Meeting the changing health needs of women in developing countries

Sewing shirts with injured fingers and tears: exploring the experience of female garment workers health problems in Bangladesh

Background

The ready-made garment industry in Bangladesh not only contributes to the nation’s economic development, but has created income opportunities for women, benefiting their whole family. However, these benefits come at considerable cost to the women. This research examines how the work environment and gendered family role in this conservative society affect the health of the female industrial workers.

Methods

A qualitative study employed in-depth interviews (n-20) and focus group discussions with female garment workers (n-4) in two cities of Dhaka district. Further, key informant interviews (n = 4) with factory doctors, along with eight workplace observations were conducted to explore the lived experience of female workers’ health issues. Interview transcripts were coded in Atlas-ti, 5.2. The data were analysed using thematic analysis approach. The themes are illustrated with case narratives.

Results

The female workers reported that their work has led to back and joint pain, continuous headache, eye pain and difficulty in breathing associated with inhaling fabric dust. Inadequate lighting, constantly sitting in one position without back rest and continuous noise from hundreds of machines makes them feel permanently tired. Further, the female workers reported that working in the factory and meeting the expectations of the families at home has doubled their workload. The doctors indicated that the physical work environment, their low job status and the nature of the job affect the health of female workers.

Conclusion

This study found that female workers in the ready-made garment industry face a high risk of health problems. Both government and non-government organizations need to be better involved in designing interventions targeting these women, to protect them from such health risks. In addition, recognition by the whole society of the important role the women play in the economy is needed, so that support by both family and society can be improved.

Electronic supplementary material

The online version of this article (10.1186/s12914-019-0188-4) contains supplementary material, which is available to authorized users.

Health and Nutrition Status of the Caregiver: Effect on Caregiving Capacity

The importance of child care in ensuring optimal child survival, growth, and development is increasingly recognized. Unfortunately, poor health and nutrition status of the caregivers likely limit their agility to provide adequate care in many countries. Direct evidence for this has been shown in Egypt, where poor dietary intake, low haemoglobin levels, and low vitamin B6 status of the mothers were related to less time spent on care, less response to infants’ vocalization, less vocalization to infants, and greater utilization of older siblings as caregivers. In Kenya, lower maternal caloric intake was associated with less physical contact with their toddlers. Indirect evidence can be inferred from a review of illnesses affecting women globally in the light of the physical and mental demands of adequate caregiving. For this purpose, ill health of women is evaluated from both epidemiological and anthropological perspectives.

Beyond Reproductive Health: Listening to Women About Their Health in Disadvantaged Beirut Neighborhoods

In this article, we aim to contextualize gynecological problems within a broader health and social context, expanding the lens beyond reproductive health. Questionnaires were administered to 1,869 ever-married women aged 15 to 59 that included questions on living, general health, and gynecological problems. These questions were open-ended, allowing women to respond in their own words. Women reported a multitude of health problems, indicating competing priorities. Musculoskeletal complaints emerged as the most prevalent and most important health problem. One in four women reported a gynecological problem, mainly reproductive tract infections (RTIs), when asked directly. Selected quotes provide clues about the complex relationship between women's lives and health.

From Sunrise to Sunset: An Ethnographyof Rural Ecuadorian Women's Perceived Health Needs and Resources

In this ethnographic study, we describe the perceived health needs and resources of women in two rural Ecuadorian communities. Nineteen women participated in semistructured interviews. Women worked 3 to 30 hours outside the home each week but described their financial resources as insufficient. Most participants perceived their health as fair to poor. Four themes emerged related to the participants' health needs: (1) lack of money, (2) "it's better to be alone," (3) the physical burden of women's roles, and (4) suffering/self-sacrifice. Traditional medicine, local experts in traditional remedies, and nutrition emerged as resources to prevent illness. We believe our results offer valuable information in facilitating participatory health projects for social change.

Changing gender roles and health impacts among female workers in export-processing industries in Sri Lanka

Since the economic liberalization in 1977, a large number of Sri Lankan women have entered the labour market and engaged in income-generating activities. Some women choose to travel abroad as domestic workers, while others choose to work in export-processing industries. This process has a profound impact on gender and gender roles in Sri Lanka. Young rural women have changed their traditional women's roles to become independent daughters, efficient factory workers and partially modernized women. Even though changing gender roles are identified as a positive impact of industrial work, the new social, cultural, and legal environments of industrial work have negative impacts on these women's lives. This paper explores health impacts of changing gender roles and practices of young rural women, focusing on the experiences of female workers in export-processing industries. Further, it contributes to the literature on gender and health, and on qualitative approaches within health geographic studies. A model is formulated to suggest a conceptual framework for studying women's health. The model describes the determinant factors of individual health status based on the question of who (personal attributes) does what (type of work) where (place), when and how (behaviours). These are also determinant factors of gender and gender roles of a society. The three types of health problems (reproductive, productive and mental health) of a woman, in this case a female industrial worker, are determined by her gender roles and practices associated with these roles.

Health care reform in New Zealand: the diversity of gender experience

Women are a heterogeneous group with varying experiences and needs of health care systems. It is important that we recognise not only differences between women, but also that individual women may have different, even contradictory, health care issues and needs. These may vary according to women's different roles, identities, contexts, and resources (financial, social, etc.). This paper explores situated ideas about identity, gender, and place and how these relate to perceptions of accessibility of health care services in the context of New Zealand's restructured health care system.

Health perceptions and health behaviours of poor urban Jordanian women

BACKGROUND

The economic recession and stringent economic adjustment programme that Jordan has gone through since the early 1980s have resulted in lower living standards and higher rates of poverty and unemployment. Poverty debilitates women and impairs their access to health care, proper nutrition and well-being in general.

RATIONALE

Women's health behaviours and problems need to be analysed from the perspective of women themselves. The purpose of this study was to describe the health perceptions and health behaviours of poor urban Jordanian women aged 15-45 years in the context of the family and community in which they live. The sample consisted of 267 Jordanian women aged 18-45 years, whose household income was below the poverty line.

METHOD

This was a community-based study that collected data using semi-structured interviews with women. Health perceptions were measured by asking the women to describe their health status, as they perceived it. Health behaviours were measured by asking the women about their personal hygiene, diet, activity and exercise, sleep, smoking, drinking alcohol, and safety and security.

RESULTS

The average age of women was 33 years, 93% were or had been married, and 87.5% had received some form of education. Although the mean age at marriage was about 20 years, 13.6% were married when they were less than 16 years of age. Study women gave a lower rating of their health status than those reported in national studies. Although they reported bathing once a week, eating about three meals a day, and getting 8 hours sleep, there remain areas for improvement in their health behaviours in terms of performing regular exercise, carrying out regular health examinations, and the type and amount of food consumed.

RECOMMENDATIONS

Implications for nursing, with a special focus on health education and meeting the health needs of these women, are presented.

Predicting under- and overnutrition among women of reproductive age: a population-based study in central Java, Indonesia

OBJECTIVES

To evaluate changes over 1 year in weight and body mass index (BMI) among a population-based sample of non-pregnant women in Indonesia and to identify risk factors for developing under- and overnutrition.

DESIGN

Cross-sectional studies in 1996 and 1997 in the same population.

SETTING

Purworejo District, central Java, Indonesia.

SUBJECTS

Non-pregnant women (n = 4132) aged 15-49 years of age who participated in both 1996 and 1997. Based on BMI, women were classified as having chronic energy deficiency (CED), and as being either of normal weight or obese.

RESULTS

The mean height of the women was below the fifth percentile of international standards. In 1996, 16.2% had CED, 72.2% were normal and 11.6% were obese. In 1997, the corresponding figures were 14.4%, 71.2% and 14.3%, respectively, revealing a significant mean increase in weight and BMI. Among women classified as normal in 1996, 3.0% developed CED in 1997. Significant risk factors for developing CED were experiences of child deaths and non-use of contraceptives. Among women classified as normal in 1996, 5.3% developed obesity in 1997. Here, significant risk factors included most indicators of wealth as well as occupation.

CONCLUSIONS

The results should be important for future efforts to prevent CED and obesity in the general population; conditions which are both associated with health risks.

Outcomes and effectiveness in reproductive health

Measuring reproductive health is problematic. Awareness of the problems needs to be raised both among those collecting and those using data on reproductive health. This paper discusses two major measurement questions--one related to ascertainment and the other to attribution. The first question is to what extent the observed levels and patterns of reproductive health outcomes in women are valid as opposed to artefacts of the data sources and the data collection methods? The second question is can lack of evidence of effectiveness for any reproductive health intervention ever confidently be separated into no effects vs an inability to measure effects? Determining the effectiveness of health interventions is notoriously difficult. Reproductive health may not be a case for special pleading in the competition for scarce resources, but equally it should not be a case for special standards of proof of the effectiveness of interventions--standards which have not indeed been met by many other, and yet unquestioned, health care priorities. "What works" in reproductive health should in fact be judged from at least four different perspectives: from that of women and their families, health professionals, the scientific community, and national and international policy-makers.

Intellectual intersections: gender and health in the Pacific

Intriguing intellectual intersections offer the promise of enriching medical geography and making it both more theoretically sophisticated and more policy relevant. Employing a socio-ecological model of health, this paper explores several of these intersections, including the incorporation of gender into our research frameworks. As a context, the complex reasons for the increased interest in women's health over the past two decades, including the persistent tensions surrounding this interest, are reviewed. Drawing not only from conventional sources but also from literature on gender relations, domestic violence and aging in the Pacific as well as recent reports on health and socioeconomic development, key issues for women's health in the Pacific Islands are addressed.

Puerperal morbidity: a neglected area of maternal health in Sri Lanka

Pregnancy is the period during which a mother prepares herself physically and psychologically for the delivery and care of the offspring. However, during this period the central concern is the welfare of the baby, but not the mother. When the mother and the child subsequently become two separate beings, the mother's health care is totally neglected unless she develops obvious symptoms of gross physiological and psychological abnormalities. This study, which was carried out in three MOH areas of the Kalutara District on maternal morbidity, had two main objectives. The first was to determine the prevalence of puerperal morbidity and the second was to identify characteristics of those with high levels of morbidity. Of the mothers who are registered by the PHM of the study area 600 were selected for this study. Data were collected using structured interviews conducted within the first week after puerperium (43-50 days after delivery). The morbidity rate revealed by the study is much higher than expected. Excessive bleeding from the vagina was reported by 40 per cent of mothers, while minor symptoms like breast engorgement and chills were reported by many mothers. Only 11 per cent of the mothers in the study did not have any symptoms or signs of ill health, and the rest reported one or more illnesses. Primae gravidae and those who experienced pregnancy wastage during an early pregnancy had a higher morbidity.

Gender differentials in tuberculosis: the role of socio-economic and cultural factors

This paper reviews current knowledge about the role that socio-economic and cultural factors play in determining gender differentials in tuberculosis (TB) and tuberculosis control. The studies reviewed suggest that socio-economic and cultural factors may be important in two ways: first, they may play a role in determining overall gender differences in rates of infection and progression to disease, and second, they may lead to gender differentials in barriers to detection and successful treatment of TB. Both have implications for successful TB control programmes. The literature reviewed in this paper suggests the following: Gender differentials in social and economic roles and activities may lead to differential exposure to tuberculosis bacilli; The general health/nutritional status of TB-infected persons affects their rate of progression to disease. In areas where women's health is worse than men's (especially in terms of nutrition and human immunodeficiency virus status), women's risk of disease may be increased; A number of studies suggest that responses to illness differ in women and men, and that barriers to early detection and treatment of TB vary (and are probably greater) for women than for men. Gender differences also exist in rates of compliance with treatment; The fear and stigma associated with TB seems to have a greater impact on women than on men, often placing them in an economically or socially precarious position. Because the health and welfare of children is closely linked to that of their mothers, TB in women can have serious repercussions for families and households. The review points to the many gaps that exist in our knowledge and understanding of gender differentials in TB and TB control, and argues for increased efforts to identify and address gender differentials in the control of TB.