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C h a p t e r 4 Making Cities Safe for Women and Girls: Integrating a Gender Perspective into Urban Health and Planning Claudia Garcia-Moreno and Manupreet Chawla The expansion of cities stems from the natural demographic growth of urban populations as well as from migration from rural to urban areas. People come to cities in search of better jobs, higher incomes, and more conveniently accessible services. Over the past twenty years, in many developing countries young women between the ages of 18 and 24 years have flocked to cities in search of work. As a result, young adult females outnumber young adult males in many Latin American and Asian cities (ECLAC 2008; United Nations 2009). The health of this subpopulation is affected by the risks and opportunities of urban and urbanizing environments (Montgomery 2009). Many rapidly growing cities lack planning and, as a result, have areas of inadequate housing and of insufficient water, sanitation, transportation , and other facilities. African, Asian, and Latin American cities in particular have experienced significant growth in such slums and informal settlements over the past two decades (WHO 2010e). Women head about one third of households in these poor urban areas (UNFPA 2009). Such conditions have enormous health implications, significantly raising the risk that women will experience sexual, reproductive and mental health problems, intimate partner violence, sexual and other forms of gender-based violence, and traffic-related injuries or death. Although urban populations enjoy better health on average than do rural dwellers , urban populations are socially and economically diverse, and many of the urban poor experience health risks comparable to those affecting rural villagers (Montgomery 2009). Therefore, health policies for 54 Claudia Garcia-Moreno and Manupreet Chawla urban areas should be based on disaggregated data instead of on a city’s total average measures of health (Montgomery 2009). Women’s specific needs and concerns must be considered when devising programs and policies to improve living conditions and health services in urban communities; currently, however, policymakers and urban planners often fail to do this. Uneven access to maternal health services among the urban population exemplifies the failure to adequately address all urban women’s needs: Although access to maternal health services is generally better in urban areas than in rural areas, access to health care in poor urban environments is usually comparable to that in rural areas (WHO 1996). A 1998–2000 Demographic Health Survey for India compared the health of urban and rural populations by poverty level; Figures 4.1 and 4.2 illustrate the study’s results. Figure 4.1 depicts differences among subpopulations of urban and rural residents in terms of how many received at least one prenatal-care visit. A higher percentage of urban women received prenatal care than did rural women; however, large differences exist within each group relative to standards of living. The graph shows that only 69.7 percent of very poor urban women in India received any prenatal care between 1998 and 2000, a percentage compaVery Poor Poor Near Poor Other Very Poor Poor Near Poor Other Urban 100 Rural 80 60 40 20 0 69.7 79.2 84.6 94.3 46.6 44.9 51.2 71.1 Percentage Visited Figure 4.1. Percentage of women receiving any prenatal care in urban and rural India (1998–2000). Source: Montgomery 2009. Making Cities Safe for Women and Girls 55 rable to that of rural women living in the upper half of rural living standards (Montgomery 2009). This study also shows that poor urban women are approximately as likely to have a physician or a nurse-midwife present during childbirth as are upper-income rural women (see Figure 4.2). By this measure of health, large differences exist between very poor and better-off urban women. Health and Safety Risks Women and Girls Face A safe and healthy city is one in which women are guaranteed all of their rights. It ensures their health and well-being by improving access to services and promoting, among other things, the elimination of gender -based violence while at the same time promoting equal opportunities for women in terms of access to economic resources, political participation, education, and employment (UNIFEM 2010b). In a safe and healthy city, women and girls are not discriminated against and can enjoy public spaces and public life without fear of being assaulted; Very Poor Poor Near Poor Other Urban Very Poor Poor Near Poor Other Rural 80 60 40 20 0 42.0 59...


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