The Honorable Professor Nkandu Luo, now Zambia’s Minister of Gender and Child Development, is a physician, professor of microbiology and immunology, a former Parliament member, former Minister of Health and founder of a an organization supporting sex workers*. Having overcome some of the challenges facing women and girls in her country, and worked to address some of the others through her varied careers, she is considered somewhat of an authority on those challenges.
On a large scale, the challenges to women’s health alone in low and low middle income countries like hers are daunting. Childbirth and pregnancy related death rates have dropped by half in Zambia over the last decade but remain the reason for nearly 8 percent of the deaths of women during their reproductive years. The impact of the country’s HIV epidemic is disproportionately born by women, and most at risk among them are married, and in long term relationships. Inferior economic and legal standing in marriage, child marriage and domestic violence all threaten women’s power to protect their own health. And, as Professor Luo added during a discussion at The Aspen Institute Friday, “Our families are too big.” She is one of eight surviving siblings, she added. Her mother had 13 children.
So what was it like to grow up as a girl in Zambia? asked Peggy Clark, the institute’s executive director of global health and development, who moderated the discussion.
“Just like everywhere else in the world, growing up as a girl is difficult,” Professor Luo said. “You are judged harshly. You should apologize for everything, including talking. If a girl gets pregnant, she’s bad. They don’t even talk about the man.”
It does, in fact sound familiar, particularly for anyone of Professor Luo’s generation, anywhere. So what’s the difference? Why are the consequences of a double standard matters of life and death in Zambia? The answer to that came when Clark asked what Zambia needs to sustain the progress it has made in the last decade and a half.
“Reduce poverty,” Professor Luo said. “I’m using the word in quotes, because Africa is rich.”
If Zambia is treated as a partner, rather than a recipient that would be a good start, Luo said. In terms of global health, we all are partners, she added: “I can fly in anytime I want, and I can fly out anytime I want. Many of these preventable diseases are infectious.”
Dr. Ariel Pablos-Mendez, the third member of Friday’s panel, and global health administrator and coordinator of Maternal and Child survival at the United States Agency for International Development warmed to the idea of paying actual salaries to the community based care workers and treatment adherence support workers. A disproportionate number of those, who have served as foot soldiers for donor-funded efforts, compensated in token gifts of fabric and rubber bracelets bearing the names of nongovernment organizations under contract with USAID are, traditionally, women. Treating monetary compensation as a gender issue might be a persuasive pitch to sell the idea, he said.
It is a concern that formed a theme of a United Nations meeting on the status of women in 2009, but it is one that Professor Luo was less quick to embrace, saying salaried home-based care work poses a dilemma, because caregiving is part of the fabric of Zambian culture.
Everyone had stayed late by then for questions following a discussion over lunch, so no time remained. It will wait for another day to discuss if work that community members are trained to provide by NGOs is part of that fabric, and if NGOs need a pitch, or guidelines to apportion the salaries it awards its workers equitably.
*The name of the organization Tasintha means “transformation” in the local Chewa language, and its mission is “To free Zambia from commercial sex work and HIV/AIDS.” It is not a sex worker rights organization.