When Sexual Violence Doesn’t Make Headlines

News of violence and injustice against women consumes the headlines every day. "Liberian women battle against ‘sex for grades’ at universities." "Delhi gang rape victim’s tragic death transforms her family’s life." Stories about ". . . the plague of violence against women."

Even amidst this steady stream of astonishing wrongs, I think about every woman and girl facing violence and injustice quietly and without notice. Too many remain invisible.

Global Health Starts With Women

This week, academic leaders from around the world are coming together for the 4th annual global health conference of the Consortium of Universities for Global Health. Nearly 1,400 members of the academic community (including some 500 students) from 751 institutions in 56 countries seek to identify a multi-sector, multi-disciplinary, interprofessional approach to improving global health.

An important aspect of the conversations is that any approach to global health must start with women and girls. Taking care of women is taking care of the family which is taking care of the community which is taking care of society.

In any dialogue about social welfare and development, there is global recognition of this centrality of women. The United Nations’ Millennium Development Goals aim to improve the lives of people around the world and ensure their basic human rights, particularly women’s issues, including poverty, education, maternal and infant mortality rates, and infections. The formation of UN Women and the appointment of Melanne Verveer as the U.S. ambassador for global women’s issues by President Barack Obama are indications of recognition of the vital role of healthy and educated women.

Progress and Need

But, as Ambassador Verveer wrote, “. . . we have indeed seen progress in protecting the human rights of women. . . . [but] there is no getting around the fact that progress is fragile in many places and barely measurable in others.”

Similarly, President Obama’s recent reauthorization of the Violence Against Women Act is an important marker both of our progress and of the continuing, deeply rooted need for attention to the health of women and girls.

As we come together this week, my partners in the Consortium of Universities for Global Health will:

• Consider novel ways to make academic institutions transforming forces in global health, expanding our moral commitment to translate knowledge

• Assemble best practices from different parts of the world. Universities are not just exporters of innovation, we are importers too.

• Share a united vision of global health, one of equity and justice, the elimination of violence, the courage to tackle world problems, and truly measurable impact.

Those are headlines I would like to see.

A Global Woman's Story

“It is time to tell the new story.” Those resonant words from Zainab Salbi, founder of Women for Women International, opened our new Center for Global Women’s Health on Friday. The Center’s inaugural symposium offered a thoughtful prologue to the body of global research in women’s health scholarship, education, and practice that Center faculty and scholars will produce.

The Center’s first chapter is enriched by an extraordinary gift for our School, a generous endowment fund for visiting global scholars. 

The benevolent donors of this endowment, Ambassador Martin Silverstein (a member of our School of Nursing Board of Overseers) and his wife Mrs. Audrey Silverstein (a lawyer and member of our Nurse Anesthesia Board) named the endowment for a mother called Dr. Soad Hussein Hassan.

This woman was born in a small village in Egypt called Abu al Akhdar to a mother who was a farmer who never went to school and a father who worked on the Egyptian railroad. She went to a diploma nursing school and became a popular school nurse first and a successful midwife later.
Through sheer persistence and commitment to her beloved nursing profession, she managed to get a World Health Organization scholarship to attend Syracuse University, leaving her family and not seeing her children for two years, to study for a B.S. in nursing, becoming one of the first people in the Middle East to receive this degree.

Knowing that she wanted a future in educating nurses, first in diploma schools, then in university programs, and realizing a bachelor’s degree would not be enough, she got herself admitted to the school of public health in her native Egypt and was the first nurse to receive an MPH. She went on to establish schools of nursing in her country as well as others such as Saudi Arabia and Kuwait. But she continued to dream about studying for a PhD and got herself admitted against all odds to another university in her country and completed a PhD in education at the age of 56.
Being the first nurse in her country to be admitted and to receive a PhD from a university in her own country -- others received PhDs ahead of her from U.S. universities – the defense of her dissertation was a major happening and was televised.

This woman, nurse, dean, global educator, and mother met in her life many of the obstacles many women encounter: poverty, harassment, discrimination, and marginalization.  She was beautiful and hence accused of using her beauty to get what she wanted. Because she was a diploma-school graduate, she was marginalized by the young new college graduates. Because she was a nurse, she was devalued by her colleagues in other, more established colleges at the university. And because she started from very modest beginnings and was ambitious, men thought she was easy prey and chased her.

Her integrity, her aspirations, and her hard work paid off: She became the modern Nightingale of the Middle East. She retired at the age of 76 after opening and running eight schools of nursing in that region of the world. At least four of these were schools with BS, MS, and PhD programs. She mentored hundreds of nurses and was a revered leader. Her story is the story of many women and many nurses in the world. She epitomized inner strength, resourcefulness, vision, strategic thinking, commitment to excellence, and love for the discipline of nursing. She also epitomized the suffering and triumphs of women who come from modest backgrounds in the developed or developing world.

Another wonderful part of this story is that this woman, in whose name the endowment is given, is my mother!

She miraculously received a PhD without ever going to high school, was married for more than 50 years, raised two daughters, and died a few days short of her 88th birthday after experiencing Alzheimer’s disease for 10 years. Toward the end of her life, hearing me read to her from one of the 10 books she wrote about nursing, brought a smile and a glimpse of recognition.

Global women’s health is a story that connects the past with the future. We have much yet to tell.

Health by Design

At Penn, collaboration occurs fortuitously and with impact. In 2010, I had the opportunity to partner with Marilyn Jordan Taylor, who is dean of Penn’s School of Design, and City Planning Professor Genie Birch to host the 18th International Council on Women’s Health Issues (ICOWHI) conference. The topic was “Cities and Women’s Health: Global Perspectives,” one of my deepest passions. Attracting more than 350 participants from more than 30 countries, the conference proved a launching pad for new approaches to urban women’s health.

The conference inspired a book, Women’s Health and the World’s Cities, which I was thrilled to co-edit with Professor Birch and Professor Susan Wachter of Penn’s Wharton School. We are pleased to present the book on January 24 from 5:30 p.m. to 7 p.m. in Penn’s Houston Hall.

For Women’s Health and the World’s Cities, we called on scholars and practitioners from the fields of urban planning, global studies, and health sciences to consider urban planning from the perspective of women’s health and to examine the effect of urbanization on women and their health.

The chapter “Transforming Urban Environments” resonates with this imperative. Penn Nursing’s Jeane Ann Grisso and colleagues identify women from Philadelphia to Manila who have led community change. “They organize, demand services, and support one another,” the authors write. “The tenacity and commitment of women leaders, in partnership with diverse stakeholders, can lead to profound urban transformation. . . . In spite of daunting realities, women in poor urban communities continue to organize to create better lives for themselves and their children.”

As urban populations continue to expand at an unprecedented rate, the demand for our communities to be responsive and adaptive to citizens’ health needs is greater than ever. This urgent need for intervention is both health-related and dependent on the fundamental systemic needs of issues like human shelter and clean drinking water. The impact of urban living is especially felt by women as gender biases, economic disparities, outmoded infrastructure, and safety threats. Reduced access to healthcare and other resources can conspire to produce dire health outcomes.

Women play critical and multiple roles in societies as mothers, leaders, students, decision-makers, voters, and workers. Health research combined with design, business, and other areas of study and expertise here at Penn are creating an increasingly influential body of work that can serve to aid and empower not only women, but the individuals and families they care for and the communities in which they live.

Women's Health and the World's Cities

Women are more likely to walk where they feel safe. That may be intuitive, but we now have the science to prove it. A new study in the American Journal of Preventive Medicine demonstrated that women throughout the United States, in cities and in suburbs, are more likely to walk where they feel safe and have access to sidewalks and other community resources. Simply stated, more walking and more physical activity mean better health.

In urban planning in particular, consideration of women’s health and social needs is more important than ever. More than half the world’s population – approximately 3.5 billion people -- live in cities. By 2030 this number is expected to increase to almost 5 billion.

People move to urban areas seeking new opportunities, new options, freedom in choices, and better resources. Women in particular believe that they can improve their economic status and social position and find better opportunities for their children by seeking work and education in the cities. However, even as urbanization offers opportunities, the health of women in urban settings is challenged.

Unfortunately, the effects of urban development and gender have received little attention. In Women’s Health and the World’s Cities, my collaborators Eugenie L. Birch and Susan M. Wachter and I called on scholars and practitioners from the fields of urban planning, global studies, and health sciences to consider urban planning from the perspective of women’s health and to examine the effect of urbanization on women and their health.

Urban planners must consider five forces in planning and developing urban areas in order to improve women’s lives:

1. Developing cities with women’s needs in mind. Women want to live in safe environments with better lighting, lower population density, and space that permit connections and allow them to provide the care that their roles demand to meet the needs of their children, friends, partners, elders, and other family members. This means providing access to resources for their children’s needs as well as elders’ needs. Improving conditions in or replacing slums, where many women newcomers to the city live, must be part of urban planning and development.

2. Focusing attention on the sociocultural context and religious mores that drive, and often dictate, women’s movements, educational and working options, and housing needs.
Developing urban areas in religiously conservative Muslim or Jewish communities or in socially strict societies requires different criteria and guidelines that determine the physical and social capitals and hence the space configurations.

3. Including women’s voices in planning decisions. Women should be key players in the policies and plans used for the development of communities. Involving women in policies related to urban planning and development ensures that their perspectives, needs, and voices are included in designing spaces with women’s needs in mind.

4. Developing a conceptual framework that provides a structure for systematically investigating gender and impact -- or lack of it -- on urban environments as well as on health and well-being. This would drive the design and translation of research programs into gender-sensitive urbanization development plans.

5. Understanding that all of these empower women and give them voice.

Contemporary urban planning must address questions that reflect the differences between men and women in urban living and the differences in health outcomes among those who live in urban areas with differential incomes. As the 21st century unfolds, urban planning must be sensitive to defining and investigating the nature of gender disparities that are characteristic of those who live in urban areas. Careful urban planning provides a momentum to empower women and to enhance the quality of their lives. More accessible education, healthcare, and resources bolster women’s abilities to fulfill their caregiving roles.

Preventing urbanization’s spatial, social, and health risks for women through careful advance planning will be far more effective and productive than intervening after the fact.

Afaf Ibrahim Meleis, PhD, DrPS (hon), FAAN, FRCN, is Margaret Bond Simon Dean of Nursing and Professor of Nursing and Sociology at the University of Pennsylvania School of Nursing and co-editor of Women’s Health and the World’s Cities with Eugenie L. Birch and Susan M. Wachter.

Safe Womanhood

Women are half of the human race. By empowering them through health and educational opportunities, we increase their personal potential to contribute to the economic, political, and social advancement of societies. What society would not benefit from such contributions?  Nurses, the largest healthcare workforce in the world, see women intimately as patients, as pregnant women, as mothers caring for their children, as managers of health, and as daughters caring for their extended families. Therefore, nurses have the knowledge, the power, the voice, and the expertise to work toward safe womanhood and to advocate for women’s health, for human rights, and for having options in life.

Women must be equal partners with equal voice to have an impact on decision-making, policy-making, and development. The marginalization and disempowerment of women hinders them from their rights as human beings to reach their full potential to flourish and effectively contribute to their societies.

At the University of Pennsylvania School of Nursing, we have established a Center for Global Women’s Health. The Center will contribute to global research in women’s health scholarship, education, practice, and leadership using an equitable and human justice framework.

The opening of the Center corresponds with the United Nations’ initiatives for the empowerment of women globally and with national attention to women’s health from President Obama and Secretary of State Hillary Rodham Clinton.  They have made girls and women central in U.S. global health programs.
 
Penn Nursing Professor Marilyn Sommers, PhD, RN, FAAN, is director of our Center for Global Women’s Health. Her research focuses on trauma, particularly injuries from rape, sexual assault, and domestic abuse. Last fall, she won the Inaugural Writing Award for Excellence in Research from the Journal of Forensic Nursing for her article “Health Disparities in the Forensic Sexual Assault Examination Related to Skin Color.” Dr. Sommers has conducted path-breaking research finding that injuries are more detectable on lighter skinned women than on darker skinned women, irrespective of race, using current exams for sexual assault injury.
 
With such innovative research, the Center for Global Women’s Health will chart new directions in the domains of safety from violence and harm, equity, empowerment, advocacy, health promotion, and disease prevention. The ultimate goal is to attain safe womanhood, which provides the context and the impetus for healthier and safer families and societies. In short, making women safe and healthy makes the world safe and healthy.