Aspiration for health - How can a focus on gender bring change in Southern Sudan

“War has caused disruption of social services such as education, health, market places and all the activities related to women’s domain. Many nurses, doctors, teachers and merchants have been killed or forced to flee the country, thereby leaving hundreds of thousands of mothers, pregnant women and children of school age to tend to themselves in the wilderness of [New Sudan]. Sanitation, safe drinking water and warm clothing are non-existent. Diarrhoea and STDs are rampant, thereby adding to the misery and death toll of children and pregnant women… As war continues, the workload for women also increases progressivly in villages of New Sudan. Women and girls walk many miles to fetch water and firewood. To remedy the situation of all these women, the women of New Sudan cry for peace, we ask our women counterparts elsewhere to applaud with us in search for peach. We ask the international community and to exert pressures possible to bear on the government of Sudan to realize that people to the South Sudan have equal rights…”

“Having been at war for the past seventeen years, Southern Sudan has been described as a waste land. There is no working economy, poverty is total, and then a progression of foreign aid workers, most of whom do not speak local languages, arrive in their “birds of steel”, as planes are sometimes called. These affluent representatives of a different world make the gap between the haves and the have-nots only to glaring. They bring meagre relief handouts and their arrogant attitudes towards the people only make the material poverty of South Sudan even more real. It is the inattention to this gap that has increased the broken heartedness”.

Table of Contents

  Definition of terms and abbreviations  4

  Introduction  5

  A gender approach towards health and development  7

  Gender empowerment reconsidered  9

  Gender focussed PHC in an environment of war and natural disaster  10

  Conclusion  15

Table of  Figures  

  Definition of terms and abbreviations  4

  Introduction  5

  A gender approach towards health and development  7

  Gender empowerment reconsidered  9

  Gender focussed PHC in an environment of war and natural disaster  10

  Conclusion  15

Definition of terms and abbreviations CHE Community Health Education

CHW Dinka Empowerment Enhanced ‘power’ to influence, and decision- making Gender Social construction of the relationship between male and female and

Health

Inequality

Inequity

Monjang NGO Participation PHC Sex

needs TFC Therapeutic Feeding Centre

UN WHO

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Introduction

Three years after the Primary Health Care (PHC) goal of ‘health for all’ should have come into effect, research still reveals ever- increasing socio-economic disparities in global health (Bravemen & Tarimo, 2002). Concurrently, the profound gender inequity of the world’s resource distribution, a key determinant of health, contiues:

“Women are half the world’s population, yet they do two-thirds of the world’s work, earn one-tenth of the world’s income, and own less than one-hundredth of the world’s property (UN, 1985:337)”

This is true particularly in low- income countries, where the majority of girls and women are deprived of adequate health care, education and decision-making power, leading to illiteracy, malnutrition, abuse, chronic illness and premature death (The World Bank, 1994; UN, 2000). Current news headlines echo this problem: African women are 175 times more likely to die in childbirth and pregnancy than Westerners are (BBC news, 20 October 2003).

Sudan, a country marked by extreme poverty due to chronic civil war, compounded by natural disasters, also reflects these gender inequities. The few statistics available show a lower primary education enrolment ratio for girls (41.9); a high maternal mortality ratio of 1500 (per 100 000 live births) and only 10% of parliament seats are taken up by women (UN, 2003).

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The denial of women’s equity and health rights has profound consequences upon the health, development and survival of children. Research across the developing world indicates that, after maternal death, more than 95% of infants died within one year, with a girl child ha ving an even less chance of survival than a boy (The World Bank 1994; Winikoff, 1988).

Clearly, girls and women need to be the focus of all PHC initiatives if public health is to be enhanced.

Focussing upon women in order to improve health is not a recent notion, but has been promoted since the UN sponsored Women’s Decade in 1976-85 (Moser, 1993). Thus, the question arises why only minor success appear to be noticeable, and how this conceptual framework can be applied into the context of a complex emergency like in Sudan.

Therefore, this essay will firstly outline the evolution of a gender approach towards health and development, elucidating its underlying principles, objectives and achievements. It will briefly explicate the socio-economic and cultural context of a Dinka community in Southern Sudan through a ‘gender l ens’ and critically reflect upon PHC programmes, with reference to the author’s personal work experience.

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