Kate Bourne is IWHC's Vice President for International Policy and Regional Programs.
In the United States, we have long expected corporations to be accountable to their employees by providing health insurance for workers and their families. Recently, around the world, the framework of corporate responsibility has expanded to include not only a company's employees, but also surrounding communities.
Investing in women's health and rights is a key mechanism for promotion of corporate accountability, as well as one of the best investments that businesses can make.
More women are living with HIV/AIDS today than ever before – but HIV is only one factor in women's health. In total, sexual and reproductive ill health (which has been around for much longer than HIV/AIDS) accounts for an estimated one-third of the global burden of illness and early death borne by women of reproductive age, which basically corresponds with prime working age.
The aspects of girls' and women's lives that put them at serious risk of HIV/AIDS are the same ones that undermine their sexual and reproductive health in general: lack of quality health services and information; and basic and fundamental gender inequity and practices which violate the rights of women and girls, such as violence, sexual coercion and child marriage.
In order to improve women's health, businesses can increase their investments in three areas: Improved access to and quality of clinical services; factual information on reproductive health, including preventing pregnancy, sexually transmitted infections (STIs) and HIV/AIDS for women and men – young and old; and empowering women so they can control their own lives.
First, sexual and reproductive health services are the health services most women use. It's also where they take their children for early care. Addressing HIV – which is primarily a sexually transmitted disease – within these existing services is essential if we're going to make any real progress in combating the pandemic.
There is plenty of evidence about the cost effectiveness of reproductive health services, primarily because they have multiple benefits, including reducing poverty and hunger, ensuring educational opportunities and gender equality, higher productivity, and attaining environmental sustainability.
An investment of $66 billion per year for basic maternal and newborn care would lead to a savings of more than $360 billion per year by 2015. In the United States, when we think of maternal and newborn care, we typically visualize incubators, and other very high tech measures. But in much of the world, it is very basic interventions – prenatal and trained obstetric care – that are needed to be able to save millions of lives.
I was just visiting rural clinics in Udaipur, India where maternal mortality has been reduced by simple actions, including setting up reliable transportation links for emergency obstetric care – not buying ambulances – just making an arrangement with the local taxi service that ensures that women will be transported even if they don't have the cash on hand. There are many other reproductive health interventions that are similarly simple – but the will and the way have not yet made them happen.
Investments are also needed to make sure that women and men – young and old – have factual information on reproductive health, including preventing pregnancy, STIs and HIV/AIDS.
In many parts of the world, awareness of HIV/AIDS is still low. Even in regions where basic awareness is high, as in much of Africa, people still have many misconceptions about who is at risk, how to protect themselves, and where to go for help. Ironically, those who need information the most have it the least.
Women who are married or in stable partnerships in which they are monogamous tend to have a particularly low level of knowledge, and they are now among the groups with the most rapidly rising rates of infection. And young men and women tend to lack even basic information about pregnancy prevention. But we also need to go beyond basic biology to provide information about sexuality, rights, and responsibilities within relationships.
Employers can easily provide health education programs for employees, or ensure that counselors are available to answer questions. Even a small enterprise that doesn't have the capacity for clinical services can provide its workers with information and ensure that they know where to go for further help. Non-governmental organizations in virtually every country are available to work with businesses, vocational schools, and in communities of workers to provide information and shift normative behavior to healthier – and happier – models.
Finally, to fundamentally improve women's health, women need to have more control over their own lives and men need to be supported to take full responsibility for their own behavior. Business already affects these relationships. When women are employed and earning income, the power dynamics in a relationship or family shift. Some aspects of this are positive – women gain more say over what happens and how family resources are spent, and this benefits the health and well-being of the family. But it can also be disruptive when men don't know or respect it, or when men are the ones who are employed, often far from home.
One of the ugliest manifestations of gender inequality is violence against women. At first glance this may seem to be a social issue beyond what we can expect business to engage on. But, the health burden of violence against women of reproductive age is equal to that of HIV, TB, cancer and heart disease combined. Now, that has got to be expensive for business as well as for societies.
Business has an important role to play in helping employees and their families to adopt positive patterns of life. At a minimum, business leaders can decry violence against women and children, and provide role models for equitable, respectful relationships. They can sensitize on-site health services and provide counseling or legal assistance.
Violence, HIV, maternity care, contraception – all are crucial issues in women's health. The healthier women and girls are; the more ingenuity, creativity, and vitality will flourish; the more children will grow into healthy, productive citizens; and the more economies – and businesses – will thrive.