Mamphela Ramphele
describes how collecting and burning wood and biomass damages women’s health and the environment, and how household electricity revolutionizes their lives.

When we become ill, many of us will be treated by doctors with advanced technology. We will receive the latest drugs. If our doctors need to, they can research sophisticated databases, press a few buttons and consult anyone in the world. But as we all know, most of the world has no such access. Indeed, even in the richest countries, there are many who do not have access to adequate medical care. Access to critical medical services is socially determined.

We have become more aware of the intimate linkage between the environment and health outcomes. The breakdown of the water, sanitation and electricity infrastructure in Iraq – and the anticipated effects on the health of a predominantly urban population – are of serious concern. We have also recently been reminded of the importance of having strong public health infrastructure and core functions in place, through the effective, immediate response to severe acute respiratory syndrome (SARS) in Viet Nam, which limited the outbreak in that country through combined clinical and public health approaches.

Environmental risks disproportionately affect poor households, and it is poor children and women who are shouldering an unfair share of this burden. Acquiring and using biomass fuel and fodder for the household may take up anywhere between two and nine hours a day in developing countries, depending on their availability. In Lombok, southern Indonesia, women spend about three hours each day cooking, and four hours each week collecting dead wood or agricultural residues to be used as fuel. In some areas of Kenya, women spend seven hours a day on similar tasks.

Work burden
In rural areas of India, there are wide differences in the work burden of men and women. Women are engaged for six hours daily in collection of fuelwood and fodder, and cooking: men spend approximately ten times less time on these tasks. In some areas, this extreme physical drudgery causes serious reproductive problems and mental disorders in women.

A 1996-1997 study carried out by Jashodhara Dasgupta of Sahayog, a research and activist group, in Uttranchal, western India – involving over 1,000 women in ten locations across 12 districts – found the proportion of miscarriages to be 30 per cent, five times higher than the average rate reported in the National Family Health Survey of 1992-1993. It noted that women have a gruelling schedule during pregnancy – including lifting heavy loads of wood, manure and grass – which added to the risk of miscarriage. The women of Uttranchal are also under continuous mental stress from anxiety over how to sustain the household. There is high male migration to urban areas, while depleted forests have made the trek to gather fuelwood and fodder much longer and tougher.
Environmental risks disproportionately affect poor households
Apart from the physical costs of collection – and the effects this has both on women’s health and the depletion of natural resources – using low-cost, widely available traditional energy sources such as coal and biomass (wood, dung, crop residues) for cooking and home heating results in a high incidence of respiratory diseases and eye problems.

Half the world’s population is exposed to indoor air pollution, mainly through the burning of solid fuels for cooking and heating. Biomass is still the main source of energy for 60 to 90 per cent of households in developing countries – some 2.5 billion people. It is the mothers and their children, primarily in rural areas, who are mainly exposed to the effects of poor ventilation of biomass fuel while using primitive stoves, and who pay the price in illness and premature death. Much evidence has been documented, for example, that associates burning this fuel with the incidence of chronic bronchitis in women and of acute respiratory infections in children.

Significant benefits
In some high-mortality Latin American countries, such as Guatemala, it has been estimated that indoor smoke from solid fuels causes 10,000 deaths a year, with 298,000 years of life lost. In a programme there, improved stoves have had a significant impact on people’s lives. Participants reported the most valued benefits – besides removing smoke from the house – were using less fuelwood, and reducing cooking time. Given the drudgery involved in collecting firewood and cooking, these are also significant benefits for rural women.

Policies for rural areas that encourage the uptake of petroleum fuels and efficient use of biomass fuels can effectively address the problems of indoor air pollution and women’s physical labour. But women must be involved in planning these policies and interventions to ensure that they are implemented successfully and sustainably. Energy policies and projects by themselves will not change the plight of women in society, but they can be used as entry points for reducing a preventable burden of death and illness among women and in promoting greater fairness in allocating opportunities and resources between the sexes.

The effectiveness of addressing this life-threatening issue will depend on three key considerations:

  • the policy and regulatory context

  • making sure that all relevant sectors/perspectives are considered in interventions that aim to increase fuel efficiency, reduce health risks and improve local ecology

  • local community involvement in technology design and application, especially with regard to stoves and ventilation.

Government programmes need to include a component to inform, educate and communicate the health, environmental, energy and financial consequences of indoor air pollution and the different interventions that reduce exposure. There are typically three types of these:

  • improved cooking and heating devices or use of cleaner fuels

  • improvements in the living environment such as better ventilation or separate cooking areas

  • changes in behaviour to reduce exposure to smoke or to reduce smoke generation through, for example, proper stove maintenance and cleaning.

Long-term sustainable solutions require full participation from local government, civil society, the commercial sector and local communities, particularly women.

A rural energy market study, sponsored by the joint United Nations Development Programme/World Bank Energy Sector Management Assistance Program (ESMAP), uncovered promising results about the impact of electrifying households on the lives of women. A survey of 5,048 women from six states of India in 1996 revealed that access to electricity directly affects the amount of leisure time they have, while providing channels to increase their knowledge and awareness through facilitating reading and watching television. It also found that women from households using electricity are likely to spend less time collecting fuel and are more likely to use fuels that are less debilitating to their health.

Healthier lifestyles
On average, these women lead healthier and more productive lives than their counterparts in households that do not use electricity. Both reading and watching television, for example, can educate and enlarge the horizons of village women and, in the long run, bring about social change. Although empirical evidence needs to be strengthened, having electricity in rural households seems to change their overall environment in such a way as to encourage healthier lifestyles, including better cooking systems.

Electricity is available in almost all villages in India today. However, according to the ESMAP study, which surveyed six out of the 20 states of India, about 60 per cent of households do not have electricity from the grid. Based on a 2001 census of India, the statistic is as low as 40 per cent of the country with access to electricity.

As the Global Health Council emphasizes, the task facing us today is daunting. Each year, all around the world, tens of millions of human beings die needlessly, and hundreds of millions of lives are ravaged by ill health. The world has the resources to greatly reduce this loss and suffering. When it comes to global health, there is no them, only us

Dr Mamphela Ramphele is the retiring Managing Director of the World Bank and Senior Advisor to its President.


This issue:
Contents | Editorial K. Toepfer | Miles to go before we relax | Practical consensus | Power shift | Equally effective | People | Peace of mind, piece of land | The young ones | Fuelling change | At a glance: Women, health and the environment | Aishwarya Rai | Unprecedented opportunity | Books and products | Chemical inheritance | Toxic trespass | First empower | Citizen engagement | Adding feminine perspective | After all ‘nature’ is female... | A unique voice

Complementary articles in other issues:
Issue on Culture, values and the environment 1996
Kristalina Georgieva: Disproportionate Effects (Beyond 2000) 2000
Issue on Poverty, Health and the Environment 2001
Issue on World Summit on Sustainable Development 2002
Issue on Energy 2003
Issue on Water, Sanitation, People 2004

AAAS Atlas of Population and Environment:
Population and natural resources
Population, waste and chemicals