How healthier girls and women benefit economy

There has always been the ethical and humanitarian case for investing in girls’ and women’s health. But the argument that such investment can yield significant economic benefits is now finding a dazzling array of takers.

Last week at Kuala Lumpur, before an august gathering of almost 5,000 people from 149 countries, Malaysia’s prime minister Najib Razak waxed eloquent about the need for public investment in education, health, safety, rights and financial independence of girls and women. Malaysia sees this as “smart investment”.

“The evidence, from developed and developing nations alike, is clear. When our girls and women are educated, when they are healthy, when they are independent, the benefits extend beyond individual freedom to prosper and achieve,” Razak noted in his keynote speech at the Third Women Deliver conference. The global meet focused on the critical need to prioritize girls and women in the run-up to the 2015 Millennium Development Goal (MDG) deadline, and beyond.

Malaysia’s national maternal mortality ratio (MMR) — the number of women dying because of childbirth-related complications per 100,000 live births — has come down from 540 in 1957 to just 28 in 2010. No doubt, Malaysia is blessed with natural resources, has less than 30 million people, and national statistics do not tell the full story. But the sharp decline in maternal deaths is undeniably an impressive achievement.

In the 1950s and 1960s, the state of health services in Malaysia was similar to many developing countries today. But Malaysia, like Thailand, Sri Lanka and many other countries, did not wait to get rich before investing in women’s education, health and rural development. This is key to its dramatic reduction in maternal mortality.

In 1970, Malaysia’s MMR was down to 105 per 100,000 live births. In the decades that followed, health services were made available at the doorstep of rural populations, health workers were sensitized on social and cultural factors that affect women’s health, midwives working in remote areas were given more support, hospitals waived fees for poor patients and a colour-coding system was designed to make it easier for women to be referred to a hospital, sidestepping bureaucratic red-tape. “Well-being clinics” were set up across the country to expand women’s access to family planning.

All these initiatives have paid off. Now, Malaysia, one of the fastest growing market economies in the world, wants to tell its story before the international community.

This is not just a Malaysian tale. Many countries across the developing world opted to invest in women’s health and human development in general long before they became rich.

A new report (closing the deadly gap between what we know and what we do) by the World Bank which generated a huge buzz at the Kuala Lumpur meet makes the economic case for investments in women’s reproductive health.

Women’s health is more than an economic issue but framing access to healthcare facilities and family planning services as smart economics gives it the much-needed visibility in the policy discourse.

Despite some global progress in tackling maternal mortality, an estimated 287,000 women died of childbirth-related complications in 2010. More than half these deaths took place in sub-Saharan Africa; just under a third happened in South Asia.

The World Bank argues that when women have better education, health and access to contraceptives, they have more power to take decisions within the household and they prioritize the well-being of their children. When children are better educated, they are potentially more productive as adults and contribute more to economic growth.

“Globally, female labour force participation decreases with each additional child by about 10 to 15 percentage points among women in the 25-39 age-group and about 5 to 10 percentage points among women in the 40-49 age-group,” the report notes. In Colombia, for example, when family planning programmes were expanded from the mid 1960s, women were able to delay their first birth enabling more schooling and making them more likely to be employed in the formal sector.

What are the lessons for India?

India trails behind other emerging economies in human development, despite remarkable economic progress over the last two decades. As per latest official estimates (2008-09), India’s MMR is 212 per 100,000 live births. To meet its millennium development goal for maternal health, this figure must come down to 109 by 2015. Anuradha Gupta, additional secretary in the health ministry and mission director of the National Rural Health Mission, told delegates at the Kuala Lumpur meet that India could still meet its target. Indeed, the centrally-sponsored Janani Suraksha Yojana, one of the largest conditional cash transfer schemes in the world, has led to a sharp surge in institutional deliveries and reduced maternal deaths.

But the battle is far from over. The national data masks huge inequities between states. Uttarakhand has a MMR of 162, while the corresponding figure for Assam is 347, according to the latest Annual Health Survey. Additionally, there are huge variations between districts. Then there are persisting malpractices like child marriages, despite the law. The poor quality of maternal health adversely affects newborns. Decline in newborn deaths has been disproportionately slow in this country. Gupta talks about a host of government initiatives to improve women and child health. Out of India’s 640 districts, 184 have been slotted as ‘high priority’ districts which will now get 30 per cent  more funds from the Centre.

All these are welcome steps. But for India to take the floor as a human development leader, there are two critical imperatives — far greater accountability to make sure that the public resources are well-spent and far greater recognition of the fact that a country does not need to become rich before it invests in women’s health. Such investment is smart economics, as Malaysia and so many other countries have shown.

The author is a Delhi-based writer.