18th June 2024 by Mandeep Singh Bhandari | Healthcare
The 1993 World Development Report by the World Bank, titled "Investing in Health," underscores the intrinsic and instrumental significance of health for societal development. Following this, the International Conference on Population and Development (ICPD) in 1994 shaped a transformative consensus encapsulated in the "Programme of Action," a seminal document advancing women's rights globally. This landmark accord addressed reproductive health rights, gender equality, and maternal and child mortality, setting the stage for the United Nations Population Fund (UNFPA) and laying the groundwork for the subsequent Millennium Development Goals (MDGs).
Over two decades post-ICPD, research has increasingly recognized the pivotal role of health investments in fostering economic growth through diverse channels such as labor, productivity, education, and age structure. As the MDGs conclude and the 2030 Agenda for Sustainable Development takes center stage, health remains a vital component, albeit with a nuanced focus. This study endeavors to distill contemporary evidence on the intricate connections between gender, health, and economic well-being, contributing to the evolving discourse on the new development agenda.
While diseases impact both genders, societal and biological factors expose women and men to distinct health risks and barriers. Recognizing these variations, we contend that a gender perspective is crucial for a nuanced analysis of the relationship between health and economic outcomes. This perspective becomes particularly evident in the disparities highlighted by the Global Burden of Disease Study, where maternal mortality in developing countries is 19 times higher than in developed nations, underscoring pervasive health inequities.
The study seeks to extend beyond existing reviews by delving into the economic benefits of life-long investments in women's health. It broadens the scope to encompass fertility, intergenerational health spillover, education, productivity, and savings as outcome variables. By examining both interventions related to women's health and the repercussions of neglecting these interventions, the research aims to provide a comprehensive understanding of the economic implications intertwined with women's health.
The landscape of women's health care in the United States presents a narrative of divergence, where the multitude of life paths available to women contrasts starkly with the somewhat stagnant delivery of health services. In comparison to previous generations, today's women find themselves at crossroads with an expanded array of life choices, each presenting distinctive health care needs. Regrettably, the traditional medical system, primarily fixated on isolated problem-solving, stands as a somewhat disjointed companion to the evolving and diverse requirements of the modern woman.
The dissatisfaction stems from a system ill-equipped to provide a comprehensive approach that aligns with the multifaceted needs of contemporary women. Navigating this labyrinth proves equally vexing for both healthcare providers and patients, who harbor a preference for a more integrated model. The stumbling blocks are manifold: a dearth of time, inadequate training, and limited access to essential infrastructure and resources leave physicians grappling with the challenge of offering holistic solutions.
Consequently, women seeking a more integrated health care experience find themselves engaged in a complex dance of assembling services from disparate providers. This conundrum persists whether the care sought pertains to general medical conditions like heart disease or more female-specific concerns. A glaring example surfaces during pregnancy, where women must orchestrate a network of providers to access birth, lactation, postpartum, and mental health services. This intricate process, demanding time and energy, becomes an added burden for women already juggling responsibilities at home and in the workplace, leaving them with insufficient bandwidth to navigate this convoluted maze independently.
Education and Women’s Health, The effect of improved women’s health on education works primarily through fertility and intergenerational health channels, as discussed previously. However, looking at school achievement and economic productivity, the Institute of Nutrition of Central America and Panama (INCAP) studies found that nutritional supplementation increased years of schooling significantly (by 1.2 grades) for women, but not for men . Both men and women exposed to Atole, the nutritious supplement, within the first two years of life showed improved comprehension and intelligence scores, independent of schooling [142]. Another effect of Atole exposure was a 46% increase in average wages for men, but not for women; one explanation for the difference is that fewer women than men engaged in income-generating activities . In Sri Lanka, Jayachandran and Lleras-Muney find a dramatic reduction in maternal mortality risk (70%) between 1946 and 1953 to be associated with increased investments in girls’ education . Using Chinese data, Sun et al. estimate that a 0.1% decline in the maternal mortality rate would reduce the female illiteracy rate by 6.1–12.8% . A study from rural Pakistan indicates that improved nutritional status increased school enrollment for children, in particular among girls, thereby reducing the gender gap in school enrollment
The ramifications of a woman's health stretch far beyond her individual lifetime, resonating profoundly in the health and prosperity of subsequent generations. Maternal health emerges as a pivotal determinant with sweeping implications, influencing aspects ranging from birth weight and neonatal survival to cognitive development, child behavior, school performance, and eventual adult health and productivity. Victora et al.'s insightful review delves into the intricate associations between maternal and child undernutrition, revealing a ripple effect that extends to adult health and human capital, emphasizing the imperative of preventing childhood ill health for accruing "important health, educational, and economic benefits."
The exploration of this intergenerational dynamic unfolds against the backdrop of Barker's groundbreaking assertion in 1995, introducing the fetal origins hypothesis that links coronary heart disease to fetal undernutrition during middle to late gestation. Famine studies, notably Dutch and Chinese, serve as natural experiments, unveiling enduring consequences of poor fetal growth, encompassing risks of malnutrition, stunting, hyperglycemia, type 2 diabetes, cardiovascular disease, and premature mortality. Remarkably, fetal exposure to acute maternal malnutrition echoes into adulthood, impacting literacy, income, labor market status, and marriage market outcomes.
Micronutrient deficiencies, anemia, and maternal undernutrition contribute to a myriad of adverse outcomes for both mothers and their offspring. Insights from a comprehensive Guatemalan study by the Institute of Nutrition of Central America and Panama (INCAP) underscore the lasting effects of nutritional interventions during early childhood, revealing taller adolescents with greater lean body mass due to sustained supplementation. Notably, maternal malnutrition, whether perceived as undernutrition or overnutrition, leaves an indelible mark. Maternal obesity, explored by Cresswell et al., increases neonatal death risk in multiple African countries. In South Africa and Brazil, children of overweight mothers face a significantly elevated risk of obesity, emphasizing the critical role of maternal health in shaping future generations. While the exact mechanisms of improved maternal nutrition's impact on child health remain complex, evidence suggests a dual benefit. Enhanced maternal nutrition not only contributes to economic development through improved human capital accumulation but also ensures a healthier trajectory for future generations. Studies from Tanzania and the Chinese famine era affirm the link between maternal nutrition interventions and additional years of schooling, with notable gender-specific effects. As we navigate the complex terrain of maternal health, it becomes evident that investing in the well-being of women holds the promise of a healthier, more prosperous future for all.
Fertility Dynamics and Socioeconomic Impact: Unraveling the Demographic Dividend, the intricate relationship between fertility rates and economic growth unfolds as a complex narrative, particularly when viewed through the lens of the demographic dividend, as explicated by Bloom, Canning, and Sevilla. The transition from high to low mortality and fertility rates propels a unique demographic bulge, creating a "boom" generation that, when coupled with sound policies and ample labor opportunities, becomes a catalyst for economic prosperity. Despite the challenging task of quantifying the economic gains linked to reduced fertility due to the multifaceted nature of developmental processes, attempts by Ashraf et al. suggest a substantial boost in per capita income over varying time horizons.
The impact of women's control over their fertility becomes evident in U.S. studies, where access to contraception and family planning emerges as pivotal for educational and employment opportunities. Goldin and Katz underscore the transformative influence of oral contraception, correlating its availability with delayed marriage age and increased pursuit of higher education and professional careers by women. Family planning programs not only shape national income through long-term effects on household finances but also enhance access to education, with children from areas with greater family planning accessibility exhibiting higher educational attainment and residing in higher-earning households.
Beyond economic implications, family planning plays a crucial role in better-planned pregnancies and healthier babies. Access to birth control aligns with delayed maternal age at first birth, increased women's participation in paid labor, augmented annual working hours, and a notable reduction in birth rates. Remarkably, family planning services two years before pregnancy have been associated with a lower likelihood of delivering low birth weight babies, particularly significant for African Americans.
The nuanced role of abortion as a proxy for fertility control reveals its influence on education and productivity. Abortion legislation and access impact educational and labor market achievements, as demonstrated by the Romanian abortion ban in 1967. The availability of legalized abortion, exemplified by the Roe vs. Wade case, not only provides women the option to avoid unwanted pregnancies but also bolsters labor force participation rates, especially among African American women. Cross-country studies further illuminate the negative impact of high total fertility rates on female labor force supply, emphasizing the role of abortion restrictions in shaping fertility dynamics. The global perspective echoes the societal benefits of improved reproductive health services, particularly in low- and middle-income countries (LMICs). Evidence from Bangladesh and Ghana indicates a positive correlation between improved access to reproductive health services and enhanced women's earnings, assets, and decreases in fertility. Interestingly, these interventions also showcase positive spillover effects, improving the health of elderly women in households. As societies grapple with demographic transitions, fertility remains a complex interplay of factors, with reproductive health services emerging as a crucial lever for socio-economic advancement.
In the realm of women's health, menopause care has long been a neglected frontier. Historically limited to hormonal therapy for addressing acute symptoms like hot flashes, today's understanding of menopause is evolving. A deeper recognition of its connection to everyday issues such as insomnia, fatigue, brain fog, and weight gain is reshaping the narrative. Left unattended, these symptoms can catalyze metabolic changes, rendering menopausal women more susceptible to conditions like osteoporosis, diabetes, and heart disease, posing a substantial burden on the healthcare system. Despite the pervasive impact of these symptoms, the attention they warrant remains disproportionately scarce, a lamentable oversight considering that the average woman spends over a third of her life in the peri- to postmenopausal stage.
In this landscape, the leaders will emerge as those who provide comprehensive solutions, addressing both hormonal and nonhormonal symptoms of menopause to avert negative health consequences proactively. The winning approach involves an integrated strategy, incorporating customized dietary and lifestyle changes alongside hormone therapy and routine screening for metabolic health issues. Empowering menopausal women, these companies will offer digital access to a supportive community of peers and professionals for education and assistance. Crucially, as menopause impacts women assuming senior leadership positions while navigating the demands of parenting and caring for aging parents, providers must develop solutions that confront the issue head-on.
A wave of companies is already stepping up to meet the demand for targeted menopausal care. Gennev, recently acquired by UWH, operates as a virtual clinic delivering integrated menopause management, featuring access to OB/GYNs, dieticians, and more. Elektra Health, a digital platform, provides education, telemedicine, personalized support, and a community of menopausal women. Apps such as MenoLabs’s MenoLife and Chorus Health’s Caria are also making strides in helping women manage menopausal symptoms. This collective effort signifies a transformative shift in menopause care, heralding a new era where the unique health needs of menopausal women are addressed comprehensively and with the attention they rightfully deserve.
Our exhaustive systematic review of existing literature on women's health and economic development yields four key conclusions that underscore the pivotal role of women's well-being in shaping thriving societies. Firstly, the positive correlation between women's health and societal productivity is unmistakable, with healthier women contributing to better-educated and more productive communities. Secondly, the empowerment of women in controlling their own fertility emerges as a catalyst for accelerated economic growth and development. Thirdly, the far-reaching impact of maternal health on subsequent generations, through intergenerational spillovers, establishes its critical significance for the health and economic well-being of future populations. Lastly, the pressing need for further investigation into the intricate connections between women's health and household and societal productivity is emphasized.
While the short-term perspective often centers around men as family breadwinners, the long-term perspective intricately ties the health of women to the foundational health and development of forthcoming generations. This study shifts the narrative from viewing women's health solely through the lens of human rights and social equity to establishing a direct link between women's health and productivity. The reviewed studies consistently underscore the symbiotic relationship between deliberate family planning, maternal health, and the subsequent health and productivity of the next generation, creating a self-perpetuating cycle of societal development.
Mothers, as the progenitors of the workforce of the next generation, play a fundamental role in shaping the trajectory of societal development. Healthy workers, both physically and emotionally, tend to be more productive, further emphasizing the intricate connection between health and productivity. A noteworthy aspect that requires additional scrutiny is understanding how health impacts the productivity of men and women differently, an area increasingly gaining attention in the expanding body of literature.
The implications of these findings are clear: investing in initiatives that address women's health is not only a moral imperative but a strategic one. Societies that prioritize and invest in women's health are poised to enjoy better overall population health and sustained productivity across generations. This study serves as a compelling call to action for informed and targeted investments in women's health for the enduring prosperity of societies worldwide.
Research Associate
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