International Women's Day: 10 key issues
The Western Pacific Region has seen considerable improvements in women’s health, including longer life expectancy, declines in the number of children per woman, an increase in maternal health service coverage and a decrease in maternal mortality. These gains, however, have been uneven across and within countries. Despite the overall progress achieved, a significant unfinished agenda remains, with millions of women in the Region facing a variety of avoidable health challenges throughout their lives.
Women’s health is determined by biological characteristics and a range of social factors. These factors constrain their ability to protect their health or obtain timely and appropriate health care. Although girls are biologically hardier than boys, societal discrimination can disadvantage them even before birth, through practices like sex-selective abortion. Some households favour boys over girls when investing in nutrition, education and health, especially when resources are scarce. Women typically have lower education levels and less political and economic empowerment than men, and shoulder the dual burden of productive and reproductive work.
Within countries, women’s health differs depending on socioeconomic determinants such as income, education, rural versus urban residence, ethnicity, and age. In Viet Nam, for example, women from the richest households are three times more likely to give birth in the presence of a skilled attendant than those from the poorest ones. In the Philippines, this difference is more than four times.
This fact sheet highlights 10 key issues that are important for women’s health over the life-course in the Western Pacific Region.
- Women’s reproductive role, entailing pregnancy and childbirth, carries health risks and accounts for a large share of women’s morbidity and mortality. Although cost-effective interventions are available, the maternal mortality ratio remains unacceptably high, with more than 200 maternal deaths per 100 000 live births in three countries of the Region. Most countries are making good progress and the overall maternal mortality has declined from 130 to 51 maternal deaths per 100 000 live births over the period 1990 to 2008.
- Undernutrition is an important contributor to child mortality in the Region. A high proportion of children under five are stunted and underweight. Malnutrition in girls also leads to suboptimal growth and development that may hamper their reproductive and productive roles in the future. In the Region, at least seven countries have low birth weight rates of more than 10%, which is a sign of maternal malnutrition. The prevalence of anaemia, which reduces resistance to infection, learning and school performance in children and productivity in adults, is 30.7% in pregnant women, 21.5% in other women and 23.1% in preschool children.
- Early marriage and unintended adolescent pregnancy are major issues in some countries of the Region. Contraceptive use has increased during the past decade. However, at least three countries have a contraceptive prevalence rate of less than 40% and knowledge of contraception is particularly low in rural and remote areas. Disabilities associated with early childbearing—e.g. obstetric fistula and uterine prolapse—significantly contribute to women’s burden of disease.
- Besides being biologically more vulnerable than young men to sexually transmitted infections, including HIV/AIDS, young women may not be able to negotiate safe sex and may face unwanted pregnancy and unsafe abortion. Prevalence of HIV infections among women in the Region is increasing, while only 32% of them have access to treatment.
- Intentional injuries are among the 10 leading contributors to the total disease burden in the Region for women but not for men, confirming that gender-based violence against women—which can result in mental ill-health and other chronic health problems—remains a public health challenge.
- Women’s exposure to lifestyle-related risk factors has been increasing. Cardiovascular diseases are the second leading contributor to the disease burden for women in the Region. Of cancers in women, breast cancer is the most frequent, with an estimated 300 000 new cases per year in the Region. Cervical cancer, with an estimated 100 000 new cases, is also an important concern.
- Mental ill-health is a significant health issue for women, with neuropsychiatric disorders ranking highest among the 10 leading contributors to the total disease burden for women in the Region. Women are much more likely than men to suffer from depression, with depressive disorders accounting for close to 42% of the disability from neuropsychiatric disorders among women, and only 29.3% among men.
- Tobacco use among women in the Region is relatively low compared to men (5% versus 57%), but it is likely to increase as women are increasingly targeted by aggressive tobacco marketing. Despite their own low rates of tobacco use, women are exposed to second-hand smoke, leading to increased rates of lung cancer and risk of coronary heart disease. Surveys show that over 50% of female students (13-15 years) in the Region were exposed to second-hand smoke in homes, and over 64% in public places.
- Life expectancy is generally higher for women than men, globally and in the Region, and has been improving steadily, with lower income countries seeing more marked improvements. These gains need to be consolidated to ensure good health and quality of life during old age. The Region is home to one third of the world’s persons aged 65 years and over, more than half of whom are women. Responsive health systems equipped for chronic care, community-based services and social and economic support can help in meeting the health needs of elderly women, but these are currently lacking in most developing countries of the Region.
- Despite their greater health needs, women—especially those from poorer or more marginalized households—face multiple barriers to access to services, including unaffordable out-of-pocket payments, long distances, lack of control over household income and means of transport, fragmented services, long waiting times, lack of privacy or confidentiality and biased or unsympathetic attitudes of providers. Health information systems usually do not collect and analyse information that is disaggregated by sex or other relevant social stratifiers, making it difficult for policies to be appropriately tailored. Health systems need to be made more responsive to women’s health needs.