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C h a p t e r 9 Women’s Health in the Urban Community: National Institutes of Health Perspective Vivian W. Pinn and Nida H. Corry Every week, 3 million people in the developing world migrate to cities , including large numbers of women (UN-HABITAT 2009b). As has been described in previous chapters, the pace of urbanization in many low-income settings exceeds local government capacity to provide basic amenities; as a result, urbanization in many places has resulted in the creation of vast urban slums, where a third of all households are headed by women (UN-HABITAT 2009b). This chapter discusses U.S. National Institutes of Health (NIH) initiatives and priorities in response to this phenomenon. After setting the stage with a review of the effects of urbanization on women’s health, the chapter discusses the Office of Research on Women’s Health (ORWH) research agenda and priorities ; Fogarty International Center (FIC) programs; other NIH initiatives ; and the larger federal framework within which the NIH works to address the needs of poor urban women in developing countries. Women and Urbanization Gender Inequality in the Urban Setting Households headed by women frequently suffer disproportionately in cities in the developing world. In fact, global urban poverty has become highly feminized because poor, urban women tend to have low-paying jobs, high illiteracy rates, and fewer years of formal education. In addition, they are more vulnerable to intimate partner violence and are often forced to juggle family caretaking with work responsibilities. Social and political factors often make it difficult for women to own a home or land or to obtain credit to start small enterprises. For women, 170 Vivian W. Pinn and Nida H. Corry unstable housing has the combined potential to decrease food security and sustainable development and further compound ill health related to slum dwelling (Kothari 2003; Benschop 2004). Data suggest that health on average is better in urban than rural settings, due to more stable employment and better access to health services, clean water, and sanitation. However, these average findings mask wide socioeconomic differentials. When the data are disaggregated, urban poor often face health risks nearly as severe as those of rural villagers and sometimes worse, including high rates of infectious diseases and mental disorders , such as depression and anxiety, for which prevalence rates among women are double those for men (Harpham 2009: 112). In addition, urban areas have a higher incidence of breast cancer, perhaps due to increased risk factors, such as dietary factors, increasing age at first live birth, and lifestyle (e.g., alcohol use, activity levels) (Byrne 1996). One specific aspect of urban health services that needs priority attention is reproductive health, which includes pregnancy, HIV/AIDS, birth, maternal health, and fertility (Harpham 2009: 111). Impoverished urban women are significantly less likely than their more affluent counterparts to have access to reproductive health or contraception and, not surprisingly, have higher fertility rates. In addition, the data suggest that urban poor women have very little access to information needed to make informed decisions about reproductive health, including protection against sexually transmitted infections (STIs), such as HIV/AIDS (Sai 1993; USAID 2004). HIV/AIDS is commonly thought to be prevalent among urban poor due to specific risk factors, such as sexual initiation at a younger age and more reported forced or traded sex. An array of urban conditions influence the spread of HIV or the severity of the illness, including overcrowding and high population density ; inequitable spatial access and city form; competition over land and access to urban development resources; pressure on environment resources ; and urban development capacity (Dyson 2003). In addition, data suggest higher rates of violence by an intimate partner in urban settings, especially slums. Gender inequality and alcohol use, which are pronounced in many urban settings, are recognized as key determinants of violence against women (Goebel, Dodson, and Hill 2010). The urban setting itself is a social determinant of health. In this setting, living and working conditions especially among urban poor women may result in unsafe water, unsanitary conditions, poor housing, overcrowding , hazardous locations, and exposure to extremes of temperature creating health vulnerability. Gender inequality is another powerful social determinant of health, as it is a fundamental structure of social hierarchy that shapes access to health care. Consequently, women in urban settings face the double burden of gender and an urban environment, Women’s Health in the Urban Community 171 which poses compounded social and structural challenges to achieving and maintaining good health (Goebel...


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