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2 The Context of Mortality and Morbidity
Pages 25-53

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From page 25...
... From this perspective, even though physical health is just one component of human development, it is an essential function of the development process (UNDP, 19911. As is the case everywhere, female health, ill-health, and mortality in Sub-Saharan Africa unfold within, and are shaped by, their sociocultural, economic, and political contexts.
From page 26...
... Taking combined mortality as its lead indicator, the World Bank's World Development Report 1993 (WDRJ finds four factors to be unremittingly important in mortality reduction: income growth, improvements in appropriate medical technology, basic education, and access to public health services and knowledge. These are not simple indicators, and there are important synergies among them.
From page 27...
... The search for reasonably consistent explanations is frustrating: why, for example, if East Africa suffers the highest regional food insecurity, are the numbers of low birthweight babies and maternal mortality rates highest in West Africa? Gender Disparities The Human Development Report applies the HDI to data from 33 countries on separate female and male estimates of life expectancy, adult literacy and mean years of schooling, and wage rates, and calculates a GenderSpecific HDI for those countries.
From page 28...
... , and some countries of the region have mortality levels that compare favorably with individual countries of other developing regions. At the same time, although most African countries have experienced steady declines in child mortality, aggregate mortality rates for the Sub-Sahara are still the highest in the world (Sal and Nassim, 19913.
From page 29...
... In response, the provision of access to high-quality emergency obstetric care is gaining recognition as the most important strategy for preventing maternal deaths in the region, in Africa, and in other developing countries where maternal mortality rates are high (Prevention of Maternal Mortality Network, 19951. Access Bias A severe limitation on access is urban-rural bias, which is extreme in Sub-Saharan Africa.
From page 30...
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From page 32...
... . One hypothesis suggested by this still uneven body of research is that women may be most likely to attempt to access the modern medical system in connection with illness in a very young child, and least likely to do so when there is a potential for some kind of stigma for example, for family planning services, diagnosis and treatment of either sexually transmitted diseases or tropical infectious diseases that seem to be sexually transmitted (for example, urinary schistosomiasis)
From page 33...
... While this is all very compelling, it is important to keep in mind that maternal education and most co-variates, such as child and maternal mortality, utilization of health services, and the like, are greatly confounded with income levels (Zimicki, 1989~. Table 2-2 presents data on adult literacy, mean years of schooling, and male-female primary and secondary school enrollment ratios.
From page 34...
... 34 Cal ._ ˘ Ct Ct so ._ Cal an o au 5o~ Ct o ._ Ct o Cat o D .
From page 36...
... The UNDP view is that these economic reforms have yet to bear fruit in human development (UNDP, 1993) , and the World Development Report agrees that the health costs of slow economic growth (as expressed in declining per capita incomes and increasing percentages of the population defined as living in poverty)
From page 37...
... At some sites, these delays were associated with increases in the numbers of maternal deaths (Ekwempu et al., 1990; Prevention of Maternal Mortality Network, 1995~. At the same time, a recent and very thorough study of the Tanzanian health system suggests that user fees would not be a disincentive were the facility to provide services of reasonable quality (Gilson, 1995~.
From page 38...
... In 1980, such single urban and rural Ugandan women were described as being in the forefront of social change and, even when they were not university women, they commanded prestige and respect (Obbo, 19803. In many African countries the processes of marrying and negotiating for the most suitable partner are real factors in social change.
From page 39...
... Kinship and Residence Power may also vary according to rules of kinship and residence. Female status is enhanced in matrilineal as opposed to patrilineal societies, and several features of matrilineality contribute to women's economic and social security (Henn, 1984; MacCormack, 1989~.
From page 40...
... SOCIAL DISRUPTION AND HEALTH STATUS War and Civil Strife In Angola, Burundi, Chad, Liberia, Mozambique, Somalia, South Africa, Sudan, Togo, and Zaire, civil strife and general violence have been the status quo for decades. Up to 90 percent of war-related fatalities in such
From page 41...
... _ _ ~ ~ the end result is the same, and they might as well earn the money. Gender Violence Article 2 of the 1993 United Nations declaration on violence against women defines the term "gender violence" as including, though not limited to, physical, sexual, and psychological violence occurring in the family and in the community, including battering, sexual abuse of female children, dowry-related violence, marital rape, female genital mutilation and other traditional practices harmful to women, nonspousal violence, violence related to exploitation, sexual harassment, intimidation at work, trafficking in women, forced prostitution, and violence perpetrated or condoned by the state.
From page 42...
... 42 C,2 Us o + ~ Up o A_ 8 ~ _ C^, ~ I ~ _ ~ C,: o ~ ~ of Cal .
From page 43...
... Estimates of rape incidence are highly speculative in the developing world overall, but there are some data, and they are chilling. Rates of rape in South Africa are extremely high.
From page 44...
... 44 Cal Ct Cal Cal ._ so o V: Cal 3 o V: o C~ 50 Em ~V: ~ _~ ,~ U:~ O At of _-O try· C-)
From page 45...
... , one thing that is clear is the hazardous relationship between very early childbearing and mortality: the risk of maternal mortality for women under age 20 is twice the rate for women between ages 20 and 34 (UNDP, 1991; WHO, 1992~. Traditional Medicine There are cultural dimensions to every part of human life.
From page 46...
... Traditional Practices Within the system that is traditional medicine are sets of what we chose to call "traditional practices," which are employed in the maintenance or restoration of what is culturally defined as "health." Some of these are tightly integrated into aspects of Sub-Saharan culture and society and may reinforce them across the life span. In childhood and adolescence, the most notable practices are early marriage and female genital mutilation; in adulthood, they include traditional practices linked to pregnancy, birth, and the postpartum period; and, in later years, they involve practices associated with widowhood.
From page 47...
... Because that is so directly an obstetric topic, it is addressed as such in Chapter 4. Female Genital Mutilation The term "female circumcision," until recently in general use, has been largely replaced by the more collective term "female genital mutilation" (FGM'.
From page 48...
... 1992. Sexually transmitted diseases: current and future dimensions of the problem in the Third World.
From page 49...
... 1991. The war on women in Mozambique health consequences of South African destabilization, economic crisis, and structural adjustment.
From page 50...
... 1986. Literacy, parity, family planning and maternal mortality in the Third World.
From page 51...
... 1992. Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya.
From page 52...
... Stanford, Calif: Stanford University Press. Prevention of Maternal Mortality Network.
From page 53...
... 1985. Maternal Mortality Rates: A Tabulation of Available Information.


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