Women: Developing Countries

Lord Crisp Excerpts

Thursday 27th June 2013 Lords Chamber

[Lord Crisp]

My Lords, I congratulate the noble Lord, Lord Loomba, on securing this debate, but congratulate him even more on the topic he has chosen—and indeed on his excellent speech which drew out the issues that we are debating. It is absolutely crucial that these issues are raised here and everywhere; and raised with the force and vigour which the speakers in this debate have shown.

I will concentrate on health and disabilities in developing countries, but I will take in a bit about the bigger picture. At the beginning, I declare two interests. First, my wife is a member of the International Gender Studies Centre at Lady Margaret Hall, Oxford, and, secondly, I chair Sightsavers.

In the wider picture to which noble Lords have already referred, there are so many issues to discuss, as the noble Baroness, Lady Brinton, mentioned, such as violence against women, their lack of representation, issues of access to employment, the fact that so many of the poorest people in the world are women, and access to all kinds of rights such as property and health. All are connected and will be anatomised by others in this debate. Essentially, however, they are all about power, position, mindsets, traditions and, of course, economics.

There is another part of that wider picture which I will draw out. It was mentioned in the House of Lords Library briefing for this debate in the form of a quotation of Kofi Annan, saying that women are the most important actors in development. It also made the point that the empowerment of women, the equality agenda, is right in itself but is also an instrument for progress in the world. We can all think of positive examples; I will mention just two. The first, well cited in health circles, is that if a girl in India has five years of education, her child is 40% more likely to reach the age of five. It is that simple. Education of girls is probably the most effective intervention in healthcare. The second is of course microfinance. The story is well told there as well, of how women have been able to revitalise communities and save their families from difficult situations through the application of microfinance. These issues are not just about women as victims; they are also about releasing the potential of women world wide.

On health more specifically, I start with a wider point about gender and the importance of disaggregating data—which I know is an issue close to the heart of DfID—and knowing the facts. An important paper by Sarah Hawkes and Kent Buse appeared in the Lancet on 18 May entitled Gender and Global Health: evidence, policy, and inconvenient truths. The inconvenient truth that it brings out is that—obviously leaving aside reproductive and sexual health—men have the bigger problems in terms of the global burden of disease and shorter lives. I am not going to talk about men, but the point here is that gender is not just a women’s issue. We need to disaggregate our data much more clearly if we are to have a real impact on health for everyone in the world. We need to think about gender as a key factor in that.

On women and health, all the issues are linked to the wider picture I mentioned earlier. I suspect that we are going to hear lots of numbers on pregnancy-related mortality today. The numbers I have are that 287,000 women died from pregnancy-related issues in 2010—that figure may have halved in 20 years but it is still extraordinarily high—and 99% of those women lived in developing countries. Again, as I suspect we will hear today, it is not just about mortality; it is also about morbidity. I have seen estimates varying from six times to 30 times as many women being affected as result of pregnancy-related complications or injuries.

The issues here are in part about how you get healthcare and proper health provision to people. They are partly about money, and ensuring that there are facilities to which women can get, but they are also fundamentally about society. They are about, as has already been said, unwanted pregnancies. They are about girl brides whose bodies are too small to bear the pregnancy which they have had inflicted upon them. It is about how men handle that. It is interesting to see a number of interesting projects around Africa where male, often traditional, leaders have been encouraged to develop programmes to ensure that their wives and women actually get access to hospitals and facilities when they need them. For example, there is an interesting project in Zambia where traditional leaders in some parts of the country inflict punishment on the men if their wives do not attend antenatal care four times. There is scope within these communities to make serious change.

Linked to that is sexual health. It is not surprising when one thinks of powerlessness and violence that more than half the people affected by HIV/AIDS in the world are women. They are often powerless on contraception. I was staggered to hear that some surveys indicate that men in developing countries understand the importance of contraception and the relevance of using a condom more than women do; that says something about education. Of course, we have already heard about child marriages and the fact that, according to the latest figures, something like a third of girls in developing countries, excluding China, will be married by the time that they are 18. The other aspect of health is that most carers and informal carers are women, a point to which I will come back.

Let me move on from health to disability. Women have higher rates of disability; perhaps that is connected with longer lives. To take the area of disability in which I am particularly interested through Sightsavers—eyes—some two-thirds of people who are blind are women; the ratio is almost 2:1. Blinding trachoma is caused by dirty water. Women are clearly much more vulnerable to it: they are dealing with the children and dirty water. It is not surprising that this infection carried in dirty water affects women far more than it does men.

Disabled women have a double disadvantage: the disadvantage of disability and the disadvantage of being women. That is borne out through all the statistics, which is another important argument for disaggregating the data. Disabled women are twice as likely to have AIDS as the general population. They have much poorer access to education and jobs. More of them are in poverty.

My final point about the challenges facing women is to recognise that it is often the women who pick up the pieces. In the HIV/AIDS epidemic in Africa, the principal carers of dying people are their female relatives. They are in a difficult position. There is some interesting research on this from the Commonwealth Secretariat which shows that, because of the stigma of HIV/AIDS in many countries and the weakness and poverty of the people involved, they are working in the most desperate conditions. The people bearing that burden are highly disproportionately women relatives.

In other research, I note that in Tanzania, for example, women are literally left holding the baby when their husbands have gone off to be miners elsewhere. They therefore figure among the poorest people in the country. I know that the noble Lord, Lord Loomba, has done his own work to address the disadvantages that widows have faced.

Women face all these challenges. What is the way forward? Some of these are societal and cultural issues, as I have already said, although I was struck by the opening words of the noble Lord, Lord Loomba, who said that when people discriminate on the grounds of race we talk about apartheid, but when they discriminate on the grounds of gender we talk about culture. Culture needs to be handled sensitively; I speak as the husband of an anthropologist, and I understand that. Changes have to happen within societies, and to come from a society’s own leaders. We need the skills of the anthropologist as well as those of the legislator and project manager. However, there is much that we can do as a legislative body, and as part of so many international bodies, as we are.

It is good that the noble Lord, Lord Loomba, has raised this issue here. As my friends in IGS have told me, we must continue to break the silence around violence towards women across all communities and nation states. There can be no well-being and good health without freedom from fear. I urge that the international focus on development, going beyond the millennium development goals, continues to address the silence that perpetuates this violence, whether it is state-sponsored violence towards women in conflict, or within the apparently safer environment of the home.

I am delighted that the millennium development goals and the high-level panel that has recently reported have focused on gender issues. We have fewer than 1,000 days to achieve the millennium development goals, and it is clear that the central role of health and education in empowering women and encouraging greater action to ensure the sexual and reproductive health rights of women and their educational needs needs to be sustained. I encourage the British Government to continue to do so, although they need no encouragement from me.

There is, however, more to say to persuade the Government on disability. I was delighted that the high-level panel on replacing the millennium development goals talked about disability and the disaggregation of data to ensure that disabled people were properly treated. This needs to be maintained. I am much more fearful here, so my only question for the Minister is: will this emphasis on disability be maintained in whatever replaces the millennium development goals, and will there be a continuing emphasis on the double disadvantage faced by disabled women? We need to make sure that we leave no one behind.

Finally, it is easy to talk about large-scale policy in terms of millions, and so on. Ultimately, this is personal; it is about individuals. So I will end on a personal note. I well remember, some years ago, my mother holding my daughter—her granddaughter—when she was just born and saying, “What a different life she is going to have from me”. She said it both with sadness and with confidence. This surprised me, coming from somebody who had more advantages than many of her generation, having graduated from one of our top universities almost 80 years ago; but she spoke with confidence. Are we holding out the same promise for today’s daughters and granddaughters? Can a woman anywhere in the world hold her granddaughter or, even better, her daughter, and see her future getting better equally confidently?