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Abstract

Affilia, the Journal of Women and Social Work was originally founded by a team of scholars in North America to provide a venue to share feminist scholarship with a focus on social justice. As the journal has become a home for nurturing feminist scholarship from around the world, this editorial explores the United Nations’ (UN) recent call for action to eliminate gender-based discrimination and to empower all women and girls around the world as well as social work’s role in these goals. Since the founding of the UN after the Second World War in 1945, many states from around the world have joined its membership. With the secretary-general as its chief administrative officer, the UN now represents 193 member states. The regular general assembly of the UN meets annually in September at its headquarters in New York. Among many priorities, the UN provides a forum for its member states to discuss and commit to improving social and economic conditions of people around the world. In September 2015, at the 70th anniversary of the UN, the heads of state and government representatives from all 193 member countries met in New York and adopted the 2030 agenda for sustainable development, which contains 17 sustainable development goals (SDGs; UN, 2015c). Goal 5(SDG5) is to attain gender equality and empowerment of all women and girls by 2030. The road to attaining SDG5 began 15 years earlier at the 55th General Assembly meeting of the UN in New York. At this UN session in September 2000, the heads of state and representatives from 147 countries resolved to attain eight goals by 2015, which became known as the millennium development goals (MDGs) (UN, 2000a). The third goal (MDG3) was to “Promote gender equality and empower women.” What progress have women made under the MDG agenda? What challenges remain in meeting the SDG of empowering women and girls? How should social workers respond to address the challenges and make SDG5 a reality by 2030?

Gender inequality has historically signaled attention to unequal power between men and women, with increasing attention to the fluidity of gender expression and the rights of trans and gender nonbinary individuals. Inequalities associated with being a “woman” include people who are assigned female sex from birth and who occupy female gender roles in their families and communities. People who embody female characteristics through gender expression or explicit change in their gender identity are also targets of systemic discrimination and violence. For the purposes of this editorial, I emphasize the continued salience of the gender binary as a powerful organizing social value and practice. Empowerment in the development literature refers to a process of attaining power among those who were previously powerless (Kabeer, 1999; Kabeer & Subrahmanian, 1999). Widely used indicators of empowerment include education, income, employment, property ownership, participation in politics, and ability to exercise financial, health care, and mobility choices (Kabeer, 1994, 1999; Kabeer & Subrahmanian, 1999; Nussbaum, 2000; Pandey, 2017; Pandey, Lama, & Lee, 2012; Sen, 1999; UN Development Programme, 1995). Empowerment is key to understanding a woman’s ability to decide when to get married, when to have children, and to control the number of pregnancies. Women’s early and forced marriage, restricted education, economic dependence on their husbands, constrained power to make intrahousehold decisions, and lack of access to well-paid and secure jobs are consequences of disempowerment. Mother’s health and education improve her and her children’s well-being (World Bank, 2012). Social workers around the world have the charge to empower women, so they may develop their full potentials and that of society.

In the past 15 years, MDGs energized individuals, groups, nations, and international organizations around the world to collaborate and intervene in pursuit of these bold milestones. A review of the progress shows that, on the whole, the world is a better place for women and girls today than in 1990. Maternal mortality rates are on the decline, women live longer than men in every region of the world, an increased proportion of girls are in school, more women are in leadership positions than ever before in legislatures and organizations, and more working-age women are engaged in paid labor force (UN, 2000b, 2009, 2015a, 2015b; World Bank, 2012). For example, in 1990, global maternal mortality ratio was 380/100,000 live births, with maternity complications alone claiming over 536,000 women’s lives annually (UN, 2000a, 2000b, 2009). Fast-forward 2013, maternal mortality ratio worldwide had dropped by 45% to 210/100,000 live births (UN, 2015a). Additionally, the enrollment of primary school–age children—both girls and boys—in developing countries increased from 80% in 1990 to 91% in 2015 (UN, 2015a, 2015b). A higher proportion of girls is also engaged in secondary and postsecondary education. Working-age women’s employment outside of the agricultural sector also increased; they now make up 41% of paid labor force compared to 35% in 1990 (UN, 2015a). Around the world, more women are holding decision-making positions than in the 1990s (UN, 2015a, 2015b). Yet, many challenges remain and need our attention. Overcoming these challenges will likely determine the extent to which we attain SDG5 by 2030. I highlight five interrelated challenges—three that have been with us all along and two as new and emerging. Social work as a profession can and should address these challenges to speed up the progress toward attaining gender equality and empowerment of all women and girls.

Maternal Mortality and Health Inequities

First, while we reduced maternal mortality over the past quarter century, we continue to lose about 2.34 million women and girls under the age of 60 each year; of these 1.2 million die during their reproductive years (World Bank, 2012). A closer look at these data shows that we lose about 289,000 women annually within 42 days of pregnancy terminations due to birth-related complications (UN, 2015a). These deaths contribute to health inequities because they are occurring mostly among women in developing countries. A pregnant woman in Nepal has 7 times higher risk of dying due to birth-related complications than her counterpart in the United States. A home delivery is perfectly safe when the pregnancy and birth are normal. Delivering at home, however, quickly turns fatal when women develop complications. A systematic analysis of 23 studies from 115 countries comprising 60,799 maternal deaths between 2003 and 2009 found that hemorrhage was the leading cause of maternal death, resulting in 37% of all deaths in Northern Africa, 30% in Southern Asia, and 27% worldwide (Say et al., 2014). Safe strategies to transport the mothers who develop complications to health facilities are simply not available for many rural women. This is a significant challenge. Hence, institutional delivery should be promoted to save the lives of mothers. In response to the MDGs, many developing countries have improved their infrastructure (hospitals, schools) and increased the supply of health and education facilities. They have also trained the workforce—doctors, nurses, midwives, and community health-care workers. However, demand for these services has not increased. The majority of women in countries like Nepal, India, and Bangladesh continue to deliver at home. It appears that the decision to use a health facility for delivery involves a complex set of intrahousehold, community, and structural factors that health professionals alone cannot address. Health professionals may advise pregnant women to seek an institution for delivery; once in labor, these women will need family or community members to transport them to the health institution at that critical time. Attaining SDG5 in the next 15 years will require greater imagination for solutions, innovation, and interdisciplinary work. For example, Action Research and Training for Health in Rajasthan, India, has both health professionals and social workers working jointly to improve maternal and child health. This organization is known for its sensitivity to local social and cultural nuances. In Nepal, social workers working for the UN Population Fund are engaged in the design and implementation of community interventions to increase women’s access to contraceptives and end violence against women of reproductive age.

Once women arrive at a health institution, it is important that they are treated with dignity and respect irrespective of their social position. Often women from marginalized background cannot afford to use health services; they may even experience discrimination by health institutions, discouraging them from future use of health services. Several studies have shown women’s unequal access to health services based on class, caste, and living arrangement (Bhanderi & Kannan, 2010; Iyengar, Iyengar, Suhalka, & Agarwal, 2009; Kesterton, Cleland, Sloggett, & Ronsmans, 2010; Nair, Ariana, & Webster, 2012). In Uttar Pradesh, India, women’s caste determined their likelihood of using contraceptives, antenatal care, and institutional delivery (Sanneving, Trygg, Saxena, Mavalankar, & Thomsen, 2013; Saroha, Altarac, & Sibley, 2008). One of the core competencies of social work professionals is to advance human rights and social and economic justice. Social work graduates are trained to analyze and understand different forms of social discrimination and injustice. Social workers need to engage with health professionals to understand, challenge, and solve these complex problems rooted in discriminatory social norms and inequalities. They have the skills to advocate for equal access to services regardless of caste and ethnicity. They can work with families and communities to facilitate equal access to reproductive health and institutional delivery.

Intimate Partner Violence (IPV) and Gender-Based Violence

Second, until recently, many societies around the world considered IPV against women a private matter, a social taboo to discuss in public (Hien, 2008; Hussain & Khan, 2008; Mitra & Singh, 2007). IPV is now a topic for social policy action. Many countries have begun collecting data to document IPV prevalence. We now know that about one in three women worldwide experiences IPV at some point in her life. We also know that IPV tends to peak during women’s reproductive years and that less than half of these victims ever seek professional help (Hussain & Khan, 2008; UN, 2015b). Health and social work professionals can team up with the state (Moosa-Mitha, 2016) to protect the most vulnerable women who are at risk of experiencing IPV. Social workers practicing in health settings should assert a critical role in early identification of abuse. They should also intervene to prevent and reduce abuse by mobilizing boys and girls, men and women, and engage in women-centered advocacy efforts, conduct home visitations, and mobilize other stakeholders in communities (Ellsberg et al., 2015; Garcia-Moreno, Hegarty, et al., 2015; Garcia-Moreno, Zimmerman, et al., 2015; Jayatilleke, Jayatilleke, Yasuoka, & Jimba, 2015; Jewkes, Flood, & Lang, 2015; Michau, Horn, Bank, Dutt, & Zimmerman, 2015; Samarasekera & Horton, 2015).

Additionally, discrimination and gender-based violence are more pronounced among those who do not conform to binary gender role and norms (Rashid, Daruwalla, Puri, Hawkes, & Chow, 2012; World Bank, 2015). A criticism is that the MDG3 not did not specify “all women” and the development programs in the past ignored the needs of lesbian, gay, bisexual, and transgender (LGBT) women (Mills, 2015). The SDG5 calls for an end to all forms of discrimination and violence against “all women and girls.” In the inaugural report on the global SDGs, the UN Secretary-General, Ban Ki-moon called for “collective global action” to attain gender equality and “fulfill the pledge of the 2030 Agenda to leave no one behind” (UN, 2016; p.2). Under the SDG5, the states are charged to develop and implement programs to empower all women and girls, including the LGBT. The World Bank (2015) has developed a resource guide to work with the LGBT women around the world. It outlines examples of progress made in different countries to assert LGBT community’s rights. For example, in 2008, India’s Tamil Nadu state developed a Transgender Welfare Board, whose members are mostly transgender community leaders, to help them better access government social policies and to protect them from discrimination and violence. Social workers can use evidence-based practices to empower all women and girls. For example, they can work with policy makers to decriminalize homosexuality or nonnormative gender identities and expressions and prevent discrimination and violence against them.

Child Marriage

Third, the age-old practice of girl child marriage has now come under greater scrutiny for the right reason. Historically, child marriage was a common practice, perhaps, since the beginning of the institution of marriage. The Ancient Rome came up with age cutoff for marital consent; they regarded the minimum age for marital consent as 14 and 12 for boys and girls, respectively, which was subsequently adopted by the Catholic Church, English civil law, and by default, the colonial America (Dahl, 2010). Worldwide, while child marriage is declining, about 14 million girls under the age of 18 are currently married annually, even before they have had a chance to understand sexual and reproductive health (UNFPA, 2012). In the United States, about 8.9% of women’s marriages occur before age 18 (Le Strat, Dubertret, & Le Foll, 2011). In some countries of Southern Asia, somewhere between 50% and 70% of girls are married before age 18 (Hampton, 2010; Nour, 2009; Pandey, 2017; Raj, 2010). These girls are married as children as a part of the tradition; many are forced into marriage (Kopelman, 2016; McFarlane, Nava, Gilroy, & Maddoux, 2016; Sabbe et al., 2013; Salvi, 2009). Regardless of how and why girl child marriage persists, the practice of child marriage has adverse consequences on women and girls. These girls not only are at a higher risk for IPV and maternal mortality but also miss out on their childhood, education, intellectual development, and an opportunity to attain financial independence in their lifetime (Babu & Kar, 2010; Hampton, 2010; Koenig, Stephenson, Ahmed, Jejeebhoy, & Campball, 2006; Lloyd & Mensch, 2008; Nour, 2006, 2009; Ouattara, Sen, & Thomson, 1998; Pandey, 2016; Raj, 2010; Raj et al., 2010; Speizer & Pearson, 2011). It will be difficult to attain gender equality until we allow little girls to enjoy their childhood. While many countries now have national laws prohibiting child marriage of girls, cultural practices seem to trump the implementation of these laws and thus little girls are married illegally (Pandey, 2017). Recognizing child marriage as a problem is the first step in the right direction. Now that we know its prevalence and consequences, we can begin to explore ways to eliminate child marriage. Helping communities maintain vital statistics—registration of births and marriages will make it easier to monitor the implementation of child marriage prohibition laws (Pandey, 2017). Social workers can also organize girls, boys, their parents, local priests, and community members to influence the decisions to delay the marriage of girls until they attain legal age. In far-western Nepal, the UNFPA-Nepal, that has several key staff social workers, has found it easier to attack child marriage by working with local priests and astrologers. Other efforts are also going on to organize girls and boys.

Demographic Imbalance Around Gender

As we advance toward 2030, we also need to address some emerging challenges. An imbalance in sex ratio and lack of institutional structures to support rising single motherhood are two significant new challenges. An imbalance in the sex ratio is a relatively new problem. We are witnessing, for the first time, gender imbalance in an unprecedented manner, resulting from multiple drivers (sex selection, neglect of female infants). As of 2015, there were 62 million more men than women, worldwide (UN, 2015b). This is approximately 8 million more than the total population of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont put together. Imagine all these states with only men. Currently, China (116 boys/100 girls) and India contribute most to this gender imbalance (UN, 2015b). While the specific implications of such gender imbalance are still unfolding, we have the potential to see devastating impacts on women and girls and their well-being. Already, thousands of women from relatively low-resourced countries (e.g., rural Vietnam and Burma) are entering countries with more resources (e.g., Japan, Taiwan, and South Korea) as foreign brides. Foreign brides are more susceptible to abuse, discrimination, and have fewer rights when they cross borders and experience lower social, economic, and health status (Tsai, 2011; Wu et al., 2004; Xu et al., 2014). Social workers are needed more today than ever before to document abuse and discrimination these women face and to empower them through advocacy and community mobilization, so that these women fight for their rights.

Lack of Policies Adapting to Changing Family Structures

Finally, new social policies and institutional structures are needed to empower women with children. The rise in single motherhood has become a worldwide phenomenon and this trend is likely to continue. Women raising children as single mothers has increased due to a host of factors including an increase in divorce rates, increase in labor force participation and financial independence of women, and improved social acceptance of births outside of marriage (UN, 2015b). In the United States, one in four children resides in a family headed by a single mother (McLanahan & Jencks, 2015). The proportion of single-mother families is increasing even in countries where state support for single mothers is on the decline (Utrata, 2015). As women are denied access to well-paying jobs and equal pay, female-headed households with children are at greater risk of poverty (UN, 2015a). Social policies have yet to catch up to the reality of changing family structure and associated needs. Social workers must become central to the design and development of new social policies that better respond to the changing family structure. We need social policies—children’s allowances, tax benefits, and other forms of income transfer policies—that are friendly to single mothers and protect them from becoming poor and homeless. Social workers have a role in mobilizing single mothers to help influence health and welfare decisions at the local, state, and national level. More importantly, social workers must also challenge setbacks (e.g., the recent ban on American foreign aid to nongovernmental organizations in resource-poor countries that offer abortion counseling) and help speedup the process of women and girls’ empowerment, so that all women have equitable access to resources to develop and utilize their full potential by 2030.

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The Road From Millennium Development Goals to Sustainable Development Goals by 2030

Abstract

Maternal Mortality and Health Inequities

Intimate Partner Violence (IPV) and Gender-Based Violence

Child Marriage

Demographic Imbalance Around Gender

Lack of Policies Adapting to Changing Family Structures

References