Women After All: Sex, Evolution, and the End of Male Supremacy (32 page)

Of course, there are many skeptical things to be said about these women: how few they were, how they made it in a man’s world by mimicking men, how they failed to protect women’s interests, how they succumbed to war. But what cannot be said about them is that they were incompetent or that they proved a single one of the claims made for centuries—involving emotions, cycles, weak constitutions, delicacy, whatever—about why women cannot lead.
They proved the opposite.
They did it. Warts and all, they performed as well or better than men in the same positions before and since, and so will many more women after them.

Incidentally, the new Norwegian prime minister is the second woman in that position in the country’s history, and the two came from opposite sides of the political divide. Two of the three top cabinet positions went to women, and in recent years Norwegian governments have hovered around half women. It’s interesting to recall that these women, and the people who elected them, are descended from the Vikings, one of the most brutal male-dominated cultures in history; Viking men used rape and other violence against conquered women from Ireland to Russia. Now women run their country.

But as much as all this reveals about women’s potential, it is not the human species; it is merely the top of the top.

In June 2013, a three-year-old organization called UN Women published a declaration:
A Transformative Stand-Alone Goal on Achieving Gender Equality, Women’s Rights and Women’s Empowerment.
UN Women merged four existing UN divisions that dealt with women’s issues. The “transformative stand-alone goal” is key; there are overall Millennium Development Goals (MDGs) for all humanity. But now
there is a stand-alone goal for women, because while the MDGs include women’s concerns, more focus is needed. The report concludes,

These ideas are not new. . . . Yet, addressing them in a holistic and comprehensive manner . . . would constitute a ground-shift in development policy and practice. . . . The world simply cannot afford to miss this once in a generation opportunity to transform the lives of women and girls and men and boys everywhere.

There are three components to the declaration: (1) freedom from violence against women and girls; (2) gender equality in capabilities and resources; and (3) gender equality in decision-making power. Each component has between three and eight targets, and each target is monitored according to several quantitative measures; every member country (and its associated UN personnel) will be expected to submit these numbers and show progress on them every year.

These are ambitious goals. Many countries cannot even accurately count births and deaths, much less measure so many subtle indicators. However, UN Women is monitoring its employees throughout the world to ensure quality control in these reports. It is good to have specific targets and start trying to measure progress toward them. And it is hugely important that women are being singled out, and not just for their sake.

We have long known that the best way to spend a development aid dollar is on educating a girl and, thus, empowering a woman, because it is proven that she will:

• have fewer births and lower infant mortality;

• raise healthier children of both sexes;

• educate those children to higher levels;

• have better health herself;

• improve the health of her husband;

• have more lifetime earning power; and

•
better resist male attempts, through threats, abuse, and violence, to divert her time and money from these aims.

So, by focusing on half the human species, UN Women is better serving the broad development goals of the other half as well. It will help guide the next phase of human evolution.

Meanwhile, the indicators show what is at stake. While the third component, gender equality in decision making, may not differ so much between the developing and the developed world, most readers of this book are not worrying about sanitation, finding toilets, access to obstetric facilities, pressure to have their daughters’ clitorises cut out, or girls risking rape, disfigurement, or death for going to school. Domestic violence is all too common in all countries, but in some, routine violence by male partners is the central fact of life for women. We should understand these scourges but, more importantly, what is working against them. There is no reason to despair, but there is a need to actively bend the arc of history; do that and the arc of evolution will take care of itself.

During evolution, we adapted to a greater male mortality by supplying (biologically) a greater proportion of males at conception; this continues to be true at birth. In the European Union, for example, that proportion is around 1.06, meaning 6 percent more newborn boys than girls. Taking all children under fifteen, it is slightly lower, 1.05. In adults it is equal (about 1.0), but in the years over age sixty-five it is reversed, with only 75 men for every 100 women (.75). These numbers reflect the basic biology of our species under conditions of good nutrition, sanitation, health care, and relative gender equality.

In China, however, the corresponding numbers are 1.12, 1.17, 1.06, and 0.93; in India, they are 1.12, 1.13, 1.07, and 0.9. Some other countries are similar. Something is wrong here—at every age there are more boys and men than expected from basic biology—and together these countries contain a third to a half of our species, so it is not just strange but
important, and we know what is at work. Girls and women are discriminated against beginning in the womb, where they are much more likely to be deliberately aborted if their sex is known. But the ratio worsens in childhood, meaning more girls than boys die, because girls are neglected. After age sixty-five, there are about 20 more men per 100 women in India and China than in Europe. This means that women, despite being naturally resilient, are dying in greater numbers throughout life. In China, the one-child policy worsens this gender bias.

Amartya Sen, a Nobel laureate economist, has called them the missing women; there should be 100 million more than there are right now in the developing world, 85 million just in China and India. The result: many millions of men without women, which should favor women’s power but usually leads instead to male violence, rape included. Evolutionary biologists know that in most species, skewed sex ratios eventually right themselves, because the scarcer sex does better in the mate market, but waiting for this rebalancing takes time and pain.

Kate Gilles and Charlotte Feldman-Jacobs of the Population Reference Bureau, in a 2012 policy brief, recommended discouraging the use of sex determination technologies (SDTs) for the unborn, recruiting doctors as partners and advocates, giving women rights of inheritance, and mounting awareness campaigns. Various countries, including China and India, have restricted SDTs; India has a “Doctors for Daughters” campaign. The Ladli program in Delhi puts money in a bank account on the registration of a girl’s birth, with further deposits rewarding school progress; girls get the money at eighteen if they have stayed single and finished tenth grade. A TV series called
Atmajaa
(Born from the Soul) dramatized the plight and value of girls and women in northern India, where the imbalance is worst; research showed that the show changed younger women’s attitudes.

The biggest success story is South Korea, which has left the ranks of skewed-sex-ratio countries, after being worst. South Korean officials enforced severe penalties for physicians offering sex selection, and they
campaigned to change patriarchal attitudes and give women well-paying jobs. Between 1985 and 2003, women who said they “must have a son” declined from 48 to 17 percent. Today, if parents express a preference, it is more likely to be for a daughter. World Bank demographer Monica Das Gupta, a bit stunned at the speed of the change, has said that son preference in South Korea “is over.”

Another unexpected change is the plummeting birth rate in Bangladesh. Ruth Levine, Molly Kinder, and the “What Works?” Working Group made it a case study in
Millions Saved: Proven Successes in Global Health.
The program relied on a large cadre of women outreach workers, a small army of Margaret Sangers giving out advice, education, and birth control, supported by mass media. Contraceptive use went from 8 to 60 percent in the last quarter of the twentieth century, while births per woman dropped from more than six to three; at last count, in 2012, the number was 2.2.

A 2012 multivariate analysis showed that education and the media made most of the difference, although religion also mattered—Hindus use birth control more than Muslims. Top writers created a soap opera centered on Laila, a family-planning outreach worker; the show changed husbands’ attitudes and reduced harassment of real outreach workers. The percentage of married women using birth control in 2007 increased with age, from 41 percent for those in their late teens to 67 percent in their late thirties; mature women had learned to stop bearing children and focus on those they have. This initiative is one of the great triumphs in family planning, and it is being imitated in Kenya, Tanzania, Brazil, Mexico, and India.

But the births that occur remain dangerous. Worldwide, 287,000 women die of childbirth-related causes every year, 99 percent of them in developing countries. A woman in Afghanistan or Sierra Leone has a lifetime risk of dying in childbirth that is 1,000 times higher than that in Norway or Switzerland. Yet Sri Lanka has had dramatic success, halving maternal deaths every twelve years since 1935 and going from around 600 to 60 deaths per 100,000 births since 1950—this with a
per capita health-care budget half the size of India’s, where
400
mothers die per 100,000 births. Sri Lanka is poor and was torn for a quarter century by an agonizing civil war that didn’t end until 2009. How could it defeat death in childbirth?

First, Sri Lanka has a tradition of female literacy; 89 percent of women can read and write, more than twice the South Asian average. It has had two women prime ministers, although only 5 percent of Parliament is female. It has good civil records, logging all maternal deaths since 1900; widespread and growing access to free health care; training of midwives (more than 97 percent of births are now professionally attended); outreach to poor, isolated women; and an all-out war on malaria. The Sri Lankan case, along with less dramatic declines in Honduras, Malaysia, and elsewhere, shows that the key variables—aside from educating girls—are government initiative (including good statistics), hospitals, and well-trained birth attendants in the community. Incidentally, 99 percent of Sri Lankans say religion is important in their lives; 70 percent are Buddhist, 13 percent Hindu, 10 percent Muslim, and 7 percent Christian.

My colleague Lynn Sibley—an anthropologist, nurse-midwife, and professor of nursing—illustrates what one determined person can do. “The things that kill mothers and babies happen quickly, they’re emergencies, they can’t be predicted,” she says. Having delivered thousands of babies, she should know. But in Ethiopia, where she has been working for years, 90 percent of women today give birth without that expertise. Traditional birth attendants (not trained midwives) assist them in their homes in rural villages, and maternal deaths are frequent.

Sibley identifies a forty-eight-hour period during and after birth when women are most vulnerable—to hemorrhage, eclampsia (a blood-pressure crisis), obstructed labor, and sepsis (systemic infection); these things kill mothers in Ethiopia and throughout the world. But to her those forty-eight hours are a window of opportunity. Ethiopia, a country of 80 million, has the world’s ninth-highest birth rate, with 720 maternal deaths per 100,000 births, or twelve times the rate in Sri Lanka.
When the Bill & Melinda Gates Foundation, which gets the best advice there is about global health, heard about Sibley’s program, it solicited a grant application and soon gave her $8 million.

She knew what to spend it on. Take hemorrhage, for example. When a woman who has just given birth is (as we used to say in medical school) “trying to bleed to death,” there are ways to “talk her out of it”—IV oxytocin; blood transfusions; in the worst case, hysterectomy. But if she “tries” this in a mud hut in the Ethiopian mountains, with a traditional village birth attendant, she may well succeed in dying.

Sibley’s idea was to teach local birth attendants a few simple things: First, recognize and respond to excess bleeding; her research showed that they did not do this before training—some even had superstitions about it—but knew the signs very well after training. Another was getting the mother to urinate; a full bladder can inhibit the contractions that stop the bleeding. (Birth, I also learned in medical school, is not a clean process, but mothers are inevitably embarrassed by some of the most common things.) Another was massaging the uterus from outside to make it contract. Yet another (after the delivery) was combined pressure from a hand or fist inside the vagina and the other hand pressing down on the uterus from outside. Finally, they were taught to get the mother to a medical center right away.

These are simple, elegant interventions that (up to a point) respect local customs and grow out of alliances with local people; Sibley’s program can, and I believe will, be scaled up throughout the poorest parts of the world. As she puts it, “Basically, no woman should die giving birth, knowing what we know today.”

Thirty years ago, few people predicted that a strange disease limited to certain populations would become a great burden on the world’s women and men. By the end of the 1980s, Thailand topped the charts in the HIV/AIDS epidemic but also soon led in fighting it. At first drug injectors and men who have sex with men prevailed in the epidemic, but HIV positivity in Thai female
sex workers went from 3.5 to 22 percent between 1989 and 1991; among twenty-one-year-old male army conscripts it went from 0.5 to 3 percent in the same two years. Then the war on AIDS was brought into the prime minister’s office, and a frank, intense campaign reduced new HIV infections by 90 percent in twelve years. Health workers visited brothels, where they entertained and taught; wooden pop-up models of penises (a red dot on the tip meant infection) made the young women laugh, even as they learned to slip condoms over the makeshift shaft. Public media campaigns directed at men did the rest.