Of all the factors that influence a woman’s health and success, none is more important than education. And the good news is that more girls and women across the globe have access to education than ever before. But the progress has been incomplete and uneven, with parts of Southeast Asia and Africa lagging far behind the rest of the world. More work needs to be done.
Every day, somewhere between 60 and 70 million girls are not in school. More than half a billion females worldwide are illiterate—about twice the number of illiterate males. It would be difficult to overstate the challenges these women face: a lifetime of lower income, poorer health outcomes – including higher risk of HIV infection and other diseases -- and higher rates of mental illness. Uneducated girls also are more likely to become child brides or trafficking victims, bear children while they are still children themselves, and see those children grow up in poverty.
Statistics show the gender gap in education is narrowing worldwide, reflecting concerted efforts to educate women and girls. However, as of 2015, fewer than half of all countries had achieved gender parity in enrollment for both primary and secondary education.
Similarly, we’ve seen significant improvement in women’s health in recent years. For example, maternal deaths – deaths caused by complications of pregnancy or childbirth – declined from 532,000 in 1990 to 303,000 in 2015. But the developing world still accounts for 99 percent of the total, and progress has slowed in recent years. Two-thirds of those deaths (201,000) occur in sub-Saharan Africa, and 22 percent (66,000) in Southern Asia. It is not unsurprising that geographies with high maternal deaths rates also have low rates of educating girls.
Maintaining and expanding education for women and girls will play a critical role in driving continued improvement in female health outcomes. In many poor countries, HIV/AIDS is the leading killer of women of reproductive age. Better educated women and girls are more likely to use contraception, which helps them avoid diseases, to delay childbirth, and to wait longer between pregnancies. Education also helps improve prenatal and postnatal care, reducing the risk of infant mortality and complications from pregnancy, which in turn leads to healthier, more stable families.
Worldwide, educated women play an important role in the birth process itself. Particularly in poor and remote areas, female midwives may be the only health care provider a pregnant woman sees, and this basic level of care can drastically improve the odds of a safe delivery and a healthy baby. Yet these overworked midwives and other health providers typically face dire conditions and desperately need more support. Often lacking infrastructure and technical skills and due to an extreme sense of responsibility, many can suffer a range of feelings from guilt, anxiety, fear, complacency, powerlessness or inadequacy. To not only catalyze but to also sustain change, both in behavior and practice, we must recognize and address these understandable human emotions as they can become barriers to doing one's best to care for mothers and their newborns.
Many governments now recognize the importance of providing trained support for pregnant women in poor communities. For example, India boosted the number of pregnant women who delivered their babies in a healthcare facility from 39 percent in 2005 to nearly 75 percent today. The country’s National Rural Health Mission provided cash payments to entice expectant mothers who would otherwise deliver at home, where they would not have had the benefit of a skilled birth attendant. However, the success of this program also underscores the critical need for more trained health care workers. According to a report published by the World Health Organization (WHO), poorer Indian states like Bihar and Uttar Pradesh face a shortage of more than 500,000 health care workers, compounding feelings of hopelessness and isolation by frontline care providers entrenched in the overwhelmed system. Until quality improvement efforts are coordinated across the entire health care system, addressing the demands on resources, and the intrinsic factors of health care provider motivation, many laboring women will continue to experience poor outcomes.
Many factors contribute to maternal health outcomes. Ongoing wars, natural disasters and economic downturns make further gains difficult, as do inconsistent international aid commitments. But it’s clear that educating women and girls can have a profound and lasting impact. Equipping girls with the knowledge to improve their own health and economic prospects helps multiply the impact of investments in public health programs. We should endeavor to provide every woman and girl with that kind of future.
Dilys Walker, MD, is Obstetrician Gynecologist, Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive at the University of California San Francisco and founding member of PRONTO International.