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Promoting Health Literacy for Women

By Bisi Bright

It is a common saying that when you educate a woman, you educate a nation. If this were true, why are we still where we are in Africa today?

An educated woman anywhere in the world is expected to have a voice; however, an African husband often expects his educated wife to be quiet. It's common to find many scholarly women in Africa keeping “mum” over issues on which they should speak out. Though men usually don't own up to it, they would rather their women be seen but not heard.

As an African woman, I am oppressed because by the restrictions of a spouse and society. Try as I may, I must not be seen to make independent decisions—it is seen as an abomination by a man if his wife makes decisions on her own and informs him afterward. Lacking this sense of freedom, I cannot be who I think I can be without sacrificing my happiness in the home. Though many of us educated women are able to cover up the feeling of oppression, it hovers around constantly. If we look at African society as a pyramid, women—generally poor women—make up the base. While educated women are higher up, they still haven't made it to the top of the pyramid, where they queue up behind successful professional men. The gender issue rears its ugly head in every aspect of a woman’s life in Africa. In spite of gender activism and advancement through global gender initiatives, the African woman often still goes about with a sense of incognizance even if she has all the knowledge in the world.  

African women health-care professionals do well at work, but not at home. Like other educated women, they endure an unfair share of misogyny woes and domestic oppression and abuse. The crux of the matter is that the African woman is not empowered in the home; she is simply there to satisfy the whims and caprices of the husband.

There was a female pediatrician in Lagos who was well loved at work and excellent at her job, but was physically abused by her husband, also a medical doctor. Neighbors confirmed she had been rushed to the hospital numerous times. A few months ago the abuse went too far and her husband killed her. The news story made it sound like she fell off the staircase. She's a prime example of how an educated woman can be kept from reaching the top of the pyramid because of domestic violence. The case has since been quiet; nothing more has been reported about the outcome.

In much of Africa, men make most of the key decisions about health care for the family, even though such decisions should be jointly made by both spouses to serve the best interest of the children and family. It's common to find highly-educated women giving birth using unskilled traditional birth attendants (TBAs) instead of at health facilities manned by skilled birth attendants such as doctors and midwives, either because their husbands prefer such methods or because they were compelled by family tradition. Many women have lost their babies because their husbands enforced a wrong decision—rather than granting decision-making authority to the woman whose life is at risk.

Poor health-care services have worsened the situation, and the high cost of health care has forced most Africans to pay out of pocket—80 percent of Nigerians, for instance, pay out of pocket, with government coverage at less than 5 percent of GDP —makes it unaffordable for most. This allows for mediocre health-care practice and for charlatans and quacks to invade the health system.

Thus, the case is being made for health literacy—the ability to access, understand, communicate, and use information to improve health. In order to counter norms of male dominance, women must be included in efforts to promote health literacy. If a woman is empowered through this type of training, her family will be healthier and the nation will thrive. People will be healthier, productivity will increase, and there will be a steep climb in GNP, GDP, and overall national growth. That empowerment has to be total, not limited to the woman’s workplace alone. A woman should be able to make key decisions concerning her health, and should be able to help other women to do the same.

At the LiveWell Initiative (LWI)—a not-for-profit NGO aimed at improving people's health through wellness promotion and health empowerment—we’ve found that health literacy is very low among Africans, irrespective of functional literacy or level of education. However, LWI found that health literacy can increase drastically after a basic one-hour Health Talk Intervention, which usually involves a lecture, health screening (which includes blood pressure measurement, blood sugar screening, and other basic tests), personalized counseling, and free medicine. Apart from its impactful health talks, LWI offers other kinds of interventions, including community health outreach, awareness campaigns, executive health seminars, and events around at least six world health days every year.

Health literacy can make a demonstrable impact on community health. For instance, a diabetic patient came to LWI after consistently falling into comas. After a 15-minute counseling session, the patient was able to recognize the difference between high and low blood glucose levels. This knowledge helped him understand how to treat each situation, whereas previously he had unintentionally been aggravating his condition. The patient's wife was on hand to make sure that he took his medication regularly, showing that health literacy coupled with good follow-up care and support at home improves health care and reduces the burden on the health system. The condition of the health-illiterate patient would have been worse had he not been assisted by his health-literate wife. A women able to make informed decisions about health issues can save the lives of her husband or her children, magnifying the importance of women’s empowerment not just in the workplace but also in the home.

Women play a key role in maintaining the health of the family, so it's important that African men treat women fairly and eschew violence, abuse, oppression, subtle relegation, and misogyny. Women need to be included in programs that teach lifestyle skills, how to recognize and manage health exigencies, and how to achieve and maintain wellness. Health-care spending should focus more on promoting wellness, since prevention is better and cheaper than curing a disease. Every woman in Africa should be empowered with health literacy and disease prevention knowledge. African women will also be able to do much more in restoring the overall health of the continent if they are allowed their rightful roles at home, and are not unduly overwhelmed by gender oppression and male-dominated day-to-day cultural practices and behaviors.

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Bisi Bright is a clinical pharmacist and public health practitioner with many years of practice experience. She holds two fellowship awards from the Pharmaceutical Society of Nigeria and the West African Postgraduate College of Pharmacists, at which she served as secretary general. She has served on international working groups and delivered papers at several international congresses. Married with children and grandchildren, she has written this piece based on her own experience.

[Photo courtesy of U.S. Army Africa]

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