Journal of Health Politics, Policy and Law 25.3 (2000) 607-611
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Empowerment and Women's Health:
Theory, Methods, and Practice
Review Symposium on Women's Health
Jane Stein. Empowerment and Women's Health: Theory, Methods, and Practice. London: Zed, 1997. 322 pp. $65.00 cloth; $25.00 paper.
Many scholarly works written since the 1960s about women's health have emphasized how the circumstances of women's social and economic subordination are detrimental to their health. A framework based on the oppression of women still dominates much of the literature on women's health worldwide, although a coherent theory of how gender inequalities affect health continues to elude us. More recently, scholars in several disciplines have begun to examine how women's agency--including their health-related decision making, political participation, and organized social movement activities--affects their social circumstances and health. The perspective of women's agency does not replace the oppression framework, but provides a counterbalance to the pervasive view of women as victims of social and political institutions that are assumed to be too remote from women's experiences or capacities to influence.
In this creative and provocative book, Jane Stein makes the argument that "empowerment processes" can reduce social inequities and improve the health of women in the developing world and in deprived circumstances within the industrialized world. Her argument synthesizes material from several disciplines, the literature on international development, and observations of women's organizations and empowerment activities in developing countries in the 1980s and 1990s. The key points may be summarized as follows:
- Development policies (e.g., top-down population control programs) and structural adjustment policies frequently have negative impacts on third-world women's life situations, which in turn have negative impacts on their health and well-being.
- To improve their situations, women around the world are using group "empowerment" strategies to reduce social inequities and to redistribute power and resources.
- Inequity affects health through its relationship to a "tangled web of factors" that includes sociopolitical conditions and psychosocial factors.
- By reducing inequity, increasing the power and status of women, and interacting with other factors that affect health (such as education), empowerment may prevent or mitigate the negative impacts of development policies on women and improve women's health. [End Page 607]
The empowerment process--which includes group participation by lay women intent on improving their own situations and in effecting social change through the redistribution of resources--is expected to produce individual and group outcomes that help maintain or improve women's health. In other words, empowerment strategies do not have to focus explicitly on health in order to affect health.
The evidence to support the links in Stein's "Women's Empowerment Model" is admittedly incomplete. (Stein refers to the evidence linking empowerment and health as "circumstantial, associational, and theoretical" .) She challenges us to think about these linkages and also to question whether traditional scientific methods are appropriate for studying empowerment processes and their impacts on health. It is not only that women's perspectives have been left out of traditional scientific discourse, she asserts, but that the methods themselves have limitations. In a section of the book focusing on scientific inquiry, she builds an argument for "feminist participatory-action research" to simultaneously study the empowerment process and facilitate it. She is an advocate for action on behalf of women's empowerment even in the absence of direct evidence that empowerment will improve their health.
Nevertheless, we must rely on existing data to assess the validity of the arguments in the book. Although she does not provide a discussion of the social movement literature to support her point, Stein asserts that women's organized efforts to both improve their condition and effect social change are occurring in many parts of the world, including developing countries, and constitute an international "women's empowerment movement." While we do not have systematic surveys of organizations or projects internationally, it is well known that projects occur in various cultural contexts and on a range of...