Health Care for Women International

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The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries Lavinia R. Mitroi, Medina Sahak, Ayesha Z. Sherzai & Dean Sherzai To cite this article: Lavinia R. Mitroi, Medina Sahak, Ayesha Z. Sherzai & Dean Sherzai (2014): The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries, Health Care for Women International, DOI: 10.1080/07399332.2014.926903 To link to this article: http://dx.doi.org/10.1080/07399332.2014.926903

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Health Care for Women International, 0:1–15, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399332.2014.926903

The Women’s Health Care Empowerment Model as a Catalyst for Change in Developing Countries

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LAVINIA R. MITROI Department of the History of Science, Harvard College, Cambridge, Massachusetts, USA

MEDINA SAHAK Department of Epidemiology and Biostatistics, Loma Linda University School of Public Health, Loma Linda University, Loma Linda, California, USA

AYESHA Z. SHERZAI Department of Neurology, Loma Linda University Medical Center, Loma Linda University, Loma Linda, California, USA

DEAN SHERZAI Department of Medicine and Basic Science, Loma Linda University School of Medicine, Loma Linda University, Loma Linda, California, USA

Women’s empowerment has been attempted through a number of different fields including the realms of politics, finance, and education, yet none of these domains are as promising as health care. Here we review preliminary work in this domain and introduce a model for women’s empowerment through involvement in health care, titled the “women’s health care empowerment model.” Principles upon which our model is built include: acknowledging the appropriate definition of empowerment within the cultural context, creating a women’s network for communication, integrating local culture and tradition into training women, and increasing the capability of women to care for their children and other women. Women’s empowerment, when viewed through the lens of its myriad cultural interpretations across the globe, is undoubtedly a multifaceted and labyrinthine endeavor to consider, let alone undertake. With the rapidly approaching 2015 deadline on the Millennium Development Goals, attention Received 7 February 2014; accepted 14 May 2014. Address correspondence to Medina Sahak, Department of Epidemiology and Biostatistics, Loma Linda University School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA 92350, USA. E-mail: [email protected] 1

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to the slow progression of Goal 3 to promote gender equality and empower women has never been greater (World Health Organization [WHO], 2014). Empowerment can be defined as the process of providing someone with the ability to control his or her own life, precluding a feeling of powerlessness. Furthermore, empowerment is a dynamic process where individuals, organizations, and communities act to shape the environments they inhabit, in order to gain control over their lives (Speer, Peterson, Armstead, & Allen, 2013). Women’s empowerment has been attempted and analyzed from a number of different perspectives up to this point. The realms of politics, economics, finance, and education have been explored, yet each of these means has proven only partially successful, often failing under the social and cultural environments’ pressures. The challenge with defining women’s empowerment is that it cannot be comprehensively defined without curtailing its meaning. Empowerment has been previously defined taking into consideration political, social, and cultural factors, with researchers adjusting for local context in assigning a meaning to women’s empowerment. One common theme often seen in women’s empowerment is the sense of stability in combination with an absence of feeling powerless. In Pakistan, for example, empowerment is defined in terms of the possession of economic stability, social acceptability, educational achievement, and family harmony (Bustamante-Gavino, Rattani, & Khan, 2011). In Afghanistan, empowerment encompasses economic empowerment coupled with social and physical security (Ahmed-Ghosh, 2006). Kabeer (2001) defines women’s empowerment as the ability for the women to have choices and the freedom to choose from that which they value. A universal right of having the freedom to make one’s own choices and address the power imbalances in these developing countries is challenging (Blanchard et al., 2013). Health care, however, provides the unique linkage between environments that other instruments for empowerment lack. Health is ubiquitous in scope; every human being must pay attention when it goes awry. As a result, health workers are universally deemed as valuable in any society. Even in gender-divided cultures where the political and social climate may be harsh for women, health workers are viewed as beneficial members of the society. For example, teachers, often proposed as one such vehicle of empowerment, are viewed as nonessential or, worse, detrimental to the certain social structures, often perceived as outsiders bringing unwanted ideas into a traditionally sound society. Health workers, on the other hand, provide services that every member of a community may require; even the strictest enforcer of an autocratic social structure is susceptible to illness. The fallibility of the human body thus bestows upon health care a unique position in the global effort for women’s empowerment. While attempts at overhauling the legal systems and political structures of developing countries have yielded only limited gains for women’s rights, exposing

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women from these environments to basic medical knowledge and techniques engenders much less resistance and can produce a more profound effect on their social elevation. Also, the benefits are twofold because women in oppressive, gender-divided societies are often those suffering greatest from lack of necessary medical care. Here we introduce a model for women’s empowerment through involvement in health care, titled the “women’s health care empowerment model.” First, we present a literature review of the preliminary work that has been accomplished in the field up to this point. Most striking is the mosaic-like definition of empowerment that emerges from the research. In the latter portion of this article, the weaknesses and strengths of the reviewed models are explored. The women’s health care empowerment model aims to improve upon the themes explored by these existing models, while maintaining empowerment as a focal point and overt goal. Principles upon which the women’s health care empowerment model is built include: acknowledging the appropriate definition of empowerment within the cultural context of the locality in which it is being applied, creating a women’s network for communication and outreach, integrating local culture and tradition into the training and work of women, and increasing the capability of women to care for their children. Ultimately, the model is meant to empower by taking advantage of the unique role of female health care providers in communities with limited access to medical services.

METHODS To identify previous studies examining the topic of empowerment through the field of health care, we conducted a literature search through the National Library of Medicine’s PubMed online search engine using the search term “women’s empowerment through health care” and alternating prepositions such as “and” and “in,” as well as the phrase “involvement in health care empowering women” and “involvement in health delivery empowering women,” in order to cast a wide net of results. Articles from 1985 to the present were taken into consideration, further enlarging the potential pool of results. This yielded 567 results, 49 of which were reviews. In addition to PubMed, EBSCOhost, an academic research database, was used to yield an additional 1,888 results, 69 of which were reviews. We then analyzed this collection of abstracts in order to identify health care oriented studies or projects aimed at, or with the end result of, the empowerment of women. We applied specific criteria to discard those articles that were not relevant to this study. Projects or studies pertaining to those countries identified as developed nations were set aside, utilizing their established legal, political, and social precedents for women’s equality as an exclusion criteria. While there is no clear convention for defining developed and developing

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nations, we utilized the common practice in use by the United Nations for data collection purposes (United Nations Statistics Division [UNSD], 2013). Additionally, empowerment models not strictly health related, such as microfinancing and loan programs targeted at economic empowerment, were excluded. A great number of articles that only discussed the need for women’s empowerment, especially in the context of health, and did not include any proposed models or solutions were also eliminated. The articles that we selected had to address the issue of empowerment specifically through a health care oriented approach and include either a model, program, or study. Ultimately, there were 14 models identified and a few relevant articles on the relationship between empowerment and health care involvement. Each model was reviewed and the following information was recorded: study type, population, duration, method of outcome measure, conclusions, weaknesses, and interesting facts. Some of these topics were not covered in several of the articles.

RESULTS The literature review yielded fewer results than we had initially anticipated. Articles on women’s economic empowerment and microfinancing programs represented a bulk of the results from the search, which were not relevant to our research topic. Despite the large pool of literature discussing women’s empowerment and health care, the majority of the material either briefly mentioned the need for empowerment as a concluding remark or established a correlation between women’s empowerment and positive impacts on maternal health. Relationships in the opposite direction, from health care involvement to empowerment, were more difficult to find. Empowerment is such a broad term, contextualized in a variety of ways, with a unique definition specific to each study, that we found that we initially gathered a large collection of literature that did not address our intended research topic. In the interest of brevity and specificity, we have chosen to focus only on the particular pool of literature discussing empowerment as an outcome of health care involvement. Currently research attempting to measure women’s empowerment outcomes is relatively in the formative phases, particularly for empowerment as an outcome of health training or education. There is, however, widely acknowledged recognition of empowerment as a key tool in the closely linked goal of improving maternal health. More recently, Ahmed, Creanga, Gillespie, and Tsui (2010) found that women’s economic, educational, and empowerment status were directly linked to the utilization of three of the most basic maternal health services including modern contraception; antenatal care in

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the form of four or more visits, as per WHO recommendation; and skilled birth attendance. Although their research indicates that inequities in empowerment did not contribute to lower utilization of maternal health services as markedly as economic status and education, they also note that the empowerment variable utilized in their study is not a validated scientific measure, because none currently exists. There was also variation between countries in the relationship between empowerment and service utilization, highlighting the need for “locally sensitive and meaningful measures of women’s empowerment” (Ahmed et al., 2010, p. 5). Empowering women through their involvement in health care gives them a voice and platform that they otherwise would not have. The mobilization of women for health projects in areas where empowerment and maternal health status are simultaneously low has been cited as an underused method with great potential that is currently untapped (Horton, 2010). One example is the work done by Tripathy and colleagues (2010) in rural India, where a participatory intervention with women’s groups targeted at improving birth outcomes also enabled participants to engage in health committees where they became more knowledgeable about government interventions and a national rural health program. When women are engaged in one aspect of the community, their contribution to further their participation in other areas of community life increases. Additionally, the presence of community resources for women can act to increase the perceived level of empowerment. Research in communities of Black South African women targeted at better understanding power within intimate relationships found that women reported less male-dominated decisionmaking when community resources were perceived as helpful, and a positive association was detected between mutual decisionmaking and knowledge of community resources. Furthermore, community involvement increases one’s sense of empowerment (Ketchen, Armistead, & Cook, 2009). Linking community involvement, specifically in the domain of health care, and empowerment is more difficult given the current amount of literature on the topic. Ultimately, we found only 14 models in which health care involvement served as a means through which women living in difficult social environments became empowered. Those studies best exemplifying this type of model included women working in Nicaragua, India, Brazil, and Bangladesh. Most of the articles were not written with the specific aim of studying women’s empowerment, but instead they were created with the goal of describing a new program in which a novel form of health care delivery was reaching a population in a developing nation where, usually, such care had previously been unprecedented. A study by Jewell (2007) in Miraflor, Nicaragua, however, focused on the topic of empowerment more than any other. In a qualitative, descriptive study, Jewell discusses women living in the Miraflor community, between the ages of 18 and 65, who had worked with the Health Brigades,

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which consisted of a group of faculty, staff, and students from the Grand Valley State University Kirkhof College of Nursing who traveled to Nicaragua after the devastating effects of Hurricane Mitch in 1998. Between 1999 and 2003, women in the Miraflor community worked with the Brigades providing primary health care delivery and promotion. After analysis of interviews with some of these women, Jewell developed a grounded theory of contextual empowerment, including two contexts: the psychosocial realm of empowerment (including self-awareness, agency, and community empowerment) and the structural realm (including the local culture, Nicaragua’s national interests, and external partnerships). After their work with the Health Brigades, the women of Miraflor were described as having discovered a sense of agency, “feeling capable to take action, such as participating from a position of strength in decision making and action” (Jewell, 2007, p. 54). Work done in India by the grassroots nongovernmental organization (NGO) Social Action for Rural and Tribal Inhabitants of India (SARTHI), similarly involves women in the process of health care delivery. Started in July 1988 for the rural women in the Santrampur taluka of Panchmahals District in Gujarat, India, the Women’s Health Program initiated by SARTHI trains local women as Women Health Workers (WHWs; Khanna, 1992). These WHWs provide their neighbors living in these rural communities with needed medical information and care in the areas of reproductive health and gynecology. The presence of the WHWs in the community also gives women the opportunity to discuss issues of gender and women’s health that they previously had not broached. In this manner, the program not only empowers those women working as “barefoot gynecologists” but also those receiving the examinations and health information. A unique aspect of this program is the manner in which local culture and tradition were integrated at several levels. For example, during the training of the WHWs, a traditional form of singing was utilized as a type of question–answer session, and in one phase of the program they researched traditional local medicines and began growing some that proved effective for use in the community, with the local women taking care of the cultivation and preparation of the medicines (Khanna, 1992). Next door to India, in Bangladesh, the organization Gonoshasthya Kendra (GK), which provides health services to the poor living in rural areas through mobile paramedics, empowers women by employing them as traveling health workers (Health for the Millions Editorial Board, 1999). Young women who have finished their secondary school certificates, usually between the ages of 16 and 20, are trained for 2 years by the organization and then sent into rural villages to provide desperately needed health services. Although initially encountering skepticism from men in these areas who were surprised to see women acting so independently, the women uncovered a newfound sense of empowerment. As one describes, “Today I am not dependent on anyone. My girl goes to college and what I earn today

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is sufficient for my daughter and me. I am happy because I am self-reliant today” Health for the Millions Editorial Board (1999, p. 32). Urban women in Vila do Joao, a slum district of Rio de Janeiro, were also empowered when trained as community health agents to implement a gender-based intervention model for HIV/AIDS education (Barbosa et al., 1998). After undergoing training for 4 months on relevant issues of HIV/AIDS, family planning, and reproductive health, the women began working in their community to educate their fellow neighbors. Analysis demonstrated that all 12 participants felt empowered after being trained and then carrying out the intervention model in their communities. They noted expanded health knowledge about their bodies, greater freedom in speaking about previously “forbidden” intimate topics, greater self-assurance and openness to others, and public recognition as social agents. The women also described an increased confidence in the community at large, despite initial fear of working in an area where drugs were being sold (Barbosa et al., 1998). Nursing was expressly mentioned in a couple of the articles as a means through which women are empowered. In Thailand, the National Nursing Development Project increased opportunities for women to pursue educations in the nursing profession by strengthening nursing schools in Thailand, providing scholarships for Thai nurses to engage in doctoral studies abroad, and providing funds to bring foreign experts to Thailand for workshops in staff development (Boontong, 2001). This project added hundreds of women to the nursing workforce in Thailand, empowering both the women who were educated and those whom they serve as the “one link to a better future.” As the Thai senator, who was a major proponent for this project describes, “Nurses, as a major force at the grassroots level, will then go out into the community empowered to change the lives of Thai women in general” (Boontong, 2001). Two studies on nursing in South Africa also noted the increased empowerment of the women involved in such projects. The KwaZulu-Natal health promotion model is created for nurses, but it is aimed mainly at rural women living in the province of South Africa after which the model is named (Uys, Majumdar, & Gwele, 2004). Implementation of the model improved the participation of the local women in primary health care delivery based on five empowerment elements. First, by utilizing a systematic, planned needs-driven curriculum, the women felt empowered to help others in the community when they became more knowledgeable about daily health problems. Second, empowering them through comprehensive content allowed the women to address specific community needs and provided them with information on their rights as citizens. Third, the use of interactive teaching greatly increased mutual respect and created a bond between the instructing nurses and the women. Also, by encouraging behavior change through small group meetings allowed the women to help neighbors, change power relationships within their own families, and influence other groups.

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Finally, the women were linked with external resources and during their work on modules at the group meetings, they were introduced to valuable contacts with which they continued to keep in touch even after the meetings. Ultimately, the implementation of the health promotion model to increase the participation of the rural women in primary health care delivery served as a tool for their empowerment (Uys et al., 2004). A second study looking at the relationship among power, gender, and nursing in the South African province of KwaZulu-Natal compared the levels of empowerment between South African nurses of the enrolled category of nurses and registered category of nurses, both in urban and rural settings (van der Merwe, 1999). It was found that there was a clear divide between enrolled nurses and registered nurses, and between those practicing in a rural setting and in an urban setting. Enrolled nurses, especially those in a rural setting, were described as feeling less powerful than registered nurses, not sharing the same professional status, being routinized, being misused, and being domesticated. Registered nurses indicated a greater sense of empowerment and were able to empower others with their independence from males (van der Merwe, 1999). Another project in Africa focused on the empowerment of women through involvement in health care is called Women Fighting AIDS in Kenya (WOFAK). Founded by women battling AIDS themselves, the program empowers HIV positive women and girls by providing education about the disease and even training in home-based care techniques (AIDSlink Editorial Board, 1996). Through becoming more knowledgeable about their condition and learning how to protect and better care for their families, the women discover a greater sense of empowerment, while those running the program are also empowered. The success of the program is credited to communication and a system of support among the women, “All activities center around a network of positive women from all parts of society responding to the community and advocating for stronger responses by the government and other agencies providing HIV/AIDS prevention and care services” (AIDSlink Editorial Board, 1996, p. 10). Networking among women as a successful tool in empowerment projects is also evidenced through a program targeted at diarrheal disease control and family planning in Turkey (Wagner, 1986). The program sends trained midwives into villages to train a few women in each community as “village health workers.” These workers in turn then transmit the information to their neighbors and aid with any pressing medical issues that may arise, receiving special support from the “village female network.” It was noted that this project increased health awareness among the women in the villages and, as a result, they felt more in control of their own lives and the lives of their infants, empowered to help their families (Wagner, 1986). Projects supported by the Japanese Organization for International Cooperation in Family Planning (JOICFP) in Bangladesh and Vietnam also

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empower women by involving them in health care work. The Integrated Family Development Project (IFDP) in rural Bangladesh, which includes literacy and financial components as well as health, trains women as family development volunteers, educating at the community level on issues of reproductive health, family planning, and health care (JOICFP, 1995b). A JOICFP mission to Bangladesh noted that this project was empowering the women involved (JOICFP, 1995b). Similarly, the United Nations Population Fund (UNFPA)-supported Sustainable Community-Based Family Planning/Maternal and Child Health (FP/MCH) Project with Special Focus on Women is empowering women in Vietnam. The JOICFP reports that women are actively involved in the project at all levels in Vietnam—including health education and family planning—and empowered, especially through the Women’s Union of volunteers, which serve as a vital link between health centers and the community (JOICFP, 1995a). Women’s involvement in nutritional health programs has also yielded increased empowerment, as demonstrated by projects in Vietnam and Pakistan. In rural Vietnam, a qualitative study was done in which a cross-sectional assessment was used to compare self-reported changes in level of empowerment between health volunteers and mothers working in a community empowerment and nutrition program (CENP) and Women’s Union members and mothers in a nonintervention commune (not engaging in CENP but still exposed to a nutrition education and rehabilitation program [NERP]; Hendrickson et al., 2002). Results indicated that the health volunteers in the intervention commune reported changes in knowledge, confidence, relationships with community members, and a sense of satisfied contribution. Women’s Union leaders in the nonintervention commune also reported changes in the same domains; however, they also reported greater decision making in the household and did not focus on the bond with the mothers of their communities that the CENP health volunteers mentioned. Mothers in the intervention communes mentioned changes in knowledge, confidence, and information sharing. Mothers in the nonintervention commune reported few changes; only one mother expressed a change in knowledge and confidence. Overall, those mothers who had taken part in CENP felt more greatly empowered than those mothers who had not taken part (Hendrickson et al., 2002). A similar nutrition program in Pakistan targeted primaryschool-age girls in the 29 poorest rural districts of the nation while involving their mothers in the planning and preparation of the school lunches provided by the program (Pappas et al., 2008). The intervention decreased malnutrition and increased school enrollment among the young girls while also increasing dietary knowledge in the communities (mainly through the women who had prepared the meals and gone through training to do so). The program is noted to have empowered the women who participated in training sessions for school committees and received mentoring by fieldworkers and NGO district supervisors. Many are noted to have obtained their first national

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identity cards, opened bank accounts, and left their villages for the first time in their lives as a result of their work with the program (Pappas et al., 2008). Although we focus in this article on the empowering effects of health intervention models specifically, researchers analyzing the combination of economic and health interventions through the IMAGE study in South Africa have noted the added benefits of a health component in a microfinance program, speaking to the utility of health interventions for empowerment. Kim and colleagues (2009) conducted the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study, a cluster randomized trial to evaluate the effect of a combined microfinance and gender/HIV training intervention, with health trainings held at loan meetings every 2 weeks for participants, who included 1,409 South African women with the median age of 45. What they found was that in comparing the IMAGE intervention to a solely microfinance intervention, there was no clear suggestion that either program had produced greater economic benefits. The IMAGE study, however, consistently demonstrated effects on empowerment, intimate partner violence, and HIV risk behavior and the change was statistically significant in many cases. As they note, “In HIV/AIDS education, group-based interventions have been found to foster critical analysis, collaborative learning, communication skills, problem solving and peer support, which, in turn, have been regarded as crucial to changing social norms and increasing knowledge, skills, and solidarity among women—all important aspects of empowerment” (Kim et al., 2009). This research not only demonstrates the significance of synergy between economic and health programs in producing broader results, but it also further indicates the possibility of positive results toward women’s empowerment through health interventions targeted at women.

DISCUSSION We found through conducting the literature review that women living in challenging social and political climates were indeed empowered when working in the field of health care. One limitation to this research, however, must be noted. The research was conducted using PubMed’s online search engine and EBSCOhost online research database, meaning only published academic articles were retrieved. This search, however, does not include reports from organizations such as the WHO and the United Nations Development Programme (UNDP), which are not indexed within online academic search engines. We wish to acknowledge the work being done by such organizations, including the WHO’s Gender, Women and Health Project and the UNDP’s Women’s Empowerment campaign, while simultaneously noting that their work, which is not published through the academic peer-review process, lies beyond the scope of this article. Furthermore, the expansion of the search as far back as 1985 in order to yield a significant collection of literature demonstrates the paucity of

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published academic research on this critical topic. While models from as far back as two decades may seem dated, we note here that the themes identified from the older models were very much in parallel with more recent work. The sluggish pace at which noticeable change within the realm of women’s empowerment occurs also lends value to these older models that address many of the same barriers encountered today in the field. Women’s empowerment, as was revealed through the various programs and models reviewed, is interpreted differently in every culture. Most striking perhaps is the concept of communal empowerment, which was seen in a number of the models, as opposed to individualistic, personal empowerment—the version adopted most popularly by the Western world. In the Miraflor community of Nicaragua, for example, one woman noted, “In the U.S. when you say ‘empowerment,’ you mean I can do this and I can get ahead. Here in Miraflor when we think of ‘empowerment,’ we think, ‘We can do this.’ No one takes steps forward without holding the hands of others on either side of them” (Jewell, 2007, p. 51). In Vietnam, this understanding of empowerment as a communal endeavor is taken even further as the root of empowerment—power—is viewed negatively in an individual context (Hendrickson et al., 2002). As Hendrickson and colleagues note, “In this case, a positive notion of empowerment is only understood within the context of the family or community, not as an individual phenomenon alone” (Hendrickson et al., 2002). Acknowledging communal versus individual empowerment allows for a better understanding of the success of some of the models through the use of active community networks. In Brazil, for example, the women of Vila do Joao had to deal with communities entangled by drug dealers; those most successful, however, were the women willing to go out into their neighborhoods regardless of the threat of danger and communicate with their neighbors (Barbosa et al., 1998). Similarly, in Turkey the midwife training and education program drew on the “social support of the village female network” (Wagner, 1986, p. 143). Furthermore, Women Fighting AIDS in Kenya notes the impact of a “network of positive women” to the success of the program’s activities (AIDSlink Editorial Board, 1996). The exchange of ideas and information between women in a community appears to be a key component to the success of empowerment projects in a number of different settings. This networking can be linked to the sense of communal empowerment that these women achieve. A successful empowerment project must thus take into consideration the particular definition of empowerment to which the population it targets subscribes, and, if communal empowerment plays a role in this particular population, networking among women should be recognized as a crucial tool for the success of the project. The role of integrating local culture and tradition into the training and work of female health workers must also be acknowledged. One particularly successful example was the training of the “barefoot gynaecologists” by the SARTHI program in India; a traditional form of singing was used to facilitate

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a question and answer session, while later in the program traditional local medicines were researched and integrated into the health work with the local women in charge of cultivating and preparing the medicines (Khanna, 1992). Empowering women is a much less difficult task when projects work in congruence with the locality as in the above example, especially in areas where gendered lines are prominently drawn. In many cases, a woman’s sense of empowerment is also closely related to how capable she feels of caring for her child. Women taking part in the nutritional programs of Vietnam were noted to feel empowered upon improving their children’s health with newly acquired nutrition information (Hendrickson et al., 2002). Identically, involvement in the same type of program in Pakistan empowered women when they learned to prepare nutritious meals for their children (Pappas et al., 2008). A project targeted at diarrheal disease prevention and family planning in Turkey is also noted to have empowered women who learned to “better control their own lives and their infants’ lives” (Wagner, 1986, p. 143). This connection between empowerment and children’s health makes the necessity for women’s empowerment doubly imperative. Models with the primary and explicit goal of empowering women are in dire need. A majority of the models we have reviewed here discuss empowerment in the context of a health promotion or primary health care project for women. Women’s empowerment through the lens of these projects more specifically refers to women empowering themselves to seek and receive necessary health care, not necessarily reaching into the other facets of their lives where greater autonomy is also vital. Empowerment merits status as an overt goal, not merely an incidental outcome, in order to establish measurable and objective endpoints from which the end result will be more likely. What we provide through this literature review is evidence of the fact that women working in health care are indeed empowered. What remains to be accomplished, however, is the effective utilization of health care as such a tool for breaking down the barriers of gendered division and oppression. Handing women the knowledge and resources of health delivery not only empowers them, but it also leads to their improved well-being, and, in circumstances where their social and political spheres are limited, women are often the demographic in most desperate needs of health care. Furthermore, the unique connection between mother and child allows for the empowerment of women through increased health care delivery involvement to benefit their children’s health as well. Thus, the benefits of medical training for women under oppressive climates are threefold: increased women’s empowerment, women’s health, and children’s health.

CONCLUSION Through the literature review presented thus far, we illustrate a number of missing components from past and present health care models for women’s

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empowerment in developing societies. The women’s health care empowerment model attempts to address these weaknesses and, if implemented correctly, fill in the missing gaps. First, it focuses on empowerment as the principal objective of the project. When the model is utilized, desired endpoints should be established as objective goals, which can be attained through the course of the program, making the results more likely. Second, any empowerment project should have an established quantitative or descriptive method of outcome measure for accurately documenting the level of empowerment of the women before, during, and after involvement in the project. This again increases the likelihood of observable results. Medical information and skills taught to the women can range from basic hygiene to administration of oral rehydration salts to midwifery, which are tailored to address the most pressing needs of the population in which the model is being carried out. The main objective is to train the women to handle the bulk of the medical problems found in their communities—problems that would have previously resulted in difficult travel to distant medical care locations or even death. One area, which is of paramount importance globally for women, is reproductive health and it should certainly make up a sizeable portion of the curriculum, especially considering that, typically in the type of developing countries where such an empowerment model is necessary in the first place, maternal mortality is alarmingly high. Methods utilized to instruct the women should be developed with an eye to cultural competency and the prevailing customs and traditions of the population involved in the project. Most importantly, the definition of empowerment used in the model should be created with an awareness of the cultural context in which it is being presented to ensure that a negative connotation may not be attached to it. Teaching methods should be developed with the same limitations being taken into consideration. Ideally, the women’s health care empowerment model should increase the level of autonomy and independence experienced by the participants. While their medical knowledge and ultimately health will invariably increase, the primary goal is the enrichment of their roles as mothers, wives, and as significant members of their communities. Where before they may have had limited responsibilities outside of their personal dwellings, after the implementation of the empowerment model they will enjoy a broader role in their community—as knowledgeable health care authorities. In the future, such an empowerment model could prove invaluable in regions such as Afghanistan, Somalia, and Sudan where women’s empowerment through political venues oftentimes meets resistance, making the need for alternative methods critical. We believe there is a need for further research to elucidate the most effective methods of delivery, prepare antecedent environmental conditions, and identify the best approach for policy change and implementation in different settings.

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The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries.

Women's empowerment has been attempted through a number of different fields including the realms of politics, finance, and education, yet none of thes...
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