Living Together, Worlds Apart by M.T. Yassini Men and Women in a Time of Change Inequality between women and men limits the potential of individuals, families, communities and nations. Ending gender discrimination is an urgent human rights and development priority, says The State of World Population 2000 report from the United Nations Population Fund (UNFPA). Gender discrimination will not end until all eyes are open to its inherent contradictions, and countries, communities and families act to end it. Gender and Health Gender inequality harms women’s health and prevents many women from participating fully in society. Unequal power relations between men and women often limit women’s control over sexual activity and their ability to protect themselves against unwanted pregnancy and sexually transmitted diseases (STDs), including HIV/AIDS. Teenage girls are particularly vulnerable. Inadequate reproductive health care for women also results in high rates of unwanted pregnancy, unsafe abortion and preventable death and injury as a result of pregnancy and childbirth. Gender-based violence – including rape, wife beating and female genital mutilation – hurts women’s health, well-being and social participation. Universal access to sexual and reproductive health care, including family planning services, was a central objective of the 1994 International Conference on Population and Development (ICPD) in Cairo. Countries agreed that empowering women and meeting people’s needs for education and health were necessary for individual advancement and balanced development. At the 1999 fifth-year review of the Conference (ICPD+5), governments agreed on these new bench-marks, among others: to halve the 1990 illiteracy rate for women and girls by 2005; to halve unmet need for family planning by 2005 and to eliminate it altogether by 2015; to reduce HIV infection in youths by one quarter by the year 2010, by providing information and services to reduce their risk and to ensure that by 2015, 90 percent of all births are assisted by skilled attendants. They also agreed that where abortion is legal, it should be safe and accessible. Providing family planning to everyone who wants it is a significant challenge. Today about one third of all pregnancies – 80 million a year – are believed to be unwanted or mistimed. If women could have the number of children they wanted, the avenge family size in many countries would fall by nearly one child. Over the next 15 years – assuming services can be provided – the number of contraceptive users in developing countries is expected to increase by more than 40 percent to 742 million due to population growth and increased demand for contraception. Providing women with safe options for pregnancy and childbirth is another priority. Today, some 500,000 maternal deaths occur each year in developing countries, where only 53 percent of all births are professionally attended. This lack of care translates into the neglect of 52.4 million women annually. Nearly 30 percent of women who give birth in developing countries, some 38 million each year, receive no antenatal care. At the end of 1999, 34.3 million men, women and children were living with HIV or AIDS, and 16.3 million had already died from the disease. HIV/ADS is now the leading cause of death in Africa and the fourth most common cause of death worldwide. In 1999 their of care translates into the neglect were 5,4 million new infections, 4.0 million of them in sub-Saharan Africa. In Africa, HIV-positive women outnumber men by 2 million. Programs that address gender inequality and engage men as partners in fighting AIDS can help slow the spread of the disease. Gender-sensitive reproductive health programs are essential to counter inequality and protect women’s health. Programs are beginning to address the dynamics of knowledge, power and decision-making in sexual relationships, between providers and clients, and between community leaders and citizens. Non-governmental organizations (NGOs) are increasingly playing important roles in providing services, for instance to address sensitive topics such as adolescents’ needs. Young men and women face different social pressures and expectations which may work against responsible sexual behavior. Many girls are forced into early and unsafe sexual activity by abuse, child marriage or poverty. Both married and unmarried youth lack access to reproductive health information and services. Training young people as peer educators encourages responsible behavior. Parents and other adults can learn to be sources of information and counseling. Men also face reproductive health problems including sexually transmitted infections, impotence and infertility. Many men also say they want to limit or space their children, but neither they nor their wives are using contraception. Reproductive health services for men have concentrated on STDs. The proportion of contraceptive use attributable to men has fallen in recent years. Good programs can increase men’s knowledge of and use of contraception. Gender-based Violence At least one in three women has been beaten, coerced into sex, or abused in some way — most often by someone she knows. One woman in four is abused during pregnancy. At least 60 million girls are “missing”, mostly in Asia, as a result of sex-selective abortion, infanticide or neglect. Two million girls between ages 5 and 15 are introduced into the commercial sex market each year. Perhaps as many as 5,000 women and girls are murdered each year in so-called “honor” killings by members of their own families. Rape, battery and other forms of gender-based violence are widespread worldwide. Many cultures condone or tolerate a certain amount of violence against women. In parts of the world, men are seen as having a right to discipline their wives as they see fit. Even women often view physical abuse as justified under certain conditions. Justification for violence stems from distorted views about the roles and responsibilities of men and women in relationships. Events that may trigger violent responses include not obeying the husband, talking back, refusing sex, not having food ready on time, failing to care for the children or home, questioning the man about money or girl friends or going somewhere without his permission. Violence can cause immense damage to women’s reproductive health and well-being, resulting in unwanted pregnancies; unsafe abortion; persistent gynecological problems; sexually transmitted diseases, including HIV/AIDS; and psychological and emotional problems that can be more difficult to bear than physical pain. NGOs are actively countering violence against women. In Colombia women’s groups provide training and support for rape survivors. A Bosnian group has counseled 20,000 women and children who have suffered from sexual violence. Men, Reproductive Rights and Equality Discrimination against women and girls will never stop without the support and understanding of men, especially in the family. Men’s attitudes and behaviors are strongly influenced by stereotypical definitions of masculinity and what it means to be a “real man”. These stereotypes, however, are unrealistic and set men up for failure, stress and difficulty in relationships. Men unable to live up to expectations that they should be powerful and competent may retreat into passivity, escape through drugs or alcohol, or resort to violence or exaggerated bravado and risk-taking. Helping women and men to communicate about their family roles and responsibilities can strengthen families, protect reproductive health, and reduce gender inequality and gender-based violence. One study in the Philippines showed that domestic violence was least prevalent when the husband and wife communicated and shared responsibility for decisions. Men’s behavior can change. In India, male health workers have motivated other men to take an interest in women’s health and help with housework. In Mali, men’s involvement in reproductive health has led to support for women’s employment. And in Nicaragua, courses on gender and power have reduced gender-based violence and increased sexual responsibility. High rates of HIV/AIDS infection, due in part to gender inequality and a failure to invest in prevention, have taken a tremendous toll in many nations. In some countries, it is estimated that the pandemic has reduced per capita GDP growth by 9.5 percent annually. The impacts on the health system and on the poor are severe, in some of the most affected countries, infected persons occupy more than half the available hospital beds. The global costs of gender violence and abuse include the direct costs of health care, missed work, law enforcement and protection, shelter and divorce. The World Bank estimates that in industrial countries sexual assault and violence take away almost one in five healthy years of life for women aged 15-44. Denying education to girls slows social and economic development: investing in education pays off. One study concluded that, other factors being equal countries having three female students or fewer for every four male students could expect 25 percent less GNP per capita than countries with greater parity in education. The economic advances in some Asian countries from the I960s through the I980s hinged in part on smaller family sizes and increased investment in girls’ education and health. Educated women with increased income invest more in their children’s health and education. The gender gap in schooling is closing in most of the world, but it remains large in South Asia and sub-Saharan Africa, where fewer than 41 percent of secondary students are female. Another cost, one that will rise in coming years as the number of older persons increases, is caring for the elderly. Everywhere, older women live longer than men do. But despite their longer life spans, public pension systems offer women less support because of women’s lower formal labor force participation. Women’s Rights A series of human rights treaties, starting with the United Nations Charter and the Universal Declaration of Human Rights, affirm the rights of girls and women. Forged over several decades by governments and influenced by the global women’s movement, these agreements provide a legal foundation for ending gender discrimination and gender-based rights violations, and oblige governments to take action. The 1979 Convention on the Elimination of all Forms of Discrimination against Women has 165 states parties. An optional protocol to the convention was opened for signature in December 1999 and will enter into force with 10 ratifications. The protocol will enable individuals and groups of women to submit discrimination complaints to the Treaty Monitoring Body.  It will also enable the committee on the elimination of discrimination against women to initiate inquiries into situations of grave or systematic violations of women’s rights. The Vienna Declaration and Program of Action for Human Rights (1993), the Program of Action adopted by the ICPD, and the Platform for Action adopted by the Fourth World Conference on Women (Beijing 1995) also strongly support gender equality and women’s empowerment. These agreements, while not legally binding, are powerful instruments for promoting change. The agreements from the ICPD and the Beijing women’s conference clearly spell out time components of reproductive rights. These include the right to sexual and reproductive health; voluntary choice in marriage, sexual relations and childbearing; freedom front sexual violence and coercion; and the right to privacy. All of these rights are essential to gender equality. However, for women’s rights to become a reality, they need to be taken seriously, especially by men. This requires education and awareness raising. Women’s rights also need to be incorporated into national policies, laws and programs. In the past few years, many legal victories have been registered. Mexico and Peru, for example, have passed laws to increase access to reproductive health services. Portugal has amended its constitution to specify that the government has to guarantee family planning. Botswana, China, Colombia, the United Kingdom and Viet Nam have increased penalties for various sexual offenses. Bolivia no longer requires that a woman be found “honest” to be considered the victim of a sexual offense. Germany has criminalized rape by a husband against a wife. Several have outlawed female genital mutilation. But much more remains to be done. Working Towards a Better Future Governments have a key role to play in creating conditions for gender equality, by removing legal barriers and changing laws, policies and programs. Political leaders can advocate and promote gender equality and encourage others to do so. Women’s increased political participation is another important way to advance. Governments have agreed that everyone should have access to reproductive health care by 2015. The key elements – family planning, services for safe motherhood and protection from sexually transmitted disease – are essential to the quality of life of both men and women.  Programs are also needed to address men’s reproductive health needs and foster their active support for women’s health. Men should be engaged in dialogues on gender inequality and its costs to men, women and society at large. Systematic gender analysis and monitoring can show what is needed to respond to the needs of both women and men and promote gender equality. Women’s groups need to be involved in designing, implementing and monitoring programs. Further improvements are needed in the quality of sexual and reproductive health care. Service providers need training and support to provide sensitive care to both women and men. Needed action against gender-based violence includes advocacy, gender-sensitivity training, legal changes, improved enforcement, safe alternatives for victims, reporting systems, mediation and counseling services, and supped for groups providing counseling and help. Elimination of gender inequality in hiring, wages, benefits and job security should include ending requirements that women prove that they are using contraceptives or are not pregnant. Human rights and health education campaigns should take into account the different perspectives of men and women. The long-term approach to ending gender discrimination requires efforts at all levels. including training children to see and avoid gender bias. Media, including film, radio, TV and the Internet, can encourage positive images and role models. Stronger partnerships among governments, NGOs and local communities to monitor and promote compliance with human rights standards are also needed, as are stronger efforts to achieve universal primary education. The international development community, including U.N. agencies and the World Bank, needs to continue efforts to mainstream gender analysis into policies and programs. Better collaboration among donors is needed to reduce duplication and share expertise. Of the $5.7 billion per year that countries have agreed is needed from international sources for reproductive health and population programs, only about $2.1 billion has been made available. Funding for education and women’s empowerment is also inadequate. While international donors, including foundations, have strongly supported efforts to promote gender equality, sufficient resources do not yet back this commitment. The last several decades have seen greater attention and some progress towards the empowerment of women. There has also been a growing recognition of how the rules governing men’s and women’s opportunities, social endowments and behaviors affect prospects for accelerated development and justice. But social change is often difficult, particularly when the basic relations between men and women are involved. The changes in these relationships, and the systems of power and belief that support them, are no less sweeping than other changes already under way in urbanization, globalization and governance. In the end, societies need their own solutions to provide a better life for both women and men, consistent with their cultures and conditions, grounded in vision of justice and gender equality. ACTIONS: >> email this article to a friend  >> react to this article  >> more articles Note: Please email your opinion to op-ed@majalla.org; Op-Ed articles are not peer-reviewed. 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