To support gender equality, we must adopt a broader understanding of women’s health and wellbeing: Dr. Kehinde Ajayi

Measures of women’s health have traditionally focused on a few key indicators such as maternal mortality and access to reproductive health services.

To mark this year's International Women’s Day, Exemplars News spoke with Dr. Kehinde Ajayi, director of the Gender Equality and Inclusion Program and a Senior Fellow at the Center for Global Development, about the growing recognition that these traditional data points, while critical, miss key factors of profound importance. For example, the availability of quality childcare can impact women’s participation in the formal economy, their ability to earn money and be self-sufficient, as well as their health and the health of their families and communities.

Dr. Ajayi explained why including factors such as childcare in the new, more comprehensive term “women’s health and wellbeing” can help identify powerful levers for supporting women.

Over the past two decades, our understanding of how we can effectively invest in gender equality has been shifting. Can you tell us about this shift and how LMICs are adapting to accelerate their progress toward gender equality?

Dr. Ajayi: Over the past two decades, we’ve seen a lot of progress in keeping girls in school, especially in African countries, which are a focus of mine. In most African countries over 80% of 10- to-14-year-old girls are in school and across the continent and 69% are completing primary school. That is up from less than half of girls completing primary school in 2000.

But even though there have been these huge gains in school enrollment, we still see gender gaps in learning and persistent gaps in earnings in adulthood. What’s really exciting now is how low- and middle-income countries are broadening their investments in adolescent girls beyond keeping them in school. They are thinking more intentionally about the things that improve women’s health and wellbeing.

Some of the innovative interventions we are seeing come out of this reassessment are cash transfers programs and financial inclusion efforts for adolescent girls and young women. We're also seeing countries establishing girls groups and using them as a platform for providing services and training, such as in the Sahel Women's Empowerment and Demographic Dividend Project. We’re seeing more calls for linkages to labor market opportunities, along with increased efforts to tailor health interventions to adolescent girls so that they have access to sexual and reproductive health services in ways that are appropriate for them.

You used the term 'women’s health and wellbeing' in your answer just now. As a member of the technical advisory group for Exemplars Global Health's Women's Health and Wellbeing project can you explain why it's important to add “wellbeing?”

Dr. Ajayi: To me, gender equality is about ensuring that everyone has an opportunity to achieve their fullest potential in life, regardless of gender. Just as there has been a broadening in our understanding of when in a woman’s lifetime we need to invest to support gender equality, there has also been a broadening in our understanding of what we need to invest in.

This expanded definition makes space for how women spend their time and the impact that has on their lives. It takes into account whether they have less job security, less access to resources, are exposed to risks, and usually have very little leisure time. All of this has clear implications for their health. Broadening our conceptualization to include all these factors that impact health provides us with a more comprehensive measure of women’s health. And it helps us better identify other opportunities and strategies and interventions to support women, outside of the health sector. For example, how might improving access to quality childcare impact a mother’s health and wellbeing?

Building on that question – why should decision makers in LMICs be keen to make investments in childcare? What is the impact on the child and the mother's health and wellbeing?

Dr. Ajayi: Childcare is an investment that has multiple impacts on multiple people. It's an important way to improve early childhood development. It impacts the health, nutrition, and education of young children. At the same time, childcare has the potential to impact women's empowerment. When quality childcare is available, studies find improvements in women's employment, as well as the employment of other family members. This has huge implications for economic productivity, both in terms of the children themselves eventually being more productive and making larger contributions to society and improved wellbeing and in terms of enabling women to work and support economic growth.

And yet, it is estimated that just 1% of children under two in LMICs are in childcare. You’ve written about some of the reasons why we don’t hear very much about childcare in LMICs. What are some of the innovative and effective ways countries are investing in this space to expand access?

Dr. Ajayi: We’re seeing innovative multi-sector approaches to addressing childcare. Leading up to the Women Deliver conference in Kigali last year, I co-organized a pre-conference on the care economy. We had policy makers, practitioners, and researchers sharing some of the exciting work they’re doing across the globe.

One compelling example is Bogota’s Care Blocks, which welcomes low-income caregivers who can access health services and training, and even do their laundry there. Kenya, where home-based childcare is common, offers another pathway. They are exploring ways to improve the quality and access to home-based childcare.

Governments are also exploring how they can provide complementary training or certification to childcare providers. For example, in the Bogota Care Blocks model, government trainers assess whether the caregivers have the skills that would've been provided through government training and certify the caregivers if they meet government standards. If they don’t meet standards, they are provided complementary training and certified. That certification may allow them to work in a formalized setting later on and improve their earning potential.

Another example is from Burkina Faso where I did an evaluation of a youth employment program. The government introduced a public works program that provides unemployed youth with six months of guaranteed minimum-wage employment working on things like digging ditches, building roads, and cutting grass. Many of the women participants would bring their children to the public work sites, trying to balance their participation with looking after their children. Some of the program coordinators decided to provide childcare centers for the projects. They trained some of the public- works participants in providing care and then set up the childcare centers. In our research, we found that the provision of childcare improved the children's early childhood development and created employment opportunities for the women providing childcare. Other countries have replicated this and are integrating childcare into public works or youth employment programs.

As someone who has worked on women’s empowerment for most of your career, what are some of the challenges you've seen in investing in women's empowerment and how can these investments in women be better designed so they accelerate our progress?

Dr. Ajayi: Because women in LMICs are often employed informally, the default for investing in women has been supporting them as entrepreneurs – helping them access credit or training. But we need to recognize that many women are self- employed out of necessity, because there aren't other employment opportunities available.

So, we must adapt investments to contexts and to profiles of women and look for multiple entry points to support women. This includes taking a systemic approach and investing in systems so they support women – ensuring women can open a bank account, have equal access to identification, a robust childcare ecosystem, and investing in women's leadership so more women can be involved in finding effective ways to increase gender equality.