Pacrrtc HralrH Draloc VoL 4' No' 2

different role and status of any of the members of the family

m u s t b e c o n d u c t e d w i t h i n t h e m a t r i x o f t h e f a m i | y a n d i t sJynaticity. lt is only then that a new equil ibrium will be

reachedwi thout thedestruct ionof theverybui |d ingb|ocksof society - the familY'

The family as the centre of analysis means that all proposed

changes havetofocus on the maintenance of family coherence

and leciprocal obligations of its members'12 Therefore a

change in the interrelaiionships and roles of farnily members

r"t, i"f" place only if the group is enhanced but not for the

benefit of an individual member' For example' to ensure

appropriate child rearing essential for the continuity of the

family'unit, this task must not be cornpromised by potential

caregivers being too busy elsewhere to.provide or purchase

equally approprlate substitute' Such assurance needs

appropriate resources and information on alternative care for

decision making as well as the abil ity and opportunity to

negottate a new arrangement That is, the n9w roles of the

,',.'e-mbers of the family must be readjusted with the welfare of

the family groups in mind rather tharr the demands of

indivrdual members being the paramount reason for change'

That is, ihe farnily aspires and actualises collectively but not

any one member indiv idual lY '

A focus on the individual to associ;rted with the biomedical

model which has been found to be detrirnental health'8 This

model does l itt le to empower people: treating them as if they

a re f ree tochoosehea | thbehav iou rsand igno r i ng the ro |eo findustry, governments and international organisatlons In

With the family as the centre of analysis the power relations'

r o | e s a n d a c c e s s t o r e s o u r c e s c a n b e a d j u s t e d w i t h i n t h esocietal diversity of race, class, ethnicity' religion' physical

environment and resources which tends to be wrongly

,rUrn"rg"a by a focus on the needs of individual members'8

Ch""s"t O"ted on such analysiswil l also proceed atavelocity

deteririned by the existing micro-dynamic and the realistic

context of the family. After all, the speed of change has been

demonstrated to be most damaging to individuals and

families.s'12'' ' So controlled and managed change at family

level wil l be reflected as orderly and beneficial change at

macro level.

Gender roles in the familY

T h e r o l e o f t h e s e x e s w i t h i n t h e f a m i | y i s t h e p r o d u c t o fsocial constructs based on traditionalvalues and interpretations

of thenatura lenvi ronment 's ,22Sexisabio|ogica|endowmentbrt g"nd"r. is a learned social value which dictates the

activities and characteristics associated with males and females'

The difference in the sex and sexual functions have become

the foundation of farnil ial division of labour' which is reflected

in the well demarcated gender roles at all levels of society'21

Those ro|es a|so Iead to differentia| occupationa|, hea|th and

educational outcomes which further endorse the social

construct and the subsequent division of labour'

Over tme women have been allocated the domestic'

caring and procreation role' The responsibil i ty for health'

repro'duction, child rearing, nutrit ion and home maintenance

have become soc ia l lYl imi t ing arrd d i rect ing th is

c h o i c e . T h e r e i s l i t t l e !recognition of horv individual !behaviours and c l to ices are icorseted bY socio-ecorrornic iconstraints or horr' a group :l i k e t h e f a m i l Y s h a P e s

individual l ives. ,

At the other end of the ,s p e c t r u m i s t h e g l o b a l :

approach with the economics

of scale just i f icat ion, toP-

" Sex is a biological endowmentbut gender is a learned social

value which dictates the

activities and characteristicsassociated with males and

females. tt

accepted and the exPected

domain of women.z2 On

the other hand men have

been relegated decision-

making, political leadershiP

and the control of familY

resources. This has led to

men's bet ter educat ion

and formal emPloYment in

contrast to women's less

recogrr ised contr ibut ionm os t l y t l r r ou gh the

down model which presupposes that deliberations, policies'

and dec la ra t i ons o f gove rnmen ts and i n te rna t i ona l

organisations wil l improve the conditions of all individuals

ani their families. The negative reactions to, and results of the

World Bank adjustments and activit ies are classic examples

of decisions made by elites so far away from where people

and families l ive.re' 20' 27 The problem of the top-down

"fprou.h has always been that the benefits do not trickle

down far enough' For example, a US$10 mill ion global

conference on poverty or any of the benefits of structural

adjustment runs into the ever-expanding trough of the rich

so that only tiny trickles ever reaches the poor'

informal sector.l0 Much of the women's contribution occurs

within the home including unpaid domestic labour and

income generation through sell ing the skil ls they normally

practised at home, eg food, childcare' sex' compani.onshiR,

sewing and other socially defined women's activit ies and

products.

With women's roles comes increased health risks that

extend far beyond their reproductive roles'1'2'3 Their multiple

roles lead to health risks that men experience in the formal

sector. To make matters worse, the conditions of women and

the i r con t r i bu t i on to the fam i | yandcommun i t ya reo f teninvisible due to their subordinate position to men'2r'24 Most

societies are constructed in such a way that attitudes, attributes

157

PRcrnc HalrH Drmoc VoL 4. No. 2 DtscussroN Paprn

liberate women from the constraints of their practical needand permit them to pursue health and other achievements oftheir choice. The enabling and empowering step is appropriateeducation specifically aimed at the abil ity to negotiate thenew division of labour and satisfy their strategic needs.

The education of women has been shown to be the mostinfluential investment.2s Education releases an enormoussource of human capital and an important source of skil lsincreasing both subsistencea n d c a s h p r o d u c t i o n .E d u c a t e d w o r r e n a l s oimprove fam i l y we l t a reth rough be t te r hyg iene ,improved nutri t ion practicesand greater effectiveness asfami ly c i rers. Mothers 'schoo l i ng r l so improveschild and mat(-rnal health,d e c r e a s e s f e r t i l i t y a n dimproves educatior.r of theirc h i l d r e n . T h e m o s rimportant determinants off a m i l y w e l l b e i n g a n deconomic growth are thelevels of female educatron

" .. . a new development paradigmthat empowers women to

negotiate a new division of laborand power relations within

the family. This new paradigmmust be people centred

emphasising social returns withpeople coming before things and

children before adults. "

These needs are determined by their sex at birth and bygender identity which is culturally constructed and sociallyproduced.s,r 0,22 The family level chan ges mustbe accompaniedby appropriate societal structural changes to enhance thenew division of labour.

Evidence suggests that the education of women is the mostinfluential investment for the improvement of family welfareand economic development.2,e,rt Education empowers

women to par t ic ipate indecision making, increasecontrol over resources andimprove the i r ab i l i t y t onegot iate a new powerrelation in the family. Theeducation and socializationof men to a new role musttake place simultaneously.

The family as the basicu n i t o f i n t e r a c t i o n a n dbuilding block of society isthe appropriate level fori m p l e m e n t i n g g e n d e rsensitive chan ges. The familymust be the centre of analvsis

and the gender gap in education.i l

The new development trend and division of labour beg thequestion of what happens to women,s reproductive anddomestic resonsibil i t ies.tr lt has been suggestedthatall theser-oles except pregnancy are only social constructs and can beshared amongmen andchildren. Howeverthiswil l necessitatenew sociaIsation practices. The decreased involvement ofwomen wrth childcare amounts to foregoing an opportunityto socialise children to a gender sensitive generation. After ali,the young captive child in the home is the most opportunemomentfor mouldin g gender sensitive attitudes and practices.

As women take on more of the role of men they wil l inheritnew health problems associated with the differentoccupations,eg military. This added burden has ro be met by the healthservices. This may mean changes to the content and structureto accommodate the new clientele. The new health servicemust redress the imbalances in service provision to men andwomen. Health professionals must attain capabil it ies fordeal ing wi th gender vulnerabi l i ty ,s and improve thei rknowledge and skil ls to address the health effects of genderdiscrimination.22

ConclusionThe improvement of women,s quality of l i fe and the

maximisat ion of thei r contr ibut ion to heal th requi resrestructuring development programs to increase investmenton women.2.2e They should be involved in allthe developmentalstages to reflecttheir special conceptualisation of their needs.

and preservation of itscoherence and reciprocal obligation ofits members must be the implicit and explicit goal of alldevelopmental efforts. This must recognise the desire ofwomen to have more control over family and society resourcesand increased participation in the determination of society,sfuture direction.

A suggested st rategy for women's par t ic ipat ion indevelopment for better health must include:. a new development paradigm that empowers women to

negotiate a new division of labor and power relationswithin the family. This new paradigm must be peoplecentred emphasising social returns with people comingbefore things and children before adults.

. men must be domesticated to take on new roles and sharethe bu rden of women. Thi s must involve encouraging andsupporting women to socialise children to new genderrole and training adult men in domestic and caring skil ls.Men mustbe enabled to share a newdivision of authorit iesand responsibil i t ies in and for the family.

. education of women to new gender roles. This it toinclude psychomotor and cognitive skil ls necessary forskil led labor and management through adult training andincreased schooling of girls.

. research to monitor the effectiveness, efficiencv andefficacy of the transfer or substitute of the women,straditional roles to men, children, surrogate replacementsor institutions.

. polit ical wil l and action to recognise and harness theenormous human capital of women. This is to includegender-sensitive policies, genderised information and

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