Taking Stock of Women’s Health

Women have battled and continue to battle for equality. Apart from societal, educational, and occupational opportunities, women also deserve the right to vital, quality, and specialized healthcare. Even though efforts to bring women’s health to the forefront have led to many advances in the field, the picture is by no means perfect – especially for women in low and middle-income countries (LMICs). A closer look at women’s health – past, present, and future – aims to shed light on unique challenges, celebrate progress, and hopefully inspire action. Understanding the gender health gap Women tend to outlive men. This is the case in all countries around the world, with an average of 4-8 years difference in life expectancy between the two sexes (1). But to what do we owe this difference in lifespan? This question has troubled researchers for many years, and though we still don’t know everything there is to know, it’s clear that social, environmental, behavioral, as well as biological (e.g. genetic or hormonal) differences are major influencers of health risk, health-seeking behavior, health outcomes, and responses from health systems (2, 3). A difference in lifespan can therefore be attributed to, for example, advances in obstetrics or maternal healthcare or poorer health-seeking behavior in men. Simply put, the more scientists and medical professionals understand the unique challenges women face, the better chance there is of innovating health solutions and tailoring healthcare to women’s specific needs. Apart from requiring specialized healthcare for conditions related to sexual and reproductive health (4), women also have a greater predisposition to several non-communicable diseases, including heart disease, some cancers, and depression (5, 6). And may experience symptoms or health conditions differently (7, 8) or respond differently to treatments (9, 10). It’s also important to emphasize the struggle some women face with gaining access to healthcare because of deeply rooted societal issues, namely sexual- and gender-based violence and poverty – issues that disproportionately affect women living in LMICs and play an important role in a woman’s physical, mental, and emotional wellbeing (2). The most common symptoms for a heart attack may differ between men and women. To put women in a position where equal opportunity to the best health outcomes is possible, health innovations, in addition to a better understanding of women’s health, are imperative. In this regard, we actually have a lot to show for the last 100 years. Notably, the development of medicinal products for maternal and sexual health – think mammograms, pap smears, and birth control – as well as improved inclusivity in medical research and coverage of healthcare costs (at least in some countries) (11). Even so, lots more can be done to close the gender health gap, and people and organizations worldwide have risen to the challenge! Closing the gender health gap Let’s start with the Danish-born founder of Clue, Ida Tin, who came up with an app that can track menstrual periods and ovulation, allowing women to easily collect information about their menstrual cycle and health. Information central to understanding and treating several women’s health conditions, including polycystic ovary syndrome and endometriosis. Others have focused their efforts on aiding the prevention, diagnosis, and treatment of cervical (12) as well as breast (13) cancer – two of the most prevalent cancers affecting women worldwide (14). In 2018, Kenya became the first country to remove tampon tax and distribute free sanitary pads in schools. Another leader in the fight against period poverty is Scotland. Becoming the first country to provide free tampons and sanitary pads to anyone who needs them in 2020 (15). Thankfully, many other countries, including Zambia and Botswana, are also recognizing the importance of supporting women’s health by lifting some of the financial burden and stigma associated with menstruation, giving women and girls the opportunity to experience life more freely, use their money for other basic needs, and even attend school (15). WA-WA Kenya supports women making reusable menstrual pads in Lake Victoria, Kenya (Photo by WA WA Kenya) Read more about period poverty and WA-WA Kenya here. On to visual aids in healthcare. Elsevier, a global leader in research publishing and information analytics, announced the launch of their 3D full female model – the most advanced model of its kind – earlier this year. The model provides an incredible amount of detail specific to female anatomy, giving educators the ability to present male and female anatomies equally, allowing future medical professionals to better understand and address gender disparities in medicine (16). On a similar note, Nigerian medical illustrator and aspiring neurosurgeon Chidiebere Ibe’s illustrations have taken the internet by storm. In particular, his depiction of a pregnant Black woman with a baby in utero had many (including myself) realizing it was the first time they had seen a photo of a Black woman shown in this way (17). In a statement made on his GoFundMe page, Chidiebere emphasized the importance of adequate representation in medicine, adding that “…a lack of diversity has important implications for medical trainees and their future patients because many conditions and signs look different based on a patient’s skin color…” (18). On his Instagram page (@ebereillustrate), you can find many more medical illustrations of Black women, including representations of the female lymphatic system in the breast and symptoms of ovarian cancer. Historically, women have been marginalized in medical research. Left out of clinical trials, critical to testing the safety and efficacy of new medicinal products. Though women’s participation in clinical trials has been on the rise since the early 1990s, it’s hard to ignore the effect their exclusion from this critical process in medicines development has had on women’s health. This article from Well and Good provides a great overview of this issue. For decades expecting and breastfeeding mothers have been considered vulnerable patient groups and have, as such, been excluded from the medicine-testing process. This has resulted in a lack of safety information for many medicines prescribed during pregnancy and breastfeeding, making treatment choices even tougher for women. To highlight an innovative project supporting

Reproductive and Sexual Health Through Sport for Development

Reproductive and sexual health rights include social, political, and economic inequalities that affect women’s and girls’ access to reproductive and sexual healthcare services and education. Core components of reproductive justice include equal access to safe abortion, affordable contraceptives, and comprehensive sex education, as well as freedom from sexual and gender-based violence (GBV). When we talk about sexual health, we often only refer to reproductive health. Yet, sexual health is more than reproduction and contraception. We need not forget about pleasure, bodily autonomy, and confidence, which are core parts of healthy sexuality. Women’s and girls’ bodies have long been under scrutiny. Bodily autonomy is a universal right, yet more than half the women in Sub-Saharan African countries do not have the right to decide whether to have sex with their partners, use contraception or seek healthcare. “When a woman’s power to control her own body is linked to how much control she has in other spheres of her life, just 48 percent of women and girls aged 15-49 years in 36 Sub-Saharan African countries are able to take their own decisions regarding their body and health.” – (UNFPA 2021) Lack of bodily control, thus, affects other areas of life as well. Cultural barriers, taboos, and gender inequality hinder reproductive rights and justice. However, opening up discussions about sex and sexuality is a crucial entry to advancing gender equality. Victory after a football match in Nairobi – Photo by MUKURU ANGAZA Sports address sexual and reproductive health and rights in Eastern Africa Sexual and reproductive health and rights (SRHR) is a key area of sport for development programs in tackling GBV in the Global South. It includes sexual and reproductive education and training by using sport and movement as tools to provide a safe space to address sensitive and taboo issues, such as consent and contraception. Holding a discussion about sexual and reproductive health through sport and movement helps increase girls’ agency, leadership, and life skills to apply in other spheres of life. Sports provide a community and place to share experiences with others, but it also teaches about open communication with teammates and respect for one’s own and other’s bodies and boundaries. Sports also induce body and self-awareness, which translates to a collective level of bodily awareness and respect. By investing in girls’ confidence, leadership skills, and autonomy through sports and SRHR, we contribute to gender equality and in turn to sustainable development. Certain sports, such as football, are still male-dominated, and including girls helps to disrupt gender norms, take over public spaces, and advance gender equality. A dance class in Nairobi – Photo by TAA Art Organisation, member of Lightup Impact Community Social organizations in the Lightup Impact network utilize sports in their development programs in Kenya. Kerio Rights Organization offers volleyball and cycling to raise awareness among youth on sexual and reproductive health and rights. TAA Art Organisation engages in dance and movement to empower youth, and Mukuru Angaza Film Academy uses soccer to facilitate mentorship programs to instill hope and discipline and tap into the talents of their communities. Cycling project in Kilifi – Photo by Wheels of Hope, Member of Lightup Impact Community Wheels of Hope leverages the power of cycling to support marginalized teenage mothers and youth: “We teach marginalized teenage girls and boys about reproductive and sexual health matters in sessions we have in some villages. We target girls mainly as they are the biggest victims of teen pregnancies due to lack of knowledge on sexual matters.” – Collins Wekesa, director of Wheels of Hope. Soccer practice – Photo by Nivishe Foundation Nivishe Foundation addresses GBV and mental health through sports programs: “We conduct weekly safe spaces offering psychosocial support for young mothers and teenage mothers which also serves as safe spaces for victims of GBV. Throughout our program, we use sports for passing more information on Mental Health, SRHR, and GBV.”  – Amisa Rashid Ahmed, founder of the Nivishe Foundation. Sport for development has the means to engage both boys and girls by bringing the community together to learn new skills and reduce inequalities. Learn more on how to engage in sports with reproductive and sexual health and GBV programming through our resources. Previous Next Author: Eeva Mäkinen

Period Poverty in Kenya: Menstrual Health is Fundamental in Building Women’s Agency

Menstrual health, gender equality, and poverty are strongly connected. Inadequate menstrual hygiene affects populations in the Global South, and women living in poverty are especially vulnerable.   Poverty affects 65% of Kenyan women who can’t afford basic sanitary pads. Lack of water sanitation services increases the risk of reproductive infections. Globally, 2.3 billion people lack basic sanitation services, such as handwashing facilities with water and soap at home. This poverty has been referred to as “period poverty”; when girls lack the resources to meet basic menstruation needs.    Period poverty means inadequate sanitary products, menstrual hygiene education, toilet facilities, hand washing facilities, and, or waste management. This results in women and girls often having to rely on men for sanitary products through transactional sex, which in turn strengthens unequal gender relations and erodes their sense of agency.    Tampons and pads are not a luxury. The cultural taboo attached to menstruation,  shortage of resources, and menstrual education prevents women from going to school and public spaces. These can lead to serious health problems and shame that disable girls from having control over their lives and bodies. Femcorner Industries produces reusable menstrual products in Migori County, Kenya. Image by Femcorner Industries. Menstruation is stigmatized Menstruation is a normal part of life for healthy women and girls. Yet, menstruation is stigmatized all over the world and considered something dirty and shameful to hide from. These social and cultural misconceptions are underlined by the sexualization of girls’ transition into women, as “becoming of age”.  Period shame, like all shame, causes negative effects on girls’ sense of self. It results in denying a core, natural part of themselves. This powerlessness over their body and life can distort girls’ outlook on how they believe they can manage life’s challenges independently. Ways forward? Girls should be encouraged to celebrate their bodies and carry them with confidence. In order to normalize menstruation, it is necessary to make it visible rather than something to hide. This is the starting point for collective cultural change; by making menstruation normal and safe, the possibility for girls and their communities to start thinking differently is created.  On an institutional level, sufficient menstrual health management is fundamental to addressing period shame and poverty, sexual issues, early childhood marriages, female genital mutilation, and reproductive health topics, such as reproductive rights, transactional sex, and teenage pregnancy prevention. Menstrual equity policy must be enforced to make menstrual products, sanitation, and hygiene easily accessible. A reusable menstrual pad is an affordable and ecological option. Local production also supports women’s entrepreneurship. Image by Femcorner Industries. Lightup Impact builds a network to support menstrual health Lightup Impact member organizations work with women’s health in Kenya. Our network of founders and experts is driven by a passion to fight inequalities in health and gender. Many of our member organizations advocate menstrual health, raise period awareness, support girls’ menstrual education, and provide sanitary pads. Learn more about the work with menstrual health in the Lightup Impact network from the resources below. WA-WA Kenya supports women making reusable menstrual pads in Lake Victoria, Kenya. Photo by WA WA Kenya. Organizations in the Lightup network working with menstrual health in Kenya: Peperusha BINTI Positive Young Women Voices Femcorner Industries WA-WA Kenya Together Women Can  Nareto Latia Indigenous people Mukuru Aganza Film Academy VIPEP Golden Girls Foundations   Additional resources: Menstrual Hygiene Management Strategy 2019-2024, Ministry of Health  Menstrual Hygiene, Unicef  Menstrual Health in Kenya, Country Landscape Analysis Previous Next

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