Transnational Research Associates

There is no doubt that the new nation of Eritrea, carved out of Northern Ethiopia after a 30 year War of Liberation, is experiencing major socio-demographic problems currently affecting the health and welfare of all of its citizens. Indeed, this country, located on the Horn of Africa, is one of the world's poorest, with severe poverty among vast segments of the 3.5 million population. The per capita income is lower than $200 per year, approximately $150 dollars below the average Sub-Saharan per capita income level. Infant mortality is alarmingly high at 135 per 1000 live births. Twenty percent of all children die before the age of five years. Only 20% of the nation can read and write and life expectancy is 46 years. (Weissman, 1996) More enlightening, but disturbing, statistics will be presented further on in this health profile of Eritrean women.

Set against such a dire panorama is the even more worrisome status of women, in particular, throughout Eritrea. They, their unique health issues, and the causes of these problems, will constitute the focus of this paper. Brief reference to the history of women's status in Eritrea will also be made and a statement of the Government's position will be offered, in contrast to the stark realities of culturally discriminatory mistreatment and neglect of women throughout this economically destitute and socio-demographically disrupted nation.
Historically, women have been relegated to the traditional tasks of raising children in Eritrean, at the time Northern Ethiopian, society. Their roles were purely traditional and were harshly restricted (hard labor, unemployment, poor diet), with all of the implications such conditions would have on their health and longevity.

Thirty years ago, when the War of Liberation erupted, the Eritrean People's Liberation Front (EPLF) enforced a surprisingly fair policy toward women, treating them as equals on a par with men. About one third of women were combatants. This dramatic new status for women enhanced their acceptance in society as a whole and, during the war years, improved their health and stamina considerably. Although there was widespread suffering in Eritrea during the 30-year war, at least certain sectors of the economy were booming and a relatively high percentage of women were enjoying �passable� health.

After Liberation, the Government's ruling party, the PFDJ, implemented an officially egalitarian stance toward women, and tries, even today, to uphold a non-sexist policy in terms of employment and income. But when demobilization occurred, the former social trends toward unequal treatment began, in reality, to surface once again. The social transformation, begun during the war, is weakening and old values seem to be reappearing. Women's rights groups, such as the National Union of Eritrean Women (N.U.E.W.) are attempting to halt the slippage back to previously dominant patterns of male supremacy (ICHRDD, 1996).

These, and other, social and cultural realities clearly place women in a secondary role in Eritrea. They are established deep within tribal practices and customary belief-systems stretching back over centuries. The actual status of women in Eritrean society, therefore, adversely impacts their health in several ways that will be explored, to varying degrees, in the balance of this report.

The overall psychological profile of women in Eritrea is disturbing. They suffer from chronic depression, isolation and a deepening sense of alienation. The causal factors of such symptomology revolve around their total dependency on their husbands or other male family figures. Women are simply not decision-makers in Eritrean society and have limited control over their own, or their children's, destiny. Many of these wives lost their husbands in the War, or witnessed the deaths of their own children from hunger, violence or disease. As if this were not enough to depress them psychologically, self-attempts to improve their own lives are met with rejection and negativity on the part of post-war male-dominated Eritrean society. Employment of women in contemporary Eritrean society is relatively rare and is reserved for selected families associated with the ruling party. In the countryside and even in major urban centers, disturbingly few women are appointed to professional or service-sector jobs.

Psychotherapy for women is not a viable option in Eritrean society, still feudal in many respects, and limited by religious beliefs and practices. Approximately 40% of the country is Christian and 40% Islamic. The remainder is animist. These figures place Eritrea in perspective and certainly distinguish it from Western Nations where psychotherapy is readily accepted and widely available. Needless to state, psychological depression leads to physical deterioration and even to life-threatening conditions, such as self-destructive thoughts, mental derangement and precocious senility.

Compounding the effects of war and psychological depression is the state of chronic fatigue in which women find themselves throughout the country. Although the birth rate is quite high, over 20% of children die at a young age. The stress, therefore, not only of childbirth under adverse conditions and on-going menstruation with risk of resultant anemia, but actual caring for infants and young children with serious or terminal diseases constitute significant factors contributing to the recurring fatigue of women in Eritrea. In addition to having given birth to disease-prone children when they, themselves, may have been malnourished, Eritrean women must perform heavy tasks, such as the fetching of water and the gathering of wood, and receive little or no food in exchange for their labor. Men and boys in Eritrean society customarily share the preferable morsels, leaving the remains of their meals to women. Malnutrition, causing anemia, further endangers the already weakened mother�s life during childbirth, when tremendous stress is placed on all physiological systems. Death of the mother is not uncommon in Eritrea, as statistics demonstrate.

Understandably, these factors accumulate and lead to illness, chronic disease, debilitation or premature death. Insofar as the birthing process is concerned, physiologically unfit mothers frequently suffer from post-partum prolapsed uterus and, over time, are prone to develop ovarian tumors, breast cancer or cervical cancer arguably due to malnutrition, various deficiencies, environmental contamination and other high-risk components of their lives. Statistics are readily available in Eritrean Health Ministry publications, although this report will concentrate on other conditions somewhat more worthy of mention.

As if nature itself were not sufficiently cruel to Eritrean women, their own society inflicts additional burdens upon them. 90 to 97% of all women ages 15 to 49, are circumcised with 60% of those subjected to circumcision receiving a clitoridectomy and 33% undergoing complete infibulation (National Statistics, 1997, 165-166). Such procedures can lead, directly or indirectly, to pelvic bone deformation during and prior to labor and birth. Additionally, infibulation can cause retention of urine, promoting a variety of kidney and bladder problems for which treatment is not always practical or available in Eritrea.

In spite of culturally imposed restraints on sexual behavior of females, there has been a steady increase among both sexes in STDs with special reference to AIDS and HIV. In fact, a newly conceived division within the Health Ministry has been created to deal with ever-mounting STD figures. Prostitution during the war contributed to moral decay and, consequentially, a steep rise in the incidence of HIV among women was immediately discernable. Some progress has been made in abatement of the problem during post-war years.

Appendix A displays the distribution of AIDS cases by age and sex. Among other trends, these figures show that 1.7 males for every female is infected, but that does not diminish the gravity of women�s cases, still constituting a major health risk. Revealingly, the Eritrean Health Ministry�s report also indicates that 72% of women infected with AIDS are housewives, more than any other category of female (EMH, 1998). The unemployed, both male and female, are also heavily impacted, the cited report confirms.

The economic implications of female AIDS are significant. The Government must spend funds to care for infected mothers and their children. Agriculture and industry are adversely affected, due to loss of the female�s important contribution to many of these two economic sectors.

If HIV/AIDS is a demographically significant occurrence throughout Eritrea, so are STDs which lead ultimately to GYN problems, sterility and even, if untreated, to permanent organic dysfunction. Death from AIDS, obviously, but also from syphilis and gonorrheal infections occurs frequently, devastating entire families.

From an educational standpoint, women are in dire straits throughout the entire country; rural, coastal and urban areas are equally affected by the disturbing nature of these statistics. Naturally, due to an uneducated person�s inability to adapt to society�s many demands, there is a correlation between poor educational background and resultant poor health and/or psychological instability.

The female literacy rate has been estimated by Wideman at 10% (1996), with government figures placing the rate in the same range. There is no need for calculating a school dropout rate for Eritrean women since 90% of those aged 45 to 49, for example, have no education whatsoever (National Statistics, 1995). The Table below demonstrates dramatically the percentage of Eritrean women in various age groups who have absolutely no education.

These figures reflect the realities of the marriage and dowry system in Eritrea that encourages girls to be wedded to sons of local families at a young age. The groom�s family contributes a large sum of money or assets to the bride�s family. This custom, with variations worldwide, is responsible for girls being sent early into marriage, not into school. The medium and long-term health implications of low educational attainment, early marriage, and traditionally forced labor patterns are obvious within the context of the country�s female population base.

Women who, for one reason or another, do not marry until later are usually kept almost in bondage in their villages or on their farms where they work at traditional tasks. As many as 65.7% of these women are on their own farms between the ages of 20 and 49 (National Statistics, 1995, 33). Hard farm labor, poor diet and debilitating environmental conditions, not to mention tribal conflicts, formally declared war, and military weaponry in the countryside, such as land mines, lead to grave health risks and chronic problems over a period of time. Local economies are shattered under such conditions, and these effects ripple back into the entire nation�s economic profile.

Given the severe living conditions in Eritrea, Africa�s poorest nation with a war-ravaged economy, and an under-equipped health infrastructure, women are subjected to a series of factors which make them highly vulnerable to permanent disability, dysfunctionality and premature death. The conditions and circumstances described above paint a bleak picture for them, in spite of the noble efforts of the National Union of Eritrean women, Oxfam advocates and other agencies attempting to redress the many injustices to which they have been subjected.

It is quite obvious that, to improve the condition of women in Eritrea, the first step must be to introduce a system of compulsory education for male and female students, on an equal basis. Food and living arrangements for families with children must be partially or fully subsidized, depending on need, so that the next generation of Eritrean men and women will be well-educated and properly nourished.

The cycle of discrimination against women must be broken, through schooling, but also through public awareness programs and specially planned government employment opportunities for both women and men. It will undoubtedly prove to be a lengthy rehabilitative process for the entire country, but one worth the time and effort expended. The health statistics for Eritrean women are simply too alarming to ignore much longer.

������., Eritrea Demographic and Health Survey, 1995, National Statistics Office, Asmara, Eritrea, March 1997.

������., Eritrea, International Center for Human Rights and Democratic Development, Montreal, Canada, 1996.http://www.ichrdd.ca/M-A/95_96/eritr96.html

�������, "Health and Child Bearing", Statistical Yearbook / Annuaire Statistique, Yearbook Publishers, New York, N.Y, 1997, 103.

Tesfamicael, N, Director, National AIDS Control Program, Semi-Annual Report, Communicable Disease Control Division, Eritrean Ministry of Health, Asmara, July 29, 1998.

�������.."UN AIDS", Joint United Nations Program on HIV/AIDS, The World Almanac, Almanac Inc., New York, N.Y., 1999, 880.

Weissman, R. "Power and Poverty in Africa: An African Star? Free Eritrea Faces the Challenges Ahead", Multinational Monitor, 17:7-8, July/August 1996 http://www.essential.org/monitor/hyper/mm0796.07.html