UN Logo for Rural Women’s Day, 2020. Source: Yahoo Images
The United Nations has designated October 15th as the International Day of Rural Women. This year, the theme is “Building rural women’s resilience in the wake of COVID-19.” The reason behind this theme is because of the health and human rights risks that are deemed risks for rural women in light of this pandemic. Rural women hold a crucial role in the fields of agriculture, food security, and nutrition, while simultaneously battling struggles in their daily lives, such as restrictive social norms and gender stereotypes. Since the coronavirus has emerged, women are less likely to have access to quality health services, essential medicines, and vaccines. Despite all these difficulties, rural women like 45-year-old Yan Shenglian of China’s Qinghai Province have been at the front lines, responding to the pandemic while their domestic work increased dramatically due to lockdowns.
Yan Shenglian volunteered along with 28,000 rural women to monitor COVID-19 in her village. Source: Yahoo Images.
Yan Shenglian’s Story
Yan Shenglian is one of 28,000 women who have served as medical workers in the province deemed as hardest-hit by the pandemic – Hubei Province. These women have been dubbed “roses in the battlefield.” Shenglian joined her village COVID-19 management team where she ensured that anyone entering or exiting the village got their body temperature checked and had their vehicle information recorded. A few years ago, perhaps Shenglian would not have been able to serve in the capacity she does currently due to a belief that participating in public affairs was a man’s job. But after attending a workshop brought by the United Nations Women, she and several women in her village learned a lifelong skill of raising pigs organically, ensuring food security in the village, even during the pandemic.
Shenglian’s story is just one village among millions in rural communities around the world. Rural women make up 43 percent of the global agricultural labor force, yet they face a great deal of discrimination in regards to land and livestock ownership, equal pay, and access to credit and financial services. These women are responsible for entire households and perform the bulk of unpaid care and domestic work, while reaping minimal, if any, benefits. In rural areas, the gender pay gap is as high as 40%, leaving women with little to no pay and giving financial authority to men. If rural women had equal access to agricultural assets, education, and markets, agricultural production could increase to the extent that the number of hungry people could be reduced by 100-150 million.
Rural Women Stuck with the Worst of COVID-19
Due to these inequalities, rural women bear the brunt of the impacts of COVID-19. The mandated border closures and lockdowns are disrupting agricultural value chains and food systems. Although this generally affects rural men, women face disadvantages that make it harder for them to recover, including a lack of agricultural assets. Additionally, rural women do not have access to digital platforms to disseminate information about the pandemic or available support. In South Africa and Asia, the majority of 393 million women who lack access to mobile phones and internet connections consist of poor rural women; they rely on person-to-person networks for information.
Rural women in India performing their daily duties. Source: Yahoo Images.
What can be done?
Women’s access to technology and digital financial services being limited is not only detrimental to them but to society. Without this access, rural women are not able to be informed on targeted solutions to problems presented by COVID-19, nor are they able to connect with the world in general. Educating women in technology and in services that they need to know, such as how to save money, take a loan, generate income, and manage their livelihoods in general, is essential in progressing rural women’s roles in society. Shenglian was able to gain skills training and received advice from professionals, allowing her to have an established livelihood. There needs to be more Shenglians among the international community of rural women, which consists of a quarter of the global population. These initiatives will be brought about only through policy. And true reform will only benefit the economy and livelihoods of these women and the villages in which they reside.
Dirty water spilling out of a large glass carboy on its side. Source: Ildar Sagdejev, creative commons.
Access to clean water and sanitation is rarely something we have to worry about here in the United States; it comes out of faucets and water fountains at a seemingly endless supply. However, in many parts of the world—including some areas of the United States—access to clean water and sanitation is a major issue and can affect more than just people’s physical health.
In 2010, the UN recognized access to safe water and sanitation as a human right, and the issue was included among the UN’s sustainable development goals in 2015. With the UN’s focus on clean water access, many developing countries have started making efforts to increase access. However, many developed countries, like the United States, have neglected to develop their rural areas, which leaves a significant portion of their population without clean water for drinking and sanitation purposes. In fact, their situations can be similar to situations in developing countries.
Many Americans would be surprised to know that in more rural areas, it’s often not uncommon for people to go without a sophisticated sewer and water system because the infrastructure has not yet been built. In Lowndes county in Alabama, a largely rural and agricultural area, less than one fifth of the population has a safe way to dispose of their sewage waste. This issue can cause the sewage to back up into their systems or to overflow to their backyards. Neither of these outcomes are ideal for promoting health.
The people that are mainly affected by water insecurity and a lack of clean water in the United States are those that are already disadvantaged; the higher your income, the more likely it is you will have complete and adequate plumbing. This leaves those that live in lower socioeconomic areas with lower performing schools and fewer resources more likely to experience issues like inadequate plumbing and lead-contaminated water.
The systems that have the most problems are the ones that serve rural communities. When a city has a sewer issue, more people are paying for the water, so the extra cost is distributed more widely. In a rural community, there are less people to distribute the cost across, so it’s harder to come by the money to update the sewer systems. Because smaller communities have a harder time paying for necessary repairs and upgrades, the residents in these areas have to choose between drinking contaminated water or paying for bottled water.
Another issue that arises is when communities have a city water system but lack the appropriate people to run it. Some areas have no one to run their systems, while other rural sewer systems are operated by volunteers. In Kanawha Falls, West Virginia, a resident was elected to clean the water, but failed to test and report the water, and the state threatened to arrest him. Scotts Mills, Oregon cannot afford to hire workers for the water system, so they rely on volunteers and community reports of smells to know when work needs to be done.
Because some systems don’t have the staff and infrastructure to test regularly, many don’t realize their water is contaminated until they experience an adverse health outcome. For example, in Kanawha Falls, cited 2 thousand times over ten years for not testing and reporting water quality, a man who had skull surgery got two infections from the contaminated water. He now has to keep his head covered when he showers.
Flint is not the only area that has experienced issues like this, and Flint is not the only community at risk. Using income information and housing age, Vox and the Washington State Department of Health created a map to show what areas are more susceptible to lead poisoning. They also take the potential of lead paint into account, but the map shows that the at-risk areas are mainly cities, especially those that used to be industrial areas. Looking at the cities I know—Birmingham and Chattanooga—I can tell the areas at the highest risk are those that have a large minority population.
Water insecurity affects people’s mental health as well. Those that have less access to clean water experience more emotional distress. One thing many people, especially in urban areas, count on is easy access to water from their taps. However, when that easy access turns out to be harmful, like it is in Flint, anxiety and worry can rise. Parents that unknowingly gave their children contaminated water may feel guilt even though they didn’t intentionally give their children toxic water. In Flint specifically, levels of fear and anxiety were at an all-time high following the news of the contamination. In 2016, there were reports of parents coming to the ER with water-related breakdowns; many were distressed over the health of their children.
Water insecurity and lack of clean water access disproportionately affect minorities and rural populations. This means these already disadvantaged groups are more likely to experience the adverse effects. Clean water access is considered a human right, but even here in the United States there are people suffering from a lack of clean water.
Access to healthcare is one of the biggest predictors of health. When someone has access to healthcare, they are more likely to seek treatment for and catch chronic diseases in early stages. This can greatly improve health outcomes and quality of life. However, when access to healthcare is restricted in any way, health outcomes and quality of life decrease, those who need consistent treatment may go without, and preventable deaths increase. Rural areas disproportionately face decreased access to healthcare, which greatly affects the health and productivity of these already disadvantaged areas.
Lack of Insurance
There are many barriers to healthcare that rural Americans face. First of all, there is a lack of insurance. This is mainly because insurance premiums are more expensive in rural areas than they are in urban areas. Urban areas have larger populations, which encourages more insurance companies to compete with each other, driving the costs of premiums down. Additionally, their larger population means the cost of medical expenses can be spread among more people. This also lowers premium prices. Because these two factors are not present in rural areas, they are left without affordable healthcare.
Additionally, many people in rural areas have incomes that fall in the gap between qualifying for Medicare and being able to afford private insurance. Medicare is available to specific low-income groups. In states that haven’t expanded Medicaid, the most common income limit for Medicaid eligibility is 43 percent of the Federal Poverty Line and childless adults are excluded regardless of income. These qualifications leave over 2 million adults in the United States uninsured. Insurance is important because it can help cover costs of healthcare which can otherwise become insurmountable. Those without insurance are less likely to seek healthcare, and when they do, it is typically worse quality than those with insurance receive. Additionally, when an uninsured individual does seek healthcare, the costs are sometimes too high and turn into medical debt. Since much of the rural population is uninsured, these problems plague many of them.
Closing Hospitals and Pharmacies
Those that do have insurance still face a bigger problem: many rural areas don’t have hospitals within a twenty-minute drive. 25 percent of those living in rural areas report that they have to drive at least 30 minutes to get to the nearest hospital. In fact, almost one in four rural Americans say access to adequate healthcare is a major issue for them. Additionally, many hospitals in rural areas are shutting down, leaving communities without the healthcare they are used to. Since 2010, there have been over eighty rural hospital closures, mainly in the southeast. These hospital closings have a devastating effect on the communities they were a part of. Mortality rates for accidents, heart attacks, strokes, and anaphylactic shock risedue to longer ambulance rides. Additionally, residents may be unable to attend routine appointments because of transportation limitations; much of the rural population is elderly, which restricts their ability to drive, and public transportation is less common in rural areas than urban areas. This also means that with the onset of troubling symptoms, residents of rural areas may wait longer to see a doctor because of the inconvenience.
Many rural areas also lack pharmacies, which can hurt those who rely on prescription drugs for good health. Even the rural communities that have hospitals may lack a pharmacist, and many of the pharmacies in rural areas are in danger of closing; many have already. This is due to higher costs of medications at rural pharmacies and lack of pharmacists in rural areas. This can have a devastating effect on residents, as many go periods of time without their prescriptions—like Insulin or medication for depression— until they can get to the nearest pharmacy. Additionally, pharmacists in rural areas are helpful in educating the community on when they can use over-the-counter meds and when patients should see a doctor.
But why are hospitals and pharmacies closing? They have few patients, many uninsured, and they are greatly affected by states’ refusal to expand Medicaid. Medicaid expansion, which 14 states have not ratified, would close the gap between those that qualify for Medicaid and those that can pay for private insurance. As discussed previously, those with insurance are more likely to seek medical care, which would bring more business—and therefore, funding—to hospitals and pharmacies, making them less likely to close. Additionally, they lack the staff required to stay open. 99 percent of students in their last year of medical school report they plan to live in communities with over 10,000 residents. Without a staff, a hospital cannot stay open.
Lack of Specialists
In many rural areas, including those with hospitals, there’s a lack of specialists, like oncologists and OB/GYNs among others. Specialists typically work in large hospitals that have adequate resources, so they tend to reside in cities. This means that those with specialized needs often have to drive to the nearest city to receive care. Traveling can pose a problem to many rural Americans as many of them are older, but this also affects many younger rural inhabitants as they may not have the time off from their jobs to drive hours to receive specialized care. This leaves many without treatment that they need and worsens health outcomes. This is especially concerning considering many rural communities have higher rates of diseases than urban communities do. Specifically, “rural African Americans have higher rates of cancer morbidity and mortality than other rural residents and have higher rates of comorbid conditions” according to Robin Warshaw from the Association of American Medical Colleges. Rural African Americans also have higher rates of disease than urban African Americans. This makes the fact that specialists are not easy to access even more concerning, especially considering they are the largest rural minority. Minorities in general have less access to healthcare, and living in an area that doesn’t have easy access to healthcare in general can exacerbate this issue.
Low Health Literacy
The healthcare system is complex, which means that patients have to work to understand what care they need and when they need it. The ability to do so is called health literacy. Studies have shown that health literacy is important to health outcomes. The higher level of health literacy a person has, the more likely they are to seek out preventative care, such as screening tests and immunizations, that can catch diseases in early stages or prevent them altogether. If a patient doesn’t understand what the doctor tells them, they are less likely to be comfortable enough to seek care. Additionally, higher health literacy rates make it easier to understand how to manage existing conditions. In addition to less access to healthcare, rural Americans have lower health literacy, which compounds their health problems. However, because rural citizens are less likely to have access to health care, it is especially important for them to have high health literacy, which can be attained by using programs that work to educate patients and clinicians on the importance of patients having an active role in their healthcare.
Solutions
Rural healthcare in America is a big problem, but it can improve. In addition to the health literacy programs, there are many solutions to close the gap in healthcare between rural and urban areas. While the common medical school experience trains students for work in populated areas, a consortium of 32 medical schools has created a rural healthcare track with their medical schools. This not only puts more doctors in rural areas, but also trains them for rural areas’ specific health needs. While the program is too new to see a significant increase in rural healthcare professionals, the majority of students who have gone to residency have stayed in rural areas and are studying specialties that are in much needed in rural areas. Additionally, there are many scholarships for those planning on practicing medicine in rural areas, further encouraging medical students to practice in areas in need of doctors.
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