Gender equity is not optional: the political choices behind women’s health

Perspectives from JordanSince the Ottawa Charter placed empowerment, participation and healthy public policy at the heart of health promotion in 1986, women’s health shows how unfinished that political agenda remains. The retreat on reproductive rights in many parts of the world is its most visible manifestation, and it is doing real harm. But treating it as the whole story obscures the quieter decisions that determine whether women can exercise health rights in practice: livelihoods and social protection, health entitlement, whose knowledge informs policy, and whether women have agency in shaping the systems affecting their lives.Jordan’s 2004 National Human Development Report, Building Sustainable Livelihoods, approached these questions through a Sustainable Livelihoods framework. The Jordanian Hashemite Fund for Human Development led the authorship, compiled the report and managed the community consultations on which it rests – work carried out through the same national network of community development centres that remains its operating platform today. Rather than measuring poverty by income alone, the approach examines the assets people hold – human, social, natural, physical and financial – the shocks that erode them, and the institutions determining whether those assets can actually be used. The consultations treated people not as subjects to be surveyed but as analysts of their own conditions.Health as an asset and a rightTwo consequences have followed. First, health becomes a community asset – something households build, hold and can lose. When illness strikes without protection, families borrow, sell livestock or withdraw children from school; a health shock depletes every other asset at once. Second, health becomes unavoidably a question of rights and power, because the framework asks not only what people have but also what institutions permit them to do with it. Entitlement, voice and accountability become analytic categories, not add-ons.The findings remain valid, and the report’s central concerns – participation, access, assets and the strength of social relationships – are precisely those needing reinforcement now. A method built to analyse shocks, insecure work and eroding protection speaks directly to a decade of climate stress and contested social spending. What has not kept pace is institutional practice. The communities consulted did not simply ask for more services; they called for accountability and genuine consultation. Problems persist not because they were unidentified, but because learning has too rarely translated into sustained institutional change.Women’s health makes the consequences visible. Health protection tied to public employment can disappear following privatisation with no equivalent entitlement replacing it. For women, loss of insurance can affect access to skilled attendance at birth and timely antenatal care. Maternal health is therefore not simply a question of clinical provision. This is the practical meaning of health in all policies: economic decisions that appear distant from the health system determine who remains protected by it.Power also operates within health care, and this is where the medicalisation trap takes hold. Participatory research in Jordan found that when couples experienced difficulty conceiving, wives could be assumed responsible and subjected to extensive testing before their husbands were examined. A shared reproductive health issue became an individual female medical problem. At the other end of the life course, menopause and midlife health barely registered as health priorities in their own right. Neglect is not always the absence of services; it can begin with whose experience is recognised as important enough to enter the evidence at all.Building community agencyApproaching its 50th year, JOHUD offers one model of the infrastructure this analysis demands. Its centres, spread across Jordan’s poorest and most remote communities, are standing local platforms rather than project offices: places where health enters the community sphere, where demand is stimulated rather than only supply expanded, and where resources, partnerships and relationships are mobilised based on priorities that communities set themselves. Through participatory research run from these centres, women have been trained to investigate and articulate local priorities rather than respond to questions defined by external institutions. The process produces information, and also confidence, communication skills and solidarity – precisely the human and social assets a livelihoods analysis identifies as foundational. Agency is not the outcome of health promotion; it is part of its infrastructure.Jordan has also developed institutions to advance women’s rights and accountability, including the Jordanian National Commission for Women and the National Centre for Human Rights. But such architecture alone is insufficient. Accountability bodies require resources commensurate with their mandates; participatory approaches need to become standing systems rather than donor-funded projects; and philanthropy, however important in helping uninsured women obtain care, cannot substitute for durable entitlement.Forty years after the Ottawa Charter, the political choices are not difficult to identify. Governments must protect health entitlement when economic policies change, situate women’s health within livelihoods and social protection, invest in community platforms capable of sustaining participation between projects, and recognise women’s health across the entire life course, including menopause and midlife.