Key Preliminary Findings
In 1998, ARROW coordinated a seven-country study on Women's Health Needs and Rights which included Cambodia, Indonesia, Laos PDR, Malaysia, Philippines, Thailand and Vietnam. The country papers aimed at providing benchmark data on women's health needs withing a women's rights framework as well as documenting action taken to implement the Beijing Platform for Action (PFA). The country researchers were either researchers working in women's health NGOs, or health researchers commissioned by women NGOs. The NGOs involved were: the Cambodian Midwives Association; Women's Health Advocacy Network (WHAN) of Thailand; SPEAK, Indonesia; CHAMPA, Laos, PDR; Research Centre for Gender, Family ans Environment in Development (CGFED), Vietnam; WomanHealth, Philippines.
Country papers focused on four priority action areas of the Beijing PFA's women's health recommendations:
- women's health and rights
- sexual and reproductive health rights
- violence against women
- gender-sensitive health programmes
Work in each area was guided by the relevant Beijing PFA recommendations which were then operationalised into indicators of women's health status, health service provision (use and quality), and policies and laws. ARROW developed this guideline document titled "A Framework of Indicators of Action on Women's Health Needs and Rights: Monitoring Implementation of the Beijing PFA".
Draft country papers have been completed. They were provided as background papers for a high-level South-east Asian Policy Dialogue jointly organized in mid 1998 by ARROW and the Gender and Development Programme (GAD) of the Asian and Pacific Development Centre (APDC). The Dialogue brought together health, population and women's development government policy makers with women's health NGOs and researchers most active in Beijing implementation in the seven countries. The Dialogue aimed to develop capacity and commitment in monitoring and implementation of the Beijing PFA's health section.
ARROW is now compiling a regional overview of women's health needs and rights emerging from the country papers and the Policy Dialogue which is to be published in 1999. The following findings and recommendations represent some of the preliminary analysis done for this regional overview which are most relevant for the meeting of the UN Commission on the Status of Women , March 1999, which will discuss the area of women's health.
Indicators to Assess Women's Health Needs - Availability and Reliability of Data
The only reliable indicators in all countries were found to be contraceptive prevalence and life expectancy. Maternal mortality data was available, but a number of researchers questioned the completeness and accuracy of the data. For all other critical indicators of women's health - e.g. reproductive cancer morbidity and mortality and screening rates; incidence of STDs and Reproductive Tract Infections; rate of unsafe abortion; incidence of gender-based violence - most countries did not have national data.
This reflects the past focus of health programmes for women on family planning and indicates the neglect of women's comprehensive health needs. It is essential that baseline data on the range of women's health concerns identified in the Beijing PFA is obtained so that women's health needs can be identified, prioritized and appropriate action taken. Furthermore, specific attention should be given to gender-based violence as a reliable and valid indicator of women's health status. Contraceptive prevalence rates, life expectancy of women and maternal mortality rates (when available) are not sufficient health impact indicators to assess women's health needs within the framework of the Beijing PFA.
Addressing the Health Needs of All Women
Data available was primarily national data reflecting national averages. Country researchers were generally unsuccessful in obtaining data which was already analysed and presented by:
- geographical location (rural and urban)
- indigenous and ethnic groups
Identifying rural and urban inequalities and differences among women as suggested in the PFA (C.89), necessary for an indepth approach to improving women's health, is thus not possible. For example, which women are more at risk for acquiring cervical cancer and less likely to seek screening of treatment in specific countries? Which women are dying in pregnancy and childbirth? - young women or old women; indigenous women; women of a particular religion or culture; poor women?
Inadequate Basic Infrasctructure and Availability Servicec for Women's Health
Some countries such as Malaysia and Thailand, have been able (prior to the Beijing Conference) to provide women with adequate infrastructure and services for maternal health care. The other countries however, have not yet achieved this and maternal mortality rates are still high in Indonesia, Cambodia, Laos PDR, Viet Nam, and the Philippines.
Contraceptive services are widely available (although not necessary accessible due to cultural, religious and political factors) in most countries, but not yet in Laos and Cambodia who have recently begun birth spacing programmes.
Availability of reproductive and sexual health services in most countries is poor. In Laos, for example, cancer treatment is not available and women (and men) who can afford to, go to Thailand. Viet Nam's cancer treatment services are urban-based and this is the situation in most South-east Asian countries. Even cervical cancer screening services for women are not yet a core part of reproductive health services in most countries. Data on the number of women who have had pap smear screeening test according to guidelines is not known generallly. For example, although pap smears are available in Malaysia through the public health services nationwide, onyl 25% of women reported ever having had a smear in a recent health longitudinal survey. This shows that accessibility and quality of service is just as critical as availability.
The availability of services for women suffering from gender-based violence is either inadequate or non-exsistant. Malaysia and Philippines were the only two countries which have set-up multi-disciplinary integrated public health services for women. Most of the other countries have reported extensive gender-violence problems. However, barriers such as socio-cultural stigmatisation, under-reporting of cases and lack of national prevalence data have undermined the seriousness of the problem.
Implementation of New Health Service Delivery Approaches
(e.g. women's rights to health, gender-sensitivity, reproductive and sexual rights)
Few countries appear to have understood, accepted and operationalised these new conceptual approaches in their related health policies and plans. The Philippines has made the most progress of the six countries with the Philippine Plan for Gender-responsive Development (1995-2025) which advocates for gender-sensitive health policies and services, these are at a pilot stage of implementation in the Department of Health. The concept of reproductive rights is included on Cambodia's Abortion Bill and Birth Spacing policy statement, which is a very progressive development.
There is an urgent need to support national and regional activities aimed at strengthening government and NGO capacity to implement the new approaches of the BPFA. Information resources, pilot health service projects, orientation and training of health service providers, policy dialogues, and revision of curricula for health service providers, are some of the critical activities.
Privatisation and Financial Crisis - Affordability of Health Services
All country studies reported a growing trend of privatisation of public health services and the introduction of service user fees for treatment and medicine. For some countries like Indonesia, this includes childbirth services. Women's access to affordable, quality reproductive health services needs to be evaluated more fully, as it would appear in a number of countries that their access is limited according to their income. The continuing financial crisis of 1997 and reduction of government health budgets has further affected the cost and availability of services. Although contraceptive services and supplies have been affected in some countries like Indonesia, this remains the most affordable and accessible reproductive health service for women in most countries due to the priorities of donor funding.
Although some countries have reported a trend of increased government spending on reproductive health, much more detailed analysis needs to be done. Much of the reproductive health budget, for example, is allocated to family planning services. There is an urgent need to develop a monitoring framework of specific financial indicators which differentiates maternal health, family planning, screening for reproductive cancers, HIV/AIDS services etc. within the reproductive health budget. In addition, financial indicators need to be agreed on to monitor spending on women's comprehensive health services.
Monitoring and Implementation of the Beijing PFA - Insufficient National Mechanisms
Country studies report in most countries that the Beijing PFA's recommendations on women's health have as yet been given little serious attention by health policy makers. There are not yet agreed upon core indicators for monitoring the new broad concept of women's health and rights, nor national institutional mechanisms to develop such a framework. Women's Ministries and departments need to bring together health policy makers and women NGOs with a health and rights agenda through sustained mechanisms such as a National Committee to facilitate and monitor implementation of the National Action Plan post-Beijing on women's health.
Project Funders: South-East Asian Gender Equity Programme (SEAGEP), a programme of the Canadian Government and the International Development Research Centre (IDRC), Canada.