The Epidemiological Transition Policy and Planning Implications for Developing Countries (1993) / Chapter Skim
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ROLES OF WOMEN, FAMILIES, AND COMMUNITIES IN PREVENTING ILLNESSES AND PROVIDING HEALTH SERVICES IN DEVELOPING COUNTRIES
ROLES OF WOMEN, FAMILIES, AND COMMUNITIES IN PREVENTING ILLNESSES AND PROVIDING HEALTH SERVICES IN DEVELOPING COUNTRIES
Pages 252-272
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From page 252... ...
Children may receive less than optimal attention both in health and in sickness because their mothers are prevented from giving John C Caldwell and Pat Caldwell are at the Health Transition Centre, National Centre for Epidemiology and Population Health, Australian National University, Canberra.
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From page 253... ...
Women can be empowered as caregivers by education and by female home health visitors. They can also be empowered by social scientific "health transition" research which, as the findings become part of public knowledge, convinces men that women's powerlessness is endangering their children, even their sons.
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From page 254... ...
In Asia, traditional healers take a rather similar view and most Indian Ayurvedic practitioners dispense modern medicine as well as prescribing ancient herbal cures. However, they may store medicines incorrectly, prescribe inappropriate dosage levels, and misdiagnose the condition for which medicines should be given.
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From page 255... ...
If it does not work, then nothing will. In rural south India this practice means that illiterate women bringing sick children even to a modern physician do not overly exert themselves to explain the history of the sickness and, if the child fails to recover, frequently do not return for further treatment because they believe that the best available treatment has already been given.
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From page 256... ...
In Sri Lanka, a system of female health visitors, who develop a relationship with the young women, has strengthened the decision-making ability of young mothers. Research in Sri Lanka indicates that half of the health decisions are made by the mother without consultation; most health decisions have been made this way in Kerala since at least the last century (Sushama, 1990, citing Mateer, 18831.
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From page 257... ...
However, it is not clear to what degree attention or neglect affects mortality, or whether the mechanisms occur through feeding, maintaining good health in other ways, or securing timely curative treatment. In sub-Saharan Africa, where there is no excess female child mortality, girls are probably more protected by a bridewealth system than would be the case under a dowry system, although it is still in many ways a man's society.
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From page 258... ...
In many Muslim societies, seclusion means that a woman cannot act easily to obtain treatment for herself or her children. Seclusion may be why educated women in the Middle East and North Africa do not have as low child mortality as their incomes and education would suggest; their problem is usually compounded because they do not have the education that such income levels in other parts of the world would ensure.
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From page 259... ...
We believe that it works partly through strengthening the individual internal locus of control and the commitment to child survival, making mothers feel personally responsible for what happens to their children and less likely to believe that it is inevitable (Caldwell et al., 19901. Girls who go to school identify themselves with other aspects of modernization ranging from nationalism to health centers, and modern medicine.
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From page 260... ...
The big advance in reducing child mortality in Sri Lanka occurred when free modern health services became accessible. Cleland and van Ginneken (1989)
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From page 261... ...
Infant and child mortality decline appeared to falter under the early Pinochet regime in Chile but subsequently fell faster than ever. The explanation may have been partly the improvement of an economy that had found itself in severe difficulties, and partly the fact that external assistance and advice by donor governments determined that the experiment under way should succeed socially as well as economically.
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From page 262... ...
A number of policy interventions that might improve the situation are, clearly, encouraging the original determination that something should be done, attendance at a modern health facility, interaction with the doctor, obtaining
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From page 263... ...
In rural South India we found that educated mothers restricted other expenditures when food was in short supply, concentrating on adequate nutrition for the whole family. Our observations showed them making less distinction than uneducated mothers between old and young, or male and female, although, as Cleland and van Ginneken (1989)
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From page 264... ...
The children of sterilized mothers in rural South India have abnormally low mortality, partly because of family planning workers' concerns for child survival (Caldwell et al., 19884. Perhaps the most promising policy interventions on the social and behavioral side for reducing infant and child mortality are to provide mothers, especially young mothers, with more self-confidence and more decisionmaking power.
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From page 265... ...
Although the Kerala experience cannot be reproduced, it is clear that many of these objectives will be fully achieved at the local level, and even at the governmental and medical school levels, only if community pressures can be exerted. Local representative bodies need a voice in controlling health services.
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From page 266... ...
Cardiovascular disease and illnesses linked to diabetes may be far more important than we thought; so may accidents and other violent deaths. There are regions such as mainland South Asia where mortality in late middle age or older, especially among men, appears to be almost inexplicably high, given the changes that have been achieved in younger mortality levels.
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From page 267... ...
It is a common experience for researchers in the poorer regions of the world, especially in rural areas of mainland South Asia and subSaharan Africa, to find that most people believe that mortality has risen over the past few generations. This belief is not prevalent in the more developed and better educated societies furthest along in the epidemiologic transition, if only because their educational levels and the better national data collection systems make their populations "developed" in depending on the media and on statistical services to determine their viewpoints.
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From page 268... ...
Our ignorance of this mortality change in countries with incomplete death registration is partly the product of deficient demographic techniques for measuring adult mortality, let alone trends and rates of change, and partly a woeful lack of cause-of-death data except from the minority who die in hospitals. The best health agenda for the Third World is reasonably clear: more investment in education, especially for females; more female empowerment, by direct intervention and through "health transition" research, which brings the social causes of unnecessarily high mortality into the public domain; more accessible and democratic health services identified with themselves by the local community; and a gradual reorientation toward attempting to reduce middle- and old-age mortality.
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From page 269... ...
Proceedings of an International Workshop, May 1989, Health Transition Centre, Australian National University, Canberra, 2 vols. Caldwell, J.C., I
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From page 270... ...
Proceedings of an International Workshop, May 1989, Health Transition Centre, Australian National University, Canberra, 2 vols. Lindenbaum, S., M
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From page 271... ...
Proceedings of an International Workshop, May 1989, Health Transition Centre, Australian National University, Canberra, 2 vols. Whyte, S.R., and P.W.
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