Every woman and every child counts

  

Eliminating health inequities

Every woman and every child counts

  In partnership with voices the collective determination of the International Federation of Red Cross and Red Crescent

  Strategy 2020 Societies (IFRC) to move forward in tackling the major challenges that confront humanity in the next decade.

  Informed by the needs and vulnerabilities of the diverse communities with whom we work, as well as the basic rights and freedoms to which all are entitled, this strategy seeks to benefit all who look to Red Cross Red Crescent to help to build a more humane, dignified and peaceful world. Over the next ten years, the collective focus of the IFRC will be on achieving the following strategic aims:

  1. Save lives, protect livelihoods, and strengthen recovery from disasters and crises

  2. Enable healthy and safe living

  3. Promote social inclusion and a culture of non-violence and peace Acknowledgements

The global IFRC health team responsible for this report would like to thank Dr Carole Presern and her team at the

Partnership for Maternal, Newborn and Child Health for providing careful reviews of the text. We also thank all National

Societies and colleagues from the Movement who provided valuable inputs and case studies. We would like to thank our

colleagues from Legal and Humanitarian values and Principle departments for providing insights and contributed to

the different angles expressed in this report. Our special thanks also go to our former intern Rikki Stern for collecting,

compiling and analysing the data.

  © International Federation of Red Cross and Red Crescent Societies, Geneva, 2011.

Copies of all or part of this study may be made for non-commercial use, providing the source is acknowledged. The IFRC would appreciate receiving

details of its use. Requests for commercial reproduction should be dir

  

The opinions and recommendations expressed in this study do not necessarily represent the official policy of the IFRC or of individual National Red Cross or

Red Crescent Societies. The designations and maps used do not imply the expression of any opinion on the part of the International Federation or National

Societies concerning the legal status of a territory or of its authorities. All photos used in this study are copyright of the IFRC unless otherwise indicated.

P.O. Box 372 CH-1211 Geneva 19 Switzerland Telephone: +41 22 730 4222 Telefax: +41 22 733 0395 E-mail: secretariat@ifrc.org Web site: http://www.ifrc.org Cover photo: Olav A. Saltbones/IFRC

  Foreword

  25 Poverty amid current universal trends exacerbates health inequities

  39 ^{International Federation of Red Cross and Red Crescent Societies} Eliminating health inequities Every woman and every child counts

  37 References

  35 The way forward

  34 Obstacles and opportunities

  32 Promote gender equality, empower women and girls, and enlist the support of men and boys

  31 Make reliable, accurate information available and encourage health-seeking behaviours

  31 Provide prevention, treatment, care and support when and where needed

  31 A holistic approach to health equity informed by human rights

  29 Chapter 4. The Red Cross Red Crescent response

  26 Public policies committed to equity present opportunities

  25 Public health systems are both a cause and a solution to health inequities

  4 Executive summary

  23 Chapter 3. The scale of the problem: the dimensions of health inequities

  21 Human rights is the framework to eliminate health inequities

  21 Progress in reaching MDGs disguises burdens

  19 Chapter 2. The time to act is now

  17 Double the risk and double the neglect: HIV and women who use drugs

  17 Social inequities compound biological differences, exacerbating vulnerabilities

  17 The unique needs of women and children

  11 Chapter 1. Focusing on women and children is a good place to start

  7 Introduction

  5 IFRC recommendations

  Table of contents International Federation of Red Cross and Red Crescent Societies Foreword

  Foreword Health inequities are affecting the life and future of all vulnerable groups of society across the world, creating systems of social injustice. By dismantling the barriers to health services and resources, we reduce the burden of disease that affects the future of children, impoverishes entire families and passes social injustice on through the generations. In this report, we focus on women and children not only because many of them suffer undue hardship, but also because women are instrumental in improving the health of their children, families and communities. This report provides evidence that health inequities can and need to be addressed through a holistic approach. Health inequities, and the resulting social injustice are closely linked with other issues such as poverty, gender inequality and human rights violations which in turn, have an impact on education, transport, health, agriculture, and overall well-being. Our interventions should therefore be multi-sectoral, going beyond health to address social and economic determinants – malnutrition, alcohol abuse, poor housing, indoor air pollution and poverty, among others. We count on our global membership of national Red Cross Red Crescent societies and you, the reader, to use this advocacy report to bring about tangible change for the years ahead. Together, we can rid the world of social injustice and contribute positively to promote a culture of respect, non-violence and peace.

  Matthias Schmale Undersecretary General, Program and services division, IFRC Stefan Seebacher Head of health department, IFRC International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  Executive summary Health inequities

  Health inequities are “unfair and avoidable differences in health status seen within and between countries”. Health inequities are systematic: they usually affect particular groups of people, and they occur across the social gradient. The most vulnerable people have the least access, not only to health services, but also to the resources that contribute to good health.

  Eliminating health inequities is an ethical imperative

  Health is a resource that enables people to achieve their fullest potential. It is unjust for this potential to be determined by the place where a person is born, or the racial or ethnic group to which a person belongs. Fortunately, eliminating health inequities is also economically sound. Simple and cost- effective measures, when scaled up, lead to significantly better health for all. Failing to eliminate health inequities leaves the most vulnerable at greatest risk. Without prioritizing health inequities, UNICEF warns: “We could find ourselves in 2015 facing the tough challenges of reaching the most deprived children of all – but with resources depleted, political will exhausted and a public that has moved on.”

  Focusing on women and children Women and children are the focus of our attention for three reasons.

  1. Women are more likely to face health inequities because women’s biological make-up demands more care. Pregnancy and childbirth are life events that expose women to greater risks.

  2. Women are the gateway to improving the health of an entire popula- tion, starting with their children and members of their households.

  3. The burden of caring for sick children and the elderly mainly falls on mothers and other female carers. This leads to time off work, loss of income and further impoverishment of families. Poverty, in turn, cuts off access to the resources that give rise to good health, it precludes treatment for poor health, and perpetuates ill-health among women and children. A vicious downward spiral begins that is carried forward to the next generation.

  Social inequalities compound biological differences

  Wider power imbalances between men and women can prevent women from exer- cising control over their own health or the health of their children. Eliminating health inequities requires a holistic approach whereby the health impacts of all government policies and societal practices are recognized and addressed.

  International Federation of Red Cross and Red Crescent Societies Executive summary

  Human rights is the framework to eliminate health inequities

  Human rights reflect existing obligations and provide the basis for national laws and regulations. Human rights related to health inequities are the rights to life, health, food and nutrition, water and education. Furthermore, the standards articulated in human rights can guide all stakeholders in dismantling barriers to health. Health inequities are often the result of human rights violations, and can be dealt with as such.

  Public health systems: a cause and a solution to health inequities

  Whilst health systems promote health, they can also lead to health inequi- ties. For example, investment in tertiary care centres, such as high-tech hos- pitals and specialized care centres, disproportionately benefit the rich at the expense of the poor. Available, accessible, acceptable and quality care should be within the reach of all people. Availability refers to putting health facilities, services and goods in place. Accessibility means healthcare resources are non-discriminatory and enable all people – regardless of geography, finances or access to information – to take advantage of them.

  Poverty exacerbates health inequities

  Poverty – coupled with universal trends such as urbanization, migration, ageing, unhealthy lifestyles and an increase in non-communicable dis- eases – plays a significant role in creating health inequities, particularly where significant gaps exist in accessing resources such as adequate food and nutrition, housing, water and sanitation.

  Public policies and societal traditions present opportunities to eliminate health inequities

  There are laws and public policies that lead to health inequities and they need to be repealed; these include laws that impede access to maternal and peri- natal health services, regulations that require spousal permission to access reproductive health services or those that limit access to life-saving treatment for pregnancy-related complications. Traditional yet harmful practices, such as female genital mutilation, can also be stopped by engaging traditional and religious leaders in their communities.

  A CALL TO ACTION The IFRC advocates on behalf of the world’s most vulnerable women and children, those who have least access to the resources and conditions that will give rise to good health. The IFRC asks policy- makers, governments and donors to align resources with needs, and to work with stakeholders, multi-lateral organizations and civil society organizations towards bridging the health divide so that all people – including the most vulnerable women and children – can achieve their fullest potential.

  International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  IFRC recommendations Governments: take the lead in prioritizing equity n Ensure universal access

  Governments should ensure universal access to evidence-based public health interventions for all and allocate health resources according to need.

  n Enable informed decision-making

  Governments should make accurate health information available to all so that everyone, particularly the most vulnerable, can make informed deci- sions about their health.

  n Take a holistic approach

  Governments should promote equality, solidarity, participation, non-discrim- ination and non-violence in all aspects of society, not just health, because tackling health inequities means tackling inequities in society in general.

  n Harness the power of a volunteer network

  Governments should make the most of Red Cross Red Crescent volunteers, who form part of the world’s largest humanitarian network, to eliminate health inequities. Volunteers are uniquely capable of reaching the most marginalized groups. Some volunteers are themselves members of these and, therefore, are an entry point for reaching those whom the formal health sector fails to reach.

  National Societies: scale up efforts n Reach the unreached

  Through their extensive volunteer networks, National Societies need to scale up their activities to bring prevention, treatment, care and support to those who are left out of the formal health system – the women and children who have the least access to appropriate health services. National Societies should expand their reach by encouraging health-seeking behaviours, as well as fostering social inclusion and peace.

  n Encourage prioritization and informed decision-making

  National Societies should use their status as auxiliaries to government to engage decision-makers to prioritize health equity and equity in all aspects of society and to hold authorities accountable.

  n Develop powerful partnerships

  In order to eliminate health inequities as quickly and effectively as possible, National Societies should engage in meaningful dialogue with key stakehold- ers and form strategic partnerships to increase the effectiveness of advocacy.

  International Federation of Red Cross and Red Crescent Societies

  IFRC recommendations Donors: create an enabling environment n

  Maintain and increase funding levels

  Given the current global economic crisis, any cuts in healthcare funding for mother-and-child programmes will have a devastating effect on the target groups – many will be exposed to even greater health risks and deeper lev- els of poverty. Peer pressure has meant that some donors have maintained their levels of funding, despite difficult economic circumstances in their own countries.

  n Align commitments with identified gaps

  Encourage skilled and adapted human resources for health, the coverage of essential mother, child and youth health interventions, and integration with other Millennium Development Goals (MDGs). Donors must ensure a well-balanced, effective and adapted response to bridge the gaps in the health of woman, child and young people.

  n Remember spending on health makes good economic and social sense

  Health spending is an investment that yields returns in individual and population health, education, and economic growth.

  n Continue to innovate in health financing

  In order to increase and improve health services in the world’s poorest countries, innovative funding mechanisms are necessary, which require the participation of a range of actors.

  n Start with the person, not the project or programme

  Investment in a comprehensive, multi-sectoral, integrated health approach is the only way forward. Standalone projects do have an impact, but the impact is limited. If a child is immunized but the mother dies in childbirth because of health service failures, the child’s welfare could hardly be con- sidered to have improved.

  National Societies together with civil society: help broker effective support n Become a responsible stakeholder for development

  Representatives from civil society organizations, the private sector and academia should play a greater role in helping their governments broker an international commitment that puts health inequity issues high on the development agenda. They should also ensure they commit to supporting countries in implementing effective measures to reduce the health gap, particularly for mothers and children. Civil society has a key role to play in being the voice of the voiceless.

  n Hold policy-makers to account

  Ensure that parliamentarians represent all their constituents, and take the right legislative and budgetary decisions. Ensure they hold themselves, and their executives, to account. International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  CASE STUDY – EGYPT Empowering women in Al-Nahda

The city of Al-Nahda, on the northern outskirts of Cairo, is a unique community. It expanded rapidly when thousands of

people lost their homes during the 1992 earthquake and were re-housed in there. Thousands of people from different communities were suddenly thrust together in a new life. In the years that followed, increasing numbers of families were re-

housed in Al-Nahda – sometimes as a result of government resettlement policies – and by 2003, the population had soared

from 13,000 to 37,000 families. By 2008, that figure had reached 52,000. The future for people living in Al-Nahda has often looked bleak – many of its residents are from low socio-economic

backgrounds with low levels of literacy, many people live on reduced incomes and there is high unemployment, a lack of

health facilities and poor social cohesion. However, in 2004, a new centre, managed by a group of Red Crescent volunteers,

was set up in Al-Nahda. Its aim was to empower community members – and women in particular – to improve the living

conditions of its residents.

The Egyptian Red Crescent organized Al-Nahda city with 20 trained women selected as community coordinators. Under

each coordinator, 40 women leaders have responsibility for a group of families. This coordination has proved to be

incredibly effective. During the avian and human influenza pandemics, the community leaders carried out a campaign that

resulted in virtually no poultry rearing in backyards.

  Medical services

Polyclinics in the city offer a wide range of medical services with some 40 people accessing the maternal healthcare and

reproductive health services every day. In addition to the healthcare services, there are also many ongoing health promotion activities to make the city’s residents more health aware. Female genital mutilation is still widely practised in Egypt and community information campaigns have focused on

educating girls, parents and grandparents about the dangers of the practice. The Red Crescent has enlisted the help of

religious leaders, doctors and sociologists to help put a stop to the practice, which is often more prevalent in low socio-

economic groups.

  Educational activities

Some 1,950 women have benefited from adult literacy classes. In addition, the Red Crescent offers vocational training and

handicrafts with about 1,500 women taking part in income-generating activities to support their families.

  

The Egyptian Red Crescent experienced such significant success in Al-Nahda that it expanded the programme to reach

all 53,000 families living in the city. The benefit of providing medical services, vocational training and capacity-building

to the city’s women has, effectively, been doubled as women assume a new role mobilizing their communities and promoting health.

  Fatima, a community coordinator in Al-Nahda, said: “Early on, I just thought of the free medical services from the

Egyptian Red Crescent polyclinic, but now I realize that it’s much more. Being a community coordinator makes me have a

responsibility towards my community to be in good health.” For more information, please visit: http://www.egyptianrc.org/ContentPageEn.aspx?pageNo=334

  International Federation of Red Cross and Red Crescent Societies

  Document type Chapter number Chapter title

  vanel/IFRC International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  Introduction: Health equities with a special focus on women and children deserve immediate attention and action

  The last few years have seen enormous and welcome developments in global

  Fact box

  public health. However, there is growing recognition – increasingly backed by evidence – that achieving the Millennium Development Goals will demand

  Based on data from 32 countries, ensuring that every woman and every child counts . women from the poorest quintile are less likely to hear about reproductive

  The Global Strategy for Women’s and Children’s Health, launched by the UN

  health messages than women from the

  Secretary-General in 2010, noted the continuing and vast inequities that still ₆ wealthiest quintile. exist. Many of the world’s most vulnerable women and children die need- lessly because of unequal access to information, prevention, treatment and services to meet their most basic needs. Wealth, education and place of birth

  “When we deliver for every

  significantly shape the health of women and children between countries and

  woman and every child, we

  within them. According to UN figures, 7.6 million children still die every year

  will advance a better life for

  around the world. Almost 95 per cent of newborn deaths occur in the devel- ₂

  all people around the world.”

  oping world. A recent WHO study has found that more than half of these deaths now occur in just five large countries – India, Nigeria, Pakistan, China

  Mr. Ban Ki-moon speaking at the

  and the Democratic Republic of the Congo. The Countdown to 2015 Decade UN Headquarters Every Woman,

  Every Child side event during the

  Report (2000-2010) states that Millennium Development Goals 4 and 5 are _th

  the 66 session of the General

  still achievable, but only a dramatic acceleration of political commitment and

  Assembly in 20 September 2011,

  financial investment can make it happen. * in New-York. India alone has more than 900,000 newborn deaths each year, nearly 28 per cent of the global total and 20 million pregnancies a year are exposed to risk. The disparity between countries is stark; in Iceland the mater-

• nal mortality ratio for women is just 5 in 100,000 live births, whereas in
₃ enables people to achieve Mozambique, the figure soars to 550 in every 100,000. Even within countries,

  Health is a resource that

  their fullest potential. It is

  poor children are at significantly greater risk of death before the age of five

  unjust for this potential to

  than their wealthier counterparts. Interestingly, in 18 out of 26 developing countries that have successfully reduced under-five mortality by 10 per cent

  be determined by the place

  or more, the gap in under-five mortality between the poorest 20 per cent and

  where a person is born or

  the richest 20 per cent of households either widened or stayed the same. So,

  the racial or ethnic group to

  even though there has been overall progress for children, in the first months which a person belongs. of their lives, their situation is not improving. Additionally, there are 2.6 mil- lion stillborn babies, who are never even counted because stillborn babies ₄ are rarely included in the statistics.

  Furthermore, the current global economic crisis is leaving more than 100 million people in poverty every year. Having to pay out-of-pocket health expenses only exacerbates their situation – the net result is that millions have no access to any services at all.

  Countdown to 2015 Decade Report (2000-2010), WHO and UNICEF, 2010. * http://goo.gl/BbSxy **

  International Federation of Red Cross and Red Crescent Societies Introduction

  Why health inequities now?

  In every region of the world, the survival of a child past the age of five is shaped, to a large extent, by the wealth of the household in which he or she resides, the region in which he or she lives, and the education of his or her _7,8 parents. Children born in rural areas or urban slums, children born to moth- ers with lower levels of education, and children born to families with lower ₉ incomes fare worse than others. For example, from a selection of countries where data is available in Africa, Asia and the Americas, a child born to the wealthiest 20 per cent of households is more than twice as likely to reach the age of five compared with children born to the poorest 20 per cent of ₁₀ households in urban areas. In Europe, similar trends are observed: under-five mortality rates are at least 1.9 times higher among the poorest 20 per cent of ₁₁ households than among the richest 20 per cent.

  A focus on primary healthcare The differences that have been outlined earlier highlight unacceptable health inequities: progress is very uneven within a country and between countries, and there are serious rights and justice issues, as well as policy failures which demand our full and immediate attention. Focusing on primary healthcare for women and children is a ‘best buy’. Women and children are among the most vulnerable, but give the greatest opportunities for gain because the health of women and children is often interdependent. Reducing the burdens that confront either women or children benefits the other. Gains often spill over to other groups, thereby strengthening community resilience. And the economic benefits are significant. It is estimated that much of the progress in East Asia over the last few decades is directly attributable to good policy choices: education for girls, access to information and services, gender equality and better representation in politics.

  Public health, development and human rights are the dimensions where the causes – as well as the solutions – to health inequities reside. Yet women and children are still left behind from available strategies that can largely mitigate such a divide in accessing health services. To be effective, health programmes must be tailored to local contexts. Effective responses can:

• decrease the social marginalization and the subsequent vulnerability of women, children and young people
• increase access to healthcare and social services – these include a comprehensive package of diseases prevention, treatment, care and support interventions
• promote a health approach informed by human rights and public health principles The Red Cross Red Crescent is acting on its commitments by increasing the resilience of women, children and young people to tackle the health risks they face in their communities. The goal is to maintain their capacity within their local communities so that they can take charge of creating an environment where people enjoy good health, and to assist in withstanding, recovering from and responding positively to any health threats they may face. To eliminate health inequities entails increasing resilience and contributes positively to global public health. The International Federation of Red Cross and Red Crescent Societies (IFRC) calls for a holistic approach informed and complemented by human
₅ rights principles. Such an approach seeks to improve the conditions that give rise to good health among all people, including the most vulnerable women and children. Human rights furnish the underlying principles of health, non-discrimination and autonomy. The IFRC articulates three components of a holistic approach to health inequities.

  1. Help ensure women and children have access to healthcare throughout their life cycle.

  2. Ensure that reliable, evidence-based and accurate information on health is available, and encourage appropriate health- seeking behaviours.

  3. Promote gender equality, empower women and girls, and enlist the support of men and boys.

  Within the work of the Red Cross Red Crescent, while there are many examples of success, it is essential to have strong

government commitment and leadership, partnership with donors and civil society organizations, and the involvement of women

and children.

  International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  These differences illustrate health inequities, which are “unfair and avoid- ₁₂ able differences in health status seen within and between countries”. Health inequities are systematic in that they usually affect particular groups of ₁₃ people. They take place across the social gradient, and differences in health are often most pronounced among the most vulnerable people, who have the least access not only to health services, but also to the resources that con- ₁₄ tribute to good health. Based on data from 32 countries, women from the poorest quintile are less likely to hear about reproductive health messages ₁₅ than women from the wealthiest quintile.

  Health inequities deserve our full attention and require immediate action. Here are the main arguments for doing so. ₁₆ Firstly, reducing health inequities is an ethical imperative. Health is a resource that enables people to achieve their fullest potential. It is unjust for this potential to be determined by the place where a person is born or the ₁₇ racial or ethnic group to which a person belongs.

  Secondly, tackling health inequities is economically sound. Simple, cost- effective measures, when scaled up, lead to significantly better health. Some of these highly cost-effective methods of reducing under-five mortality are immunization, micronutrients, treatment for diarrhoea, malaria and acute ₁₈ respiratory infections, as well as improved prenatal and delivery care. For example, data from Bangladesh, India and Pakistan suggests that home- based care reduces newborn deaths by between 30 to 61 per cent. Home- based care provides new mothers information on exclusive breastfeeding, thermal care for infants and the danger signs for newborns.

  Community health workers, volunteers and midwives are examples of people who can visit with newborns and their mothers within existing health pro- ₁₉ grammes. Simple measures not only improve maternal and child health but also create additional benefits, enabling women and children to lead healthy ₂₀ and productive lives, and contribute to resilient communities. Prevention, early detection and early treatment avoids the necessity of expensive and protracted care, freeing money for food and children’s education as well as for ₂₁ tackling women’s illiteracy. Investing in skilled providers such as midwives who specialize in low-risk pregnancy, child birth and postpartum care, as well as being trained to deal with any complications, is also one of the health best buys because they can provide care in communities and primary healthcare centres. They can also link women with emergency obstetric care services if they need them. WHO estimates that countries require a minimum of six skilled birth attendants per 1,000 births if they are to achieve the aim of 95 ₂₂ per cent coverage. Health spending, therefore, is an investment that yields returns in the health of individuals and the general population, as well as in education and economic growth.

  Finally, failing to eliminate health inequities potentially leaves the most vul- nerable at greatest risk. Without prioritizing health inequities, UNICEF warns: “We could find ourselves in 2015 facing the tough challenges of reaching the most deprived children of all – but with resources depleted, political will ₂₃ exhausted and a public that has moved on.”

  International Federation of Red Cross and Red Crescent Societies Introduction

  CASE STUDY – BANGLADESH Delivering maternal and child healthcare at low or no cost The poor in Bangladesh confront a whole host of obstacles to prevention, treatment, care and support. Health spending ₂₄ represents only 3 per cent of the country’s GDP, of which the government only contributes 1.1 per cent. Poor women and children in rural areas and urban slums are particularly vulnerable because continued investment in primary health _{25 26} centres is low and most healthcare services are funded by direct payments. Moreover, the critical shortage of healthcare ₂₇ workers is among the highest in the world. The Bangladesh Red Crescent Society works to reduce human resources and financial obstacles by providing care at community level. Red Crescent mother and child health centres provide medical check-ups, education, counselling to pregnant women, skilled birth attendance, postnatal care and primary healthcare services. A total of 58 mother and child health centres, along with five maternity hospitals, collectively treat more than 100,000 general patients, attend over 5,000 births yearly and disseminate thousands of health messages on a regular basis. Each centre is staffed with at least one community midwife, who provides care 24 hours a day, seven days a week. Midwives receive 18-months’ training at a government-affiliated nursing institute in the country’s capital, Dkaha. They then return to their communities to provide care locally. The centres are also staffed by an assistant community midwife, a skilled birth attendant, three community health promoters, an income-generating assistant, and a member of staff who provides service support. This team contributes to the effective delivery and financing of prevention, treatment, care and support. The clinics provide inexpensive care, substantially less than private clinics. Dr Christiane Haas, a health adviser for the German Red Cross, reflects: “In a country like Bangladesh, where still more than two-thirds of health expenditure is privately financed through out-of-pocket payments, there is potential for the Red Crescent health centres to become a model for community healthcare financing mechanisms. This approach, together with a well-managed poor fund, contributes to strengthening the equitable access to healthcare and fairness in spending on health especially in rural areas.” Clinics, for example, charge only 2 to 3 cents per patient for medical advice and 3 US dollars for normal birth delivery. Each community finances a poor fund to cover the costs of people who cannot afford the fees. “The poor fund,” Dr A.S. Haider, former health director of the National Society, now on mission to Haiti, explains, “is one example of how communities are working together to reduce health inequities locally. The community has really shown motivation and supported the poor fund of the MCH [mother and child health] centre over the last six years.” Mrs Shahida Begum, an 18-year-old labourer who lives in a slum in Dhaka, was able to receive care thanks to the work of the Red Crescent and the contributions of her community. Mrs Begum and her husband, a rickshaw puller, had moved to Dhaka in search of work. Soon after, Mrs Begum got pregnant. Suffering from malnutrition and anaemia, she became physically and mentally unwell. Thanks to a household visit by a community health volunteer, Mrs Begum was referred to the Jamila Khatun centre for care during her pregnancy. Mrs Begum attended the centre, where a Red Crescent community midwife provided antenatal care and counselling. Mrs Begum was unable to pay for the services and she applied to the centre’s management committee for financial assistance to cover the costs. She received care for free through finance from the community fund and went on to deliver a healthy baby on 29 January 2011 at the centre. Mrs Begum became an advocate for the work of the Red Crescent in her community, and encouraged her family, neighbours and friends to seek advice and care at the centre. This is one example of how the Red Crescent is now reaching increasing numbers of women and children each year. Many of the health centres have been supported by the German Red Cross for over ten years. In June 2011, both National Societies celebrated the transfer of ownership and leadership to the Bangladesh Red Crescent Society. The Red Crescent mother and child health centres provide affordable primary health services to the poor and marginalized women and children of Bangladesh.

  International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

16 IFRC

  International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  Chapter 1. Focusing on women and children is a good place to start

  This report shares some of the challenges and triumphs that Red Cross Red

  Fact box

  Crescent National Societies have faced whilst working to eliminate health ineq- uities that affect women and children in particular. The case studies may serve

  The majority of people with HIV in

  as useful examples of how inequities can be eliminated or reduced. Policy-makers

  sub-Saharan Africa and certain

  may adapt the lessons to the needs of their own communities and tailor policies

  countries in the Caribbean are

  accordingly. This report shows that the path to achieving health equity is challeng-

  women, and globally HIV and AIDS ing but hopeful, and that focusing on women and children is a good place to start. is the leading cause of death among women of reproductive age.

  The unique needs of Women’s biological make- women and children up demands more care.

  Women and children should be the focus of our attention because not only

  Pregnancy and childbirth

  are they more likely to face health inequities, but they are also the gateway

  are life events that expose

  to improving the health of an entire population. Lack of access to prevention, treatment, care and support renders women more vulnerable to health inequi- women to more health ties because women’s biological make-up demands more care. Pregnancy and

  risks and necessitate more

  childbirth are life events that expose women to greater health risks, which medical care. mean they need more medical care.

  Women also live longer than men, so they are at greater risk of developing chronic ₂₈ Obesity and health problems that require medical attention. Women’s biological make-up renders women more susceptible to contracting HIV through unprotected inter- ₂₉

  malnourishment

  course. Furthermore, some diseases, including HIV and AIDS, burden women

  Today, the world’s most vulnerable

  disproportionately. For example, the majority of people with HIV in sub-Saharan ₃₀

  women and children may, on

  Africa and certain countries in the Caribbean are women, and globally HIV and ₃₁

  one hand, fall into hunger and AIDS is the leading cause of death among women of reproductive age. malnourishment and, on the other, face obesity and overeating which exposes them, in turn to non-

  Social inequities compound communicable diseases. Both phenomena are closely linked biological differences to poverty.

  Wider power imbalances between men and women sometimes prevent women from exercising control over their health. For example, women may be less able ₃₂ to negotiate for safer sex and demand that their partners wear condoms. In addition, longer life expectancies often make women physically and financially dependent on their caregivers, and this dependency puts older women at risk ₃₃ of elder violence.

  The health of mothers and children is closely linked, so reducing the burden of health inequities on either women or children improves the health of the other. For example, more than 90 per cent of the children living with HIV contract the virus through mother-to-child transmission, either during pregnancy, at birth ₃₄ or through breastfeeding.

  International Federation of Red Cross and Red Crescent Societies

Chapter 1. Focusing on women and children is a good place to start CASE STUDY – MALAWI Empowering communities to fight against

  gender-based violence The Dzaleka refugee camp in Malawi is the temporary home of over 10,000 refugees, the majority of whom come from Burundi, the Democratic Republic of the Congo and Rwanda. Life in the camp is difficult. Some men to turn to violence, and women and children in the camp are vulnerable to physical and sexual abuse. As Janette Honore, a volunteer with the anti-gender-based violence committee, explains, “A girl may need soap and lotion. Instead of just helping her, the men want sexual favours.” Because violence against women is a critical health issue and a violation of human rights, the Malawi Red Cross empowers refugees in the camp to take control of gender-based violence in their communities. The Malawi Red Cross raises awareness among refugees on gender-based violence (often referred to as GBV) and equips them with the knowledge and skills to respond to it. “The main stakeholders in the GBV fight,” explains Joseph Moyo, Malawi Red Cross population movement manager, “are the refugees themselves.” The Red Cross distributes leaflets and key messages, and trains volunteers to conduct GBV education in the language

  Under-five mortality rate, by wealth quintile, residence and mother’s education, 2000–2010 (deaths per 1,000 live births) spoken in the camp. The Red Cross also helps resolve gender-based violence through mediation, psychosocial counselling and income-generation activities for victims. If necessary, it also helps victims seek justice through the formal legal system.

  Sergeant Christopher Sibale sees the success of the Malawi Red Cross through the increase in reported cases. Before, people were “victimized and disdained”, but now they come forward. Awareness activities have “really had an impact”.

  Children who live in poorer households and rural areas and whose mothers have less education are at higher risk of dying before age five.

  Under-five mortality rate, by wealth quintile, 150

  146 residence and mother’s education, 2000-2010 (deaths per 1,000 live births)

  121 120

  114 114

101

  91

  90

90 Note: Calculation is based on 39 countries with

  67 most recent Demographic and Health Surveys

  62 conducted after 2005, with further analyses by

  60

  51 UNICEF for under-five mortality rates by wealth quintile, 45 countries for rates by residence and 40 countries for rates by mother’s education.

  The average was calculated based on under-

  30 five mortality rates weighted by number of births. Country-specific estimates obtained from Demographic and Health Surveys refer to a ten- year period prior to the survey. Because levels or trends may have changed since then, caution y y should be used in interpreting these results.

  Rural None oorest Urban Fourth

Middle

  

P Second Richest

Primar Source: or higher Secondar http://reliefweb.int/sites/reliefweb.int/files/ resources/Child_Mortality_Report_2011_Final.pdf

  WEALTH RESIDENCE MOTHER’S EDUCATION

  International Federation of Red Cross and Red Crescent Societies Eliminating health inequities Every woman and every child counts

  UNAIDS has a strategic goal to eliminate the vertical transmission of HIV and reduce AIDS-related maternal deaths by half by 2015. This involves providing anti-retroviral therapy for women with HIV for their own health, and giving anti-retroviral prophylaxis to prevent women from transmitting the virus to their children. ³⁵ Such an approach illustrates how the prevention, treatment, care and support of HIV and AIDS has benefits not only in terms of maternal health, but also in child health. The burden of caring for sick children mainly falls on mothers or other female carers. This leads to time off work, loss of income and further impoverishment of families. Poverty, in turn, cuts off access to resources that give rise to good health, precludes treatment for poor health, and perpetuates ill-health among women and children. A vicious downward spiral begins. Children who live in poorer households and rural areas, and whose mothers have less education, are at a higher risk of dying before age of five.

• Children and maternal death and disability
• All forms of disease and disability confronted by females throughout their lives
• Women and health, including the roles of women in the health system
• Differences between women and men in their access to, and the quality of, the healthcare they receive
• The spectrum of sexual and reproductive health issues

  Double the risk and double the neglect: HIV and women who use drugs