Women with their specific needs and inevitably dependent status in certain stages of life are much more vulnerable to the effects of political and religious environment which surrounds them. Religious beliefs of their immediate surroundings affect their sexual and reproductive behavior at least to the same level as their own beliefs and values; and political and socio-economic environment determines choices they have with regards to reproductive behavior. Any methods designed to control the level of human reproduction are a sensitive political as well as religious matter and a public health issue. The reproductive health of a nation is a public health issue. Therefore, risks associated with the use and misuse of certain women’s heath medicines that control fertility and reproduction affect the health of the individual as well as the society. Political decisions, socio-economic environment, culture, administrative measures, religious influences, and public policies profoundly affect decision-making of individuals and couples when and how they start a family, how many children they wish to have, how many children they do have, and spacing and timing of pregnancies. Thus we need to adapt our approach to risk management by adapting planning to social, religious and cultural variation. This will have implications for advising women about how to use medicines for controlling reproduction and the design of educational programs about safe use of medicines for women’s health.
Review by Frank L Wallace, MD, MMS
The fundamental issue is one of gender inequality and on a global level, no less. For most of recorded history, human societies were largely paternalistically driven with women relegated to a secondary, even distant second-class status. The male of any hierarchal structure determined what was best for, and what, the woman would be allowed to have. A coequal relationship was extremely rare, if at all, to occur historically. We see that most glaringly today in what is called the emerging, undeveloped world. This ages-long accepted gender inequality itself can be reduced to an anthropological issue with how it manifests secondarily in all the social, political, religious, cultural, and finally biological spheres, impacting collectively women’s health. The resultant barriers for women to obtain essentially coequal health determinism have been well discussed in the entirety of this book. To be sure, there has been slow progress in granting women equality in the last 100 years, but it has been uneven throughout the world and inconsistently practiced. Despite the 1994 ICPD historic milestone resulting in the 4 tenets under its Program of Action being a platform for 179 signatory governments, the UN and WHO follow on actions furthering these tenets, and ACOG’s championing women’s unrestricted EC access, we are still left with dealing with very little real movement in this kind of gender health equality. Otherwise this book would not have had to be written. Until the fundamental anthropological mind-sets at the heart of all these secondary barrier issues are changed, there can be little expected in the way of immediate resolution to women’s health. But, it can be done with patience slowly over time through the continued actions advocated in this chapter and book.
Frank L Wallace, MD, MMS (AVATAR Worldlink)
