* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
"In my home country of Somaliland and other parts of the developing world, women do not wish for greater access to healthcare because they do not know that healthcare is, or should be, available," writes midwife, U.N. diplomat and former Foreign Minister Edna Adan Ismail
Imagine this. Your child is sick, but you need your husband’s permission to buy medicine. Your child doesn’t improve, and you still need your husband’s permission to attend a health clinic. In fact, you need his permission to do anything to help your child feel better.
Imagine this. You have a serious health problem and have been told that pregnancy may be fatal for you. Contraception could save your life, but under pressure from your family, you are forced to avoid it, putting yourself in unnecessary danger.
Imagine this. You desperately need an emergency Caesarian section to safely deliver your child. This time, your husband gives permission for the surgery. But the doctor is unable to operate because your father refuses to give him permission to do so.
In my home country of Somaliland, I have witnessed these life-threatening scenarios happen time and time again. I have been forced to call in a police officer to witness the refusal of a male relative to give permission to operate on a dying woman. I have demanded that if these relatives refuse to give permission, they should sign a declaration in front of the law stating that they wish for her to die.
When talking about improving healthcare, it is paramount that local traditions and customs are taken into account. In some cultures, including mine, women – for example - cannot make their own decisions in regards to medical care, even in emergency situations.
In Somaliland and other parts of the developing world, women do not wish for greater access to healthcare because they do not know that healthcare is, or should be, available. One cannot miss what one has never had. Just as most women in the United States would never dream of giving birth without skilled professionals in attendance, in many cultures, women cannot imagine anything other than giving birth at home assisted by female family members or the old women of the village as it has been for generations. In addition to that, due to lack of social and economic empowerment, women often underutilize the existing healthcare resources that are already available to them.
Improving women’s access to healthcare will involve much more than lowering costs, improving transportation, or opening more clinics. It is a matter of changing people’s outlook on life. One of the first steps is to raise awareness that healthcare is both a right and a necessity. Women should recognize healthcare as a priority and demand greater access. They should demand this from their countries, from their communities, and from their families. If women remain content to go without antenatal care and to give birth under unsafe conditions, then there is no incentive to provide them with better access and infrastructures.
Ignorance is the enemy of healthcare. People tend to fear the unknown and, to the uneducated, the world of medical science is the unknown. In countries where education is not freely available, the healthcare profession is looked upon with suspicion. Having watched women give birth at home for generations, people naturally question the motives of health workers who seek to change traditional practices. Only by opening the minds of women through education in the health sciences will we help them understand the value of prenatal checkups, breastfeeding, immunizations and other healthcare that women in the developed world take for granted.
We must improve education, particularly among young women. In Somaliland, the majority of them cannot read or write, let alone understand (such) concepts such as the human reproductive system, the transmission of sexually transmitted diseases, or the dangers of poor sanitation. Better education will help them understand the importance of healthcare.
Improving access to healthcare in countries such as mine is a problem of great magnitude. It cannot be improved simply by spending more money to build a 'clinic'. The problem can be solved only through dedicated and systematic efforts to empower women, to change the way they see themselves, and to train more midwives.
Edna Adan Ismail is a nurse-midwife, UN diplomat, and former Foreign Minister of Somaliland. She will be speaking on women’s access to healthcare at the forthcoming Trust Women Conference in London, 3-4 December. Register now and save up to 20% www.trustwomenconf.com