Dossier, Volume 13 #5, Development: Small Steps

Visible Women and Frontline Workers

In 1994 the International Conference on Population and Development--Cairo reviewed progress and priorities to strengthen the developmental context of programming in reproductive health. In 1995 the Beijing Conference has highlighted the theme of the status of women. It is therefore timely to share some personal portraits of women, health and development issues from several Third World countries where I work, and some images of key players, particularly the church, in this evolving struggle.

BANGLADESH 1995. A woman here has just committed suicide after a rape. She was convicted of adultery by the Islamic leaders in her area, as it requires two women to testify against a man, since sharia law holds that a woman's word is worth only half of a man's and the man did not admit to the rape.

Since my first visit here, in 1990, the percentage of women with some education has risen from 39 to 42 per cent, and those with secondary education from 12 to 15 per cent. The number of current users of contraception has more than doubled over the past ten years. This has contributed to a substantial decrease in infant mortality by limiting higher-risk births such as those "too frequent, too early or too late"--which statistically have a lower chance of survival. Maternal mortality is also falling, in part as a result of contraceptive use as well as safer delivery techniques practised by traditional birth attendants. Visibly more women are able to use health services.

On this 1995 trip, there is a gherao or demonstration of female university students protesting discriminatory rules prescribing that unlike their male counterparts, they must be in their rooms by sunset. Each time I come to Bangladesh, I see more women able to move about without too much curiosity or difficulty. The first time I came it took me a while to see what was "wrong with this picture"--it was a world seemingly inhabited only by men.

This trip we pass a huge field, where a swaying line of women in beautiful multicoloured saris walk along single-file, turning over "pulses" (legume seeds) to dry in the sun. Ten years ago each woman would do this work alone in her courtyard, invisible to the outside world.

Within Bangladesh women's health advocacy groups have become increasingly strong. Bangladesh government leaders have with difficulty shifted from a narrow population or fertility-control approach to address reproductive health and women's rights more broadly. However, within the country, conservative Islam is moving against this tide.

Of concern to the Roman Catholic community, the Vatican sided with fundamentalist Islam against the Cairo conference's support for artifical contraception, safe motherhood and use of condoms for HIV prevention. Groups such as Catholics for a Free Choice and Catholics Speak Out helped to move the Vatican to a compromise position, and it ultimately joined the international consensus on the 113-page Program of Action from Cairo.

At the same time, I have taken comfort in the numbers of senior health officials, including practising Roman Catholics and Muslims, who have used their leadership positions at UN agencies such as World Health Organization and the United Nations Population Fund to address the conservative forces of both religions.

NEPAL 1993. This Hindu country has one of the highest maternal mortality rates in the world, and use of contraception is minimal. One image remains in my mind: as our health team walks along a winding mountain path, we hear chanting and drumming ahead of us. As we keep to the side of the narrow path, a procession of men appears, carrying on a bier the draped, red-cloth-covered body of a fully pregnant woman who has died in labour at term. We are struck with this vivid reminder that in this part of rural Nepal, a woman has a one in twelve lifetime risk of dying in labour.

These words from the husband of a woman in obstructed labour who needed transport to hospital for a Caesarean section: "She cannot go. Her duty is to stay here and feed the water buffalo. After her work is done she can stay in the barn to deliver her own child. If she dies it is fated." And a young malnourished mother of two girls, forced by her husband (from an arranged marriage to pay off a family debt) to conceive again so he could hope for a son, resorted to an unsafe abortion once the pregnancy was discovered. She was close to death when we saw her in a small hospital, brought there by her parents.

What should be the role of organized churches such as Roman Catholicism in this complex debate? Have they become so distant from gender and development issues, so deeply rooted in a conservative ethos and identified with the patriarchal societal view, that they can't see the need for fundamental changes? If the Vatican is the only face of the church I feel deep sorrow for my faith. However, I take some hope from the frontline church that I encounter so often in my work, a reminder that the church is not monolithic, that we shouldn't confuse the Vatican with the church, that perhaps it is the laity that leads.

GHANA 1994. An impressive Roman Catholic nun-physician is running a small project to provide home-based care for women with AIDS. These women have been sent by their families as commercial sex workers to other West African countries, and they have now returned home with AIDS. My friend, the nun, tells me, "The pope isn't a frontline worker." There is no doubt in her mind that there is a role for condoms as a strategy to prevent HIV transmission, as one component of care and counselling for AIDS patients and their families, while we address the longer-term cultural and socioeconomic issues of families that "sell" daughters into prostitution.

In another region in a remote area of the country, the Roman Catholic Church has set up schools for girls, conducted female literacy classes, and organized food banks to buy from farmers at harvest at a good price and sell the food back cheaply in the "lean season," when so many children die of malnutrition. One of the best hospitals in the region is Roman Catholic, and while it is understated, contraceptives are supplied. The diocese has also provided many of the wells for safe water, and has the best immunization coverage in its primary health care area.

As the Brazilian lay theologian with the World Council of Churches, Marilia Schuller, commented, the Program of Action from Cairo makes "recommendations concerning human rights, environmental sustainability, overconsumption by the wealthy, gender equity, and women's empowerment....Recognition that these factors are interrelated opens a critical door toward the creation of a more just, egalitarian, and humane society."

Dr. Gretchen Roedde is a physician living in Haileybury, Ontario. A specialist in primary health care planning and training, she travels regularly to the Third World on assignment for a variety of international organizations.