|Year : 2009 | Volume
| Issue : 2 | Page : 274
Experiences of the Network: Towards Unity for Health Women and Health Taskforce
D Gonzalez de Leon1, J Lewis2
1 Department of Health Care, Universidad Autónoma Metropolitana Xochimilco, Mexico
2 University of Connecticut, School of Medicine, Farmington, USA
|Date of Submission||04-Nov-2008|
|Date of Acceptance||17-Jun-2009|
|Date of Web Publication||06-Aug-2009|
D Gonzalez de Leon
Department of Health Care, Universidad Autónoma Metropolitana Xochimilco
Source of Support: None, Conflict of Interest: None
Context: Women's health is an often neglected component of health professions education despite the well-documented need to improve the health status of women, especially in low income countries. This paper was written on behalf of all members of The Network: Towards Unity for Health Women and Health Taskforce (WHTF) which unites leaders in women's health and higher education from different countries around the world. The WHTF objectives include teaching health providers the skills and knowledge necessary to improve care to women; encouraging universities to partner with community women's groups; promoting the inclusion of women's rights and gender issues in curricula; and cultivating leadership among female health professions students.
Objective/Content: The main goal of the paper is to provide an overview of the collaborative processes, the accomplishments and the lessons learned in this project since the early 1990s. It includes the history and evolution of the Taskforce; the importance of human rights and gender issues in approaching women's health; teaching tools - the Women and Health Learning Package (WHLP); implementation of WHLP in health professions education and community settings; and main outcomes and future challenges. The WHLP was implemented in fourteen universities and seven university community programs. A new edition of WHLP will be available in 2009.
Conclusion: The WHTF is a model of south-south collaboration in health professions education and community programs to improve women's health. It has been successful in reaching universities and communities all over the globe and provides a model for other education, health and community issues.
Keywords: Women′s health, gender and health, health professions education
|How to cite this article:|
Gonzalez de Leon D, Lewis J. Experiences of the Network: Towards Unity for Health Women and Health Taskforce. Educ Health 2009;22:274
This paper was written on behalf of all members of the Women and Health Taskforce (WHTF) which is part of The Network: Towards Unity for Health (Network: TUFH). The paper provides an overview of the collaborative process, accomplishments and lessons of this project over the last seventeen years. It includes the history and evolution of the Taskforce, the importance of human rights and gender issues in addressing women’s health, the teaching tools developed, the implementation of these tools in health professions education and community settings; and the main outcomes and future challenges.
The WHTF was first convened as a small group of women academics – the Women and Health Group - at the 1991 Network: TUFH conference in Illorin, Nigeria. Women’s health had become a major topic of debate among women’s rights advocates and a priority for action within international organizations and funding agencies. The main objective of this original group was to stress the need for introducing women’s health and gender issues into mainstream health professions education.1
The group attempted to stay in communication and to keep women’s health on the agenda of The Network: TUFH. However, it was difficult to maintain momentum between annual meetings. The group continued to meet and explore mutual interests but it was not until 2002 that financial resources were obtained to support the formal creation of the WHTF. The Taskforce was fully recognized as part of The Network: TUFH at the Kenya 2002 conference. This provided an opportunity for the Women and Health Group to expand.
The significance of the WHTF is the south-south collaboration to improve health professions education and health outcomes for women.2 The group unites leaders in women’s health and higher education and currently has over 20 members from different regions and countries around the world.3 The Network: TUFH provided a natural organizational platform to the WHTF.4
The WHTF has been an active and growing forum for the exchange of ideas and development of strategies and resources for women’s health. Its vision addresses the complex nature of the issues in this field, including social and gender inequalities. The main objectives of the Taskforce are to:
- teach current and future healthcare providers the skills and knowledge necessary to recognize and address the multiple determinants of women’s health
- encourage students and universities to partner with women’s groups and community organizations to promote grassroots solutions for responding to women’s health needs
- create opportunities and strengthen inclusion of women’s human rights and gender issues at health sciences schools
- cultivate leadership skills among female health professions students
The goal of the WHTF is to improve access to high quality and appropriate healthcare for women, particularly in developing countries, through the training of health professionals who are prepared to serve as qualified caregivers and advocates for women’s rights.
The WHTF has been supported through the collaboration between three organizations: Global Health through Education, Training and Service (GHETS), which provides administrative coordination, funding and technical assistance;5 the University Sains Malaysia, which obtained and managed startup funds; and The Network: TUFH.
Why is Women’s Health an Important Issue?
The need to improve women’s health status was initially recognized in the late 1970s. Major global forums on women include the 1979 Convention on the Elimination of All Forms of Discrimination against Women, the 1987 International Conference on Safe Motherhood, the 1994 Fourth International Conference on Population and Development (ICPD), the 1995 Fourth World Conference on Women (FWCW) and the 2000 Millennium Summit. Two of these conferences, the ICPD held in Cairo and the FWCW held in Beijing, were the first global forums where agreement was reached that women’s rights should be fully recognized as human rights. These conferences recommended a new orientation for population policies in developing countries and provided a new integrated framework for women’s health issues. The ICPD recognized reproductive rights as part of fundamental human rights and called for universal access to services by 2015. The FWCW validated the ICPD recommendations using a broad definition of women’s health in its Platform for Action:
“Women have the right to the enjoyment of the highest attainable standard of physical and mental health. The enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women’s health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology. However, health and well-being elude the majority of women. A major barrier for women to the achievement of the highest attainable standard of health is inequality, both between men and women and among women in different geographical regions, social classes, and indigenous and ethnic groups…” (United Nations, 1995).
Despite the global consensus on this broad definition of women’s health, policies and programs in developing regions continue to focus on women of reproductive age. However, even progress in reproductive health has been slow and limited.6 Gender equality is an unfulfilled promise and the health problems affecting millions of women around the world continue to be neglected (United Nations Population Fund, 2004; 2005; 2007). This neglect is particularly true for women in other stages of life – early adolescence, climacteric and old age - and ignores the fact that not all women are mothers and that their health needs go far beyond reproduction and motherhood.
Women’s health conditions differ widely among and within countries and are worse in the less developed regions of the world. The health status of women is severely impaired in societies where women are not valued, as well as by conditions of poverty, political conflict, migration, environmental degradation and natural disasters. According to international data, key issues in women’s health include:
- Violence against women is a social and public health problem in all countries and socioeconomic environments and evidence suggests that it is more far-reaching than previously believed. Between 10-15% of women have suffered physical violence from their male partners and 12-25% have experienced rape or attempted rape in their lifetimes (De Bruyn, 2003).
- Every year, more than 120 million couples have unmet needs for contraception and 80 million women experience unintended pregnancies. One third of pregnant women have no access to reproductive healthcare services and only about 60% of all deliveries are attended by skilled practitioners (Glasier et al., 2006).
- Annually, more than half a million women die from preventable obstetric causes: obstructed labor, unsafe abortion, hemorrhage, sepsis and pregnancy-related hypertension. Of the estimated 536,000 maternal deaths in 2005, developing countries accounted for 99% of the total (World Health Organization, 2008a).
- Nearly 66,000 women die following unsafe abortions each year, accounting for 13% of all maternal deaths (World Health Organization, 2007).
- Each year, an estimated 14 million adolescents (5-19 years old) give birth. Girls face multiple barriers to contraception and those living in developing countries face the highest risk of adolescent pregnancy. Most adolescents who become pregnant are married, but for many others pregnancy results from rape or coerced sex. Adolescent girls are twice as likely to die during pregnancy and childbirth as older women, and for those under 15 the risk is five times higher (Rowbottom, 2007).
- An estimated 33 million people were living with HIV in 2007. Women account for half of all HIV infections (United Nations, 2008). In countries severely affected by HIV, the AIDS epidemic is thought to have reversed progress in maternal mortality (Ronsmans & Graham, 2006).
- Cervical cancer is the second most common cancer in women, with 273,000 estimated deaths in 2002. Most cases (83%) occur in developing countries where they account for 15% of female cancers, compared to 3.6% in developed regions (Gakidou et al., 2008). Estimates indicate that 45% of breast cancer cases and 55% of breast cancer-related deaths will take place in low and middle income countries in 2009 (Porter, 2009).
- An estimated 100 to 140 million girls and women suffer the consequences of female genital mutilation. Annually, 3 million girls are at risk for this practice in Africa alone (World Health Organization, 2008b).
- At the end of the 20th century, 450 million adult women in developing countries were stunted as a result of chronic protein-energy malnutrition during infancy and childhood (The World Bank, 1997). Anemia is one of the most common nutritional problems among women in these countries, with rates from 20-40% for all women and 40-60% for pregnant women (World Health Organization, 2000).
- Overweight and obesity are becoming critical nutritional problems among women in a number of developing countries. Obesity increases women’s risks for serious chronic non-communicable diseases: diabetes, cardiovascular diseases, metabolic disturbances, certain types of cancer, osteoarthritis and psychological disorders (Monteiro et al., 2004). Obesity has also negative effects on women’s reproductive health: adverse pregnancy and childbirth outcomes, hormonal disorders and infertility and increased risk of gynecological cancers, among others (Lederman, 2001; Grimes & Shields, 2005).
The Work of the Women and Health Taskforce
Membership in the WHTF is based on commitment to its goals and objectives. A five member Management Committee is elected by the WHTF members. This group provides continuity between Network: TUFH meetings through teleconferences, planning, project development and review of mini-grant proposals and fellowship applications.
The WHTF has become an active and growing presence within The Network: TUFH. Since 2003, it has provided support for specific thematic poster sessions on Women and Health. In 2006, members of the WHTF organized and coordinated the pre-conference workshop “Social Accountability: Experiences of the Women and Health Taskforce,” at the Network: TUFH conference held in Ghent, Belgium. At the 2008 annual meeting in Bogota, Colombia there were four poster sessions and two mini-workshops, as well as two WHTF meetings. GHETS has provided fellowships for faculty and students to present at Network: TUFH conferences, as well as support to participate in a variety of local and regional meetings. The fellowships have been critical for ensuring global representation at the WHTF annual Network: TUFH conferences. They have also engaged students in women’s health issues early in their careers and provided them with role models from many professions and regions of the world.
One of the most important initiatives of the WHTF is the Women and Health Learning Package (WHLP), an online, flexible and free learning resource for use by educators, health providers and health sciences students worldwide.7 This resource currently includes a series of fourteen learning modules on different topics. Each module has an introductory section containing a brief description about its underlying educational philosophy; the rationale for teaching about the social determinants of health; an overview of recommended learning methods and illustrative case studies; and formats for collecting feedback from both students and tutors.
There have been two editions of the WHLP and a third will be available in 2009. The third edition will include updated versions of the current modules and 3-5 new modules. Additional case studies will be added for each module to provide examples from different regions of the world.8 Table 1 shows the topics, authors and institutions involved in preparing the first fourteen modules.
Table 1: Learning Modules of the Women and Health Learning Package
The learning modules were developed by individuals and teams from universities around the globe. They reflect the priorities of local women’s health advocates and the realities that health providers encounter in the countries represented. These modules are, first and foremost, part of an effort at many universities to change the way in which knowledge about women’s health is understood and transmitted to health professions students. Therefore, the modules were designed to help students acquire a wider perspective on health issues that are often considered difficult to address due to cultural, ethical, legal or political considerations.
Each learning module contains author information; a global, regional and country-specific overview of the topic; bibliographical resources and recommended websites; case studies; and tutors’ and students’ notes for guiding discussion on the case studies. The modules are all written in English and were conceived as flexible educational resources to be adapted, translated, modified or supplemented to meet local needs, and especially to meet the specific learning needs of students. Because the WHLP was intended as a dynamic resource that will continue to grow and evolve, tutors and institutions using the modules are requested to share any translations, additional or modified case studies or new versions of the modules.
In 2003, the WHTF Management Committee selected seven universities to pilot programs utilizing the WHLP. Programs were implemented in 2004-2005 with GHETS technical assistance and funding ($1200 USD mini-grants) in order to increase awareness and document the effectiveness of this resource in a variety of cultural settings. Since 2003, 17 pilot programs have been funded. In 2008, four universities were selected and supported. Additionally, in 2005-2009, some modules were implemented in community-based projects designed by five universities (Table 2).
Table 2: Pilot Programs Utilizing the Women and Health Learning Package (WHLP)
An implementation and evaluation workshop for the first seven pilot teams took place at the 2004 Network: TUFH annual conference in Atlanta, Georgia, USA. The final reports of the seven projects were presented during a workshop at the 2005 Network: TUFH annual conference in Ho Chi Minh City, Vietnam.9 Each pilot institution measured the impact of the modules and case studies on their students’ understanding of women’s health issues. The modules were assessed for their effectiveness and adaptability for introducing key women’s health topics into health professions education. The evaluation workshop provided an opportunity to discuss implementation issues and to foster an international dialogue on the relevance of teaching critical and often controversial subjects.
Highlights about current GHETS funded projects are presented in Figure 1. Figure 2 shows comments from participants in workshops implemented by members of the WHTF in community and university settings.
Figure 1: Highlights on Current Community-based and University Projects
Figure 2: Comments About the Women and Health Learning Package (WHLP) from Curriculum Participants
Outcomes and Future Challenges
The WHTF has fostered dialogue between health professions schools from all regions of the world and increased awareness of women’s health issues in The Network: TUFH. It created the WHLP fourteen learning modules through a formalized review, update and revision process and is currently providing support for the development and review of new modules. This process allows for the inclusion of more countries and institutions and broadens the scope and impact of the WHLP. Another outcome was the translation and adaptation of some of the cases and the current initiative to develop more regional case examples. These materials are available on the webpage and include WHLP modules, manuals, translations, links to other sites and an evaluation form. The WHLP is also available as a CD-ROM. Over 450 faculty, students and community organizations have received copies of the WHLP. An evaluation of the use of the modules is currently underway.
There were many other outcomes of the WHTF: 1) a listserv which provides for ongoing, active participation and discussion of WHTF and WHLP; 2) faculty development through pilot project training and Network: TUFH sessions (workshops, poster sessions and informal discussions); 3) inclusion of the modules in curricula at many institutions in all regions; 4) dissemination of WHLP and WHTF model through brochures, the website and presentations at international and regional conferences; 5) development of an evaluation tool for the WHLP; and, 6) an evolving research network with an initial focus on how health professionals screen and treat gender-based violence.
Challenges include identifying sources of funding to provide basic staff support and technical assistance to keep the WHTF projects on track between annual meetings; finding startup money for new projects; and better documentation of the use of modules and the impact on faculty, students, practicing health professionals and communities. The last point is made more complex by the variety of schools and countries and the fact that educators are often more interested in implementation than evaluation.
Elements that contributed to the success of the WHTF were participatory learning and group cohesiveness; participation by students, faculty and communities; and cross-cultural and interdisciplinary collaboration.
The WHTF provides a model for other initiatives to support development of health professions awareness, curriculum development and community education on important under-recognized health issues. The WHTF demonstrates the effectiveness of south-south educational collaboration and has been a driving force in bringing attention to women’s health issues in health professions education and community health.
New members are welcomed to the work of the Taskforce. They can subscribe to the listserv through the website and/or participate through the activities at the annual Network: TUFH meetings.
The authors would like to acknowledge the work of the WHTF Management Committee (Rogayah Ja’afar, University Sains Malaysia; Nighat Huda, Ziauddin Medical University, Pakistan; Mohamed Moukhyer, Ahfad University, Sudan; Sarah Kiguli, Makerere University, Uganda; and, Hester Julie, University of the Western Cape, South Africa) and all members of the WHTF. In addition, the support of GHETS staff Jessica Greenberg, Bridget Canniff, Rachel True, Marion Billings, Julia Dettinger, David Egilman and Fernando Mora was critical to the work of the WHTF presented in this paper.
1. The original Women and Health Group was led by Professor Rogayah Ja’afar, University Sains Malaysia, head of the WHTF Management Committee from 2002 to 2005. The current head is Professor Nighat Huda, Ziauddin Medical University, Pakistan, who was also part of the original group. Special recognition is also given to Jessica Greenberg, Bridget Canniff, Rachel True, Marion Billings and Julia Dettinger, GHETS staff whose hard work and commitment were essential to the creation and development of the WHTF since 2002.
2. South-south collaboration refers to the process of collaboration between developing countries in contrast to more traditional north-south collaboration between developed and developing countries.
3. Egypt, India, Iran, Kenya, Malaysia, Mexico, Pakistan, Philippines, South Africa, Sudan, Uganda, Nigeria and the United States of America.
4. The Network: TUFH “… is an international organization of academic health professions institutions and organizations promoting equity in health through community-oriented education, research and service. It is a non-governmental organization in official relationship with the World Health Organization.” See: www.the-networktufh.org
5. GHETS “…is a non-governmental, non-profit organization based in the USA, dedicated to improving health in developing countries through innovations in education and service… provides startup grants to local training institutions in low-income countries, and the technical help to launch and improve programs that prepare and support healthcare workers in rural and poor communities.’ See: www.ghets.org
6. See: Countdown 2015. Sexual & reproductive health & rights for all. Special report. ICPD at ten: Where are we now? New York, NY: Population Action International / Family Care International / International Planned Parenthood Federation, 2004; United Nations. Agreed conclusions of the Commission on the Status of Women on the critical areas of concern of the Beijing Platform for Action. New York, NY: United Nations, 2006.
7. The creation of this educational resource was possible with the participation of a large list of contributors that includes authors, reviewers and editors. The WHLP is available for free download at The Network: TUFH and GHETS websites: www.the-networktufh.org / www.ghets.org Institutions in developing countries that are unable to download the WHLP from the web-based version are encouraged to request a free copy on CD-ROM. Distribution of free copies is managed by GHETS.
8. Support for the production of the WHLP was provided by the Network: TUFH, GHETS, University Sains Malaysia and Global Knowledge Partnership.
9. Funding for the WHTF workshop held in Vietnam was provided by Global Health Partnerships.
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