Volume 385, No.
9975, e25–e26, 4 April 2015
Comment
Towards universal health coverage: applying a gender lens
Published Online: 15 October 2014
Article Info
Investment
in the health and wellbeing of women and girls is not only the right
thing to do from a moral and human rights perspective, but it is also
smart, strategic, and cost-effective. Because health is a function not
only of the health sector but of government, combined with one's working
and living conditions, psychosocial status, and other socioeconomic
factors, approaches taken by Latin American governments to address the
gender dimensions of health reforms are in some cases overlooked because
they lie outside the health sector. Therefore, application of a
so-called gender lens, defined as the social and cultural constructs
that prescribe men's and women's roles in society, requires looking at
the health sector and beyond to examine the range of social reforms that
affect health outcomes. From my perspective as the former Chilean
Minister of Health and Director of UN Women, and two-time President of
Chile, I would like to highlight a few distinct and hidden lessons from
Latin America on addressing gender inequalities in health, in the hope
that making these lessons explicit might serve to draw attention to
opportunities for action both within and outside the region.
Across
the Latin American region, substantial progress has been made in the
struggle for gender equality, unlocking the potential for increased
participation by women and empowerment, which has a positive effect on
health. For example, 18 countries in Latin America provide at least 12
weeks maternity leave.1
These labour laws typically only apply to workers in the formal sector
(ie, those who receive social security), but reforms in Brazil, Chile,
Costa Rica, and Uruguay recognise the labour rights of domestic workers
and provide them with the legal entitlement to maternity leave. Other
forms of protection that affect health and are provided by all Latin
American countries include protection from discriminatory dismissal
during pregnancy and maternity leave, and the provision of at least 1
hour a day for breastfeeding up until the child's first birthday.1
Another
legislative imperative for promoting gender equality in health are laws
that entitle pregnant teenagers to continue their education both during
and after pregnancy. This point is especially important in Latin
America because fertility among adolescents in the region has been on
the rise since the 1990s.2
A child born to a mother who can read is 50% more likely to survive
past the age of 5 years than is a child born to a mother who cannot
read.3 Argentina, Chile, Panama, and Mexico have laws that support expectant teenage mothers to continue their education.4
This type of legislation disproportionately helps the poor—a study done
in the region shows that girls in the poorest quintile are four times
more likely to become pregnant than those in the richest quintile.5
As
Minister of Health in Chile between 2000 and 2002, I developed a
commission on gender and health that instituted measures to correct
regressive health financing on the basis of the ability to pay rather
than risk, which disproportionately assisted women. Subsequently, when I
became President of Chile in 2006, my administration tripled the number
of free early childcare centres for low-income families to support
women to continue in the labour force. I also instituted an annual
performance-based salary bonus linked to an institutional commitment to
work toward gender equality in all public services. This bonus system
was used to incentivise the transformation of intentions for
mainstreaming gender into measurable goals that were monitored every
year.6, 7
As
the Executive Director of UN Women between 2010 and 2013, I had the
privilege of reaching out around the world to advocate for the rights of
women and girls. As a global spokesperson for gender equality, I have
pushed for, and witnessed, rising global attention to women's rights and
ending violence and discrimination against women. In all regions,
countries have expanded women's legal entitlements, more women are
exercising leadership in politics and business, more girls are going to
school, and more women survive childbirth and can plan their families.
In
my present term as President of Chile, I have sent a Bill to Congress
to create a Ministry of Women and Gender Equality (currently under
discussion in the chamber of deputies), and given instructions across
government to introduce a gender lens into ministerial strategies,
policies, and programmes.
Despite this encouraging
progress, more remains to be done. There is no better investment that a
country can make to extend democracy, justice, and economic growth than
investing in girls and women. In our complex world and in view of
unprecedented economic, demographic, and environmental challenges, we
can no longer afford to waste the potential of half the world's
population. Addressing these challenges will need a health response with
a special focus on women. I strongly believe that the struggle for
gender equality and women's rights is the greatest cause of the 21st
century both within Latin America and beyond.
I am President of the Republic of Chile. I declare no competing interests.
References
1Economic Commission for Latin America and the Caribbean and United Nations Children's Fund. Challenges:
newsletter on progress towards the Millennium Development Goals from a
child rights perspective. Childcare and parental leave. http://www.unicef.org/lac/challenges_12_eclac-unicef.pdf; July, 2011. ((accessed Sept 19, 2014).)
2United Nations Children's Fund. Challenges:
newsletter on progress towards the Millennium Development Goals from a
child rights perspective. Teenage motherhood in Latin America and the
Caribbean, trends, problems and challenges. http://www.unicef.org/lac/desafios_Nro4_eng_Final(1).pdf; January, 2007. ((accessed Sept 19, 2014).)
3United Nations Educational and Scientific and Cultural Organization. Education counts: towards the Millennium Development Goals. United Nations Educational, Scientific and Cultural Organization,
Paris; 2011http://unesdoc.unesco.org/images/0019/001902/190214e.pdf. ((accessed Oct 1, 2014).)
4Economic Commission for Latin America and the Caribbean. Review
of the implementation of the Beijing declaration and platform for
action and the outcome of the twenty third special session of the
general assembly in Latin American and Caribbean countries. http://www.eclac.cl/mujer/noticias/paginas/8/36338/ECLACBeijing15.pdf; 2009. ((accessed Sept 19, 2014).)
5Economic Commission for Latin America and the Caribbean. Reproductive health and rights: HIV/AIDS and gender equality. in: Social panorama of Latin America. ECLAC, Social Development Division and the Statistics and Economic Projections Division,
Santiago; 2005: 231–249
6Solar, X. Gender and public policies: state of art. Germina,
Santiago; December, 2000http://www.germina.cl/wp-content/uploads/2011/05/publicacion2_genero_politicas_publicas_estado_del_arte.pdf. ((accessed Sept 25, 2014; in Spanish).)
7Ambrosio, V. Good
practice from Chile: gender in management improvement programme. EC
initiatives on gender equality in development quarterly newsletter. http://capacity4dev.ec.europa.eu/public-gender/document/newsletter-december-2009; December, 2009. ((accessed Sept 25, 2014).)
