer people. This is happening both in the South and in the North, both in the East and the West, both in poverty-stricken and in developed countries. Patrizia Romito, from the University of Trieste, said: "A part of the (health) services in Italy are cur­rently going private; ministers are cor­rupt, they get control of the state firms, and get rich from them." She concluded: "Whenever the state sector turns private, health services deteriorate." This hits women first of all, as abortion in Italy is under threat once again, and there is again talk about the rights of the fetus. All the while doctors, the champions of fetus rights, are actually defending their economic interests, setting up private clinics and making money on illegal abortions. Elena Barayeva, a Russian, said that "nothing functions in Russia; communism did not work in the past, democracy does not work now. An abor­tion costs $200 since the ministry has decided to exempt it from the social in­surance." Health insurance has nearly disappeared in Serbia as well— in the future, almost all services will be for pay. Those who are full of the so-called na­tional sovereignty talk or of "the return to one's roots and belief of the Western conspiracy are the ones who are the main players in selling out the national wealth. This is the case in Turkey and in Serbia. Nurie, from Istanbul, linked militarism with privatization: "Privatization of all health services began with the military regime (in the '80s). It con­tinued in the times of Tansu Chiler." Nurie also mentioned the mark-up rates on pharmaceutical imports. Turkey prides itself on having the greatest number of pharmacies. Ser­bia is close behind. While it is certain that ex­cessive medicalization brings in huge profits, it does not imply better medical protection at all.

The globalization of the economic system has introduced new models of women's employment. Unfortunately, experience proves that this does not improve working conditions at all, but rather results in more severe health problems. Multinational companies set unbearable conditions for women—the work is monotonous, repetitive, and ordered to the utmost. It is true that the differen­ces between the North and the South are huge, but the two have a lot in com­mon, especially in women's positions in multinational companies. In both the North and the South, inequality based on sex is perpetuated. Some of the models of employment (part-time, temporary, seasonal, etc.) in France imply that a woman working part-time earns much less than half the wages . In Japan, such employment means that if a woman works just an hour a day less than a man, she does not have the right to vacation or to trade union associa­tions. In Brazil, Chile, and Mexico, the number of employed women is on the rise, but with increasingly insecure work contracts. Most cases are of low-qualified jobs with lower wages (70% of men's wages). SILVIA ESTRADA (Philippines) spoke about the model of "Asian tigers" that directly jeop­ardizes women's health. Women are losing traditional sources of food and health as their arable land is destroyed to construct factories. Women are grow­ing increasingly poor in these "world's wonders"—the tiger economies. Asian women are exposed to all sorts of ex­ploitation: the sex trade, slavery, sexual tourism, AIDS. This Asian model, with Asian capital, is now getting transferred to Mexico, Brazil, and other countries in the so-called cus­toms free zones. This is not only the case in third world countries. It is presented here as an enormous step forward here as well. Within that model, women are left with almost no possibility for profes­sional promotion. The so-called loans for entrepreneurship are no solution either if they are aimed solely at integrating women in the same economic model. That makes it impossible for women to build up alternative economic models.

A lot was said on the impact of AIDS on women's health. Numerous research data was presented: AIDS in women is a disease transmitted mostly sexually; 42% of the overall number of those afflicted with AIDS are women; 50% in every 7,000 newly discovered cases are women; two thirds of infected women are young, poor, married, do not take drugs, nor have over the year prior to the discovery of infection had sexual contacts with other partners. Namely, their husbands have infected them with AIDS. In many parts of the world, AIDS brings death to women 15-29 years of age, as for ex­ample in Sao Paolo, Brazil. Some 90% of those afflicted with AIDS live in under­developed countries and make up the poorest layer of the population. A majority of AIDS afflicted women do not have access to medical services or treat­ment. This has been a part of the women's health research network.

"First they give us poison, then they sell us medication"

Betsy Hartman, a feminist demog­rapher from Hampshire College in Amherst (Massachusetts, USA) described the policy of "her state" as: "neo-Malthusian, anti-immigrant, conservative." The ideas of Malthus (1766-1834), an English economist and author of essays on population development, have been renewed and disseminated by his followers, especially in the second half of this century. Neo-Malthusians ascribe the poverty of the third world and of those on the margins of the developed countries exclusively to population growth, rather than to the unequal division of wealth, exploitation, and backwardness. The control of population growth has passed through various phases that we cannot go into here. Their common denominator is that all are ex­tremely repressive, misogynist, and ag­gressive. Since the 1950s, due to the precipitation of the debts crisis in the poverty-stricken countries of the third world, \ population policy has grown ever more aggressive. It takes two prin­ciple courses: pro-natality and anti-natality (stimulation and de-stimulation of child-birth for the needs and interest of the state or a particular race, nation, or class). This has been a trend for some time now in Serbia, where senile academics of the Serbian Academy of Sciences and Arts, Orthodox fundamen­talists, the ruling party, etc. moan over the white plague and call on Serbian women to give birth out of patriotic reasons while they reproach Albanian women giving birth as having "separatist" mo­tives.

Let us go back to Betsy Hartman, who said in Rio that "the US believes population growth to be a THREAT," because if it is excessive, the country cannot produce for exports, can­not pay off its foreign debt, and should by all means introduce measures of birth control. That method has been estab­lished "radically, as efficiently as pos­sible, with as little costs as possible, and in the fastest and easiest way possible." And how do you achieve this? Both Betsy Hartman and many women attending the congress denounced population policy measures. Brutal repressive policies against women are "the fruit" of a joint operation of world finance institutions, multinational companies, and local govern­ments (mostly in third world countries, but also in many other parts of developed countries, e.g. Atlanta, in the southern US).

The range of repressive measures is wide: enforced sterilization, especially by the long-term use of hormone pills (in most cases Norplant and Depo Provera, anti-fertility vaccines, etc.). Research has shown dozens of side-effects that per­manently impair women's health. Women's bodies are abused in various medical experiments. Gita Sen stated that a doctor in India was carrying out an experiment on a thousand women, applying new reproductive technologies, while "neither he nor others are control­led by anyone." The feminists naturally denounced him and those like him. For­tunately, we have increasing numbers of progressive medical workers, human rights organizations, trade unions, and even some political parties joining us.

Many feminists pointed to the fact that powerful finance institutions (primarily the World Bank) condition granting support to underdeveloped countries with the implementation of repressive population control measures. Local state officials, corrupt as they are, take profits on the sly, while in public they present themselves as "protectors" of women's morals and fetuses. In fact they are the hard-line pro-lifers. This happens both in Bangladesh and in the Philippines, Peru, Senegal... "The foreign debt is killing us. The World Bank offers us restructuring programs: first they give us poison, then they sell us medication..." (an activist from Senegal).

Betsy Hartman pointed to the new traps of the establishment of population policy: over the past few years, population control has been euphemistically called by many family planning, while doing the same thing. Feminist health models have nothing to do with the control over reproductive ability in women, but with the establishment of conditions for women to make the decision on their own. That is the policy of reproductive rights, health and sexual enlightenment, information on reproductive health, on benefits and risks of use of medication, all contraceptive methods, medical treat­ments, efficient, reliable, harmless and legal abortion, etc. Without all this it is impossible to speak about women's right to choice.

"Caution with all who propagate sacred things..."

Frances Kissling, the leader of the Catholics for a Free Choice (CFC) move­ment, spoke about the globalization of conservatism (cultural, political, economic). The spread of religious fundamentalism, Kissling believes, is both a reaction and a response by church institu­tions to the efforts of the women's move­ment to get organized, to make decisions, and to set up strategies. What is common to all fundamentalists? That they always act against women, says Frances. Fraima Mernisi (Morocco) believes that the aim of fundamentalists is to "prevent demo­cratic processes." For Marieme Helie-Lucas (Algiers/France), the founder and the coordinator of the international net­work Women Living Under Muslim Laws (WLUML), "all fundamentalists, regardless of their background or religious demand, have one political aim: mustering political power so as to control women's lives, especially women's sexuality, including the right to self-determination and passing of reproduc­tive decisions." Frances Kissling and the CFC movement are the thorn in the Vatican's side. She herself is also a vehe­ment critic of Vatican conservatism. At the conference, she called on women to "pay close attention to religious institu­tions" and pointed to the fact that fun­damentalists "are far more interested in the private domain than in the public domain, and they ground themselves in family authority..." Fundamentalists especially wish to "engage in education, to bring up the young and teach them in religious dogma," they certainly try to get as close as possible to people through various "caritative" activities. Different pro-lifer NGOs offer great help in this. Argen­tineans have pointed to such a role of Caritas.

Fundamentalists set up strategic al­liances. Frances says: "The Vatican does not like Islam. Islam leaders do not fancy Catholic leaders; they compete with each other, but establish alliances so as to propagate their fundamentalist ideo­logies." That was especially conspicuous during the Conference in Cairo (1994). Kissling believes that fundamentalists in the shadows—i.e. extremist conser­vatives, who constantly talk about the family as sacred—are far more dangerous than the religious fundamentalists. She therefore advised "caution with all who propagate something sacred." It is exact­ly those who are committed to the "sacredness" of the family, marriage, fetus, or return to the root of faith, who wage war against women: in the US, Protestant fundamentalists attack clinics where abortions are performed; in Atlanta, they attack lesbian bars; in Algiers, the Is­lamic fundamentalists rape and murder girls who do not wear chador; in Senegal and Turkey they demand that women go to universities in kelebah; in Russia Or­thodox fundamentalists demand that women bear more "Russian" children; their counterparts in Serbia demand that Serb women bear more "Serb" children, and that Albanian women bear less, and on top of that propagate hatred toward other nations.

Fundamentalists of all ethnic and religious backgrounds have one thing in common: a hatred of feminists.

However, women are not only critics of fundamentalist policies. In many cases, they support and are even activists in fundamentalist movements. Kissling tried to explain such participation of women with extremely patriarchal es­sence of fundamentalism: women are reduced to powerless creatures, the "weaker" sex that needs "protection." Un­fortunately, some women fall for the fun­damentalist trap of false protection (slavery in fact), and a fair number of them accept fundamentalism. "Some fun­damentalist ideas are allegedly just: they free women from responsibility, from autonomy, give them false security."

Pinnar Illkaracn, from Istanbul (Women for Female Human Rights), says that the Islamist parties in Turkey have many women members, that they demand the right to wear kelebah in schools, at university... They have been very active in elections, but the fun­damentalists would "expel them immedi­ately" after elections from all positions of power. "There are many women wearing kelebah at the University, while other women do not wear it, as it is not our cus­tom. Those so-called intellectuals talk of Islam very sweetly, seductively, and are in fact very well paid for the job. They do not know Islam at all, they do not even speak Arabic" (A feminist from Senegal).

"What use have we of agendas nobody adheres to"

Governments of most countries do not consider at all the category of gender, not to mention its implication in health policy. Women are not present while these policies are drafted, and where they were present, their presence has not lead to political changes or im­plementation of the Cairo or Beijing documents.

A feminist from Nicaragua said in dismay: "Almost no state observes the conventions it has signed. Nothing binds them to enforce these conventions. So I wonder: what use have we of agendas nobody adheres to!" In some countries, these recommendations are enforced, al­though it is the name that is changed rather than the contents. For instance, governmental documents say "reproduc­tive health" instead of "family planning" while in fact they continue to do what they did before. In some countries these agendas are enforced more by donor agencies than by governments. Women of Latin America, especially Argen­tineans, Chileans and Brazilians have addressed numerous criticisms to such agencies. Celia, from Argentina warned that many NGOs are "in the function of governmental and party policies." These are the so-called governmental non­governmental organizations (the Red Cross, governmental humanitarian organizations, etc.). There are also the NGOs funded by the state and its ideologies. Susana, from Buenos Aires said that "there are many women's groups working for the needs of the state rather than women's needs."

Women agreed that CHANGES IN POLICY ARE ON THE LEVEL OF RHETORIC. Lilian, from Uruguay, said: All who start talking from the standpoint of gender use legal demagogy, but all that is sheer rhetoric—they want to take political character away from women's groups." In Serbia, governmen­tal women-politicians in the fashion of Buba Morina are a far cry even from rhetoric. They are "commissioners" for family, for there is not even an aware­ness that women are anything other than wives and mothers.

In many countries, the number of women politicians is on the rise exactly at the point when financial means are reduced and social benefits cut—probably as a part of hurling the hot potato into women's hands. For instance, the Social-Democratic government in Bolivia has a fair number of women. "Alliances with women in Parliament and government should be established; established but by no means should one fall into the traps of their rhetoric and empty promises, but rather persevere in our demands." (Mer­cedes, from Bolivia)

Many women directed severe criticism against UN policy. Especially alarming is the fact that the UN agencies have not ceased cooperating with religious leaders (mulas). Instead of backing the demands of autonomous women's groups for health, reproductive and sexual rights, the agencies offer support to the most conservative religious leaders. "For March 8th, UNIFEM (the United Nations Development Fund for Women) invited religious leaders to speak on TV about family planning. I do not know whether this was a deliberate plan by the UN, but I know that it was not for the benefit of women, and I know that the UN deliberately uses the patriarchal power of clan leaders and so-called tradition in order to control women" (A Senegalese woman). Women's groups, especially in cir­cumstances of grave economic crisis and wars, engage in offering services which actually should be done by the state. This is the way in which many regimes, via the free and "invisible" labor of women have bought social peace in their states. That is currently going on in all countries in former Yugoslavia.

The Gloria Declaration adopted many suggestions and recommenda­tions. I shall list some of them: work with law enforcement; constant criticism and opposition to international and na­tional policies harmful to women's health; pressure on governments and donor organizations to fulfill the commit­ments they have undertaken in the domain of reproductive and sexual rights; control and demand of estab­lishment of control mechanisms over ministries and commissions in charge of women’s issues; initiation of strategies for control over the private sector and a demand for its increased liability in the domain of women's health; demand to reducing military expenditures and re channeling of those funds into health and education; endeavors to separation of the state from the church and other religious influence, etc.

"We not only denounce injustice, we also demand the right to sexual pleasure"

Women oppose the patriarchy on all points of the planet, they establish con­tinental alliances, build up new strategies, and do joint research. Rosalind Petschessky (Hunter College, New York) presented results of one of the most in­teresting pieces of research. She is the coordinator of a project of the International Reproductive Rights Research Group (IRRRAG — an international re­search network for reproductive rights). The research took four years and was car­ried out in seven countries (Brazil, Egypt, Malaysia, Mexico, Nigeria, Philip­pines, the US). The research deals with women's self-determination. To clarify: women's self-determination has nothing to do with the self-determination of the nation, i.e. of the "nations' fathers." It is in most cases diametrically opposed to it. The "nations' fathers" usually opt for the new state and the so-called collective rights, so that women lose even the rights they had obtained earlier. In feminist vocabulary, women's self-deter­mination is women's autonomy over their own bodies, reproductive capability, maternity, and the use of their bodies for medical purposes. Martha Lamas from Columbia says: "This implies putting a full stop to repression and enjoying sexuality without feeling guilty."

The IRRRAG research is based on talks with women in cities, in rural areas, of all ages, and of different ethnic and religious backgrounds. Talks with them concerned their attitude to child-birth, marriage, sexual intercourse, strategies of resistance, and the "negotiation" they use in exerting their rights with the sur­roundings, men, and health workers.

The conclusion was that it is essen­tial to link reproductive and sexual rights to development (the status of women in the global economy), and that it is essential to link these rights to pleasure. Namely, we should not just denounce injustice and abuses, but fight for the right to sexual pleasure and to information on health and sexuality, says Rosalind Petchesky.

The research showed that there are two models women use in exerting their sexual rights: adjustment and submission to the traditional norms, or resis­tance, as "women are struggling everywhere. These are not only feminists, but also women in the vil­lages."

What do these women's strategies demonstrate? They demonstrate that women everywhere resort to control of their reproductive capability, be it in the traditional or in the modern way. In all countries, except in the US and Malaysia, women use many more methods to stop child-birth rather than to make the in­terim periods between pregnancies longer. They do this in various ways: they conceal contraceptive pills from their partners, avoid sexual inter­course... In all seven countries, women believe that they have the responsibility to control fertility and justify this with ethical reasons. "I take care of the children, I make decisions on that, I suf­fer for them" (A Chinese peasant woman). Women altogether rejected the idea of the church deciding on child­birth because "My decision is not offen­sive to the trust in God; it is not the church that feeds my children, it does not give a damn that I suffer" (A Mexican peasant woman). This is a con­cept of "practical ethics." Women have learned that women's organizations (non-governmental, autonomous) help them exert their rights a great deal, but that health care systems in all seven countries do not or do so inadequately. Women in Nigeria use traditional methods of delivery and abortion, the same in Egypt, Malaysia, the Philip­pines. Women feel uncomfortable in state and even in private health centers. Health care staff members are usually impolite to women. Women demand the right for sexuality: "Sexual rights are not a bourgeois nor a feminist idea," says a peasant woman from north-east Brazil.

There, activists of the feminist group SOS Corpo have been working in villages for years. Sonja Corea, from the abovementioned group, says: "Our agen­da is social justice, sexual justice, and erotic justice."

IRRRAG research has shown that regardless of all difficulties (economic, social...) women have said THREE NO'S: NO to unwanted preg­nancy; NO to domestic violence and abuse of women for medical purposes, and NO to unwanted sexual intercourse.

The activists who took part in the IR­RRAG research were often exposed to condemnations and threats. Hajira from Nigeria says: "Uleme constantly send us threatening letters. We allegedly pro­pagate promiscuity because we talk to women about sexuality."

Women are struggling even in the circumstances of being confined to the home. Not even then do they accept the fate of passive victims. They act subversively even in the grimmest regimes. Women in today's Iran demand the right to reproductive health. Homa, a re­searcher (living in Canada, refugee from Iran since Komeini took power there) says that women in Iran can no longer endure the amount of violence, cruelty and totalitarianism. As the "choice" is considerably limited, they look for loopholes in the system. They say: "Fine, we are living in sexual segregation. But then give us health centers where only women shall work. The sexual segrega­tion grants us this right." They change their language—they are trying to use it subversively to their own benefit. That is only the beginning. And we know that they remember their ancestors in their own countries. They know that women in Magreb now, like in the past, have rejected SBER (the virtue of patience and resignation). An activist from Al­giers confirms this today: Zehra told us in Rio that they "defy the fundamen­talists: four of friends get into a car and head for some fun. I have not lost hope," she repeats constantly.

Women are linked in networks, al­liances, and coalitions on national and inter­national levels. The whole planet is net­worked in threads of women's action, women's solidarity.

To list some of them in the field of reproductive rights and health: the IR­RRAG, the ISIS (Latin American and Cyprus Women's Health Network); Catholics for Free Choice; FINRAGE (Feminist International Network for Resistance to Reproductive Rights and Genetic Engineering); the Amsterdam-based Women's global network for Reproductive Rights; the IWHC (Inter­national Women's Health Coalition); WEMOS and LAACAP (Women's Inter­national Network Against Abuse of the Pharmaceutical Industry); WLUML (Women Living Under Muslim Law); the EFI (International Women's Resistance), etc.

Canadian feminists proposed that the next WOMEN AND HEALTH con­ference, in the year 2000, be held in their country. The suggestion was adopted with a vote.

Stasa Zajovic

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