The cost of authoritarianism on women’s health

Women’s bodies too often pay the price for instability and authoritarian actions in countries around the world, as we have seen most recently in Ukraine.

The international community has watched in horror as Vladimir Putin’s Russia has deliberately bombed maternity wards in Ukraine as well as apartment buildings and theaters clearly marked as having children sheltering inside. Together with indiscriminate cluster-bomb attacks on schools and nurseries, these atrocities have led to the deaths and injuries of pregnant women, new mothers and their children.

But Ukraine is far from the only place where women — and their health – are suffering because of what authoritarians and other rogue actors have done. In crisis after crisis, women have been terrorized through sexual violence, physical and psychological trauma, as well as state-imposed inequity. Even when their bodies aren’t the battleground upon which conflicts are waged, their health is sacrificed as the services and care specific to women’s health — including the ability to manage regular menstrual cycles — disappear.

The full impact of conflict and oppression on women’s well-being is unfortunately often overlooked by global stakeholders focused on immediate security and humanitarian concerns. But this must change. Women’s unique health needs must move to the forefront of international response efforts. That includes meeting women’s physical needs, making sure that women’s health providers and advocates are among decision-makers, as well as universally condemning and punishing those who make war on women.

Autocrats, extremists and other destabilizing entities seek power, control and obedience — characteristics of patriarchal regimes that value men at the abject expense of women’s basic human rights. One of the most tragic ways in which this is demonstrated is the egregious indifference to the suffering of women and their children.

There’s a twisted and terrifying logic at play when rogue actors intentionally and unrelentingly demean the well-being of women around the world because — time and again — women have proven essential to the pursuit of peace and reconciliation. But for women to contribute, they need to be healthy.

There’s a clear connection between authoritarian regimes and poor health for women: Of the 29 countries that make up the bottom quarter of the Hologic Global Women’s Health Index, only three are considered “free” in Freedom House’s country rankings.

Examples abound.

South Sudan’s ongoing conflict has led to widespread rape and other forms of assault by all armed parties and “a hellish existence” for women and girls, a new report from the United Nations shows. Survivors are revictimized by fistula, unwanted pregnancy, post-traumatic stress, as well as sexually transmitted infections because of a lack of accountability and a glaring void in women’s health care.

Similar atrocities have been reported by survivors of the conflict in Tigray, Ethiopia, with starvation added into the mix. About 9 million people in Northern Ethiopia need food aid, but, until a recent ceasefire that remains uncertain, the region had been cut off from humanitarian assistance for well over a year. Moreover, women and young girls are being brutally physically and sexually assaulted, compounding the suffering.

In Afghanistan, barriers to women’s health under the Taliban are quickly killing mothers and their children. Already, risk of maternal mortality is rising, also endangering the health of infants who survive. According to

United Nations Population Fund (UNFPA), every two hours a woman in Afghanistan dies due to pregnancy and birth complications. The health care system is teetering closer to collapse, with basic yet critical supplies — like those needed for childbirth — extremely scarce.

Women in some Afghan provinces have been refused access to clinics and hospitals if they arrive without a male relative. Bath houses — a hygiene lifeline for some of the poorest in Afghanistan — are no longer accessible to women. Most women’s shelters have been closed, and survivors of abhorrent acts of domestic and sexual violence have been forced back to their abusers.

Starvation is an issue in Afghanistan, too. More than half of the Afghan population is acutely food insecure, according to the latest Integrated Food Security Phase Classification (IPC) report. As a result, emaciated babies slowly and painfully deteriorate because their mothers are so undernourished themselves that they cannot breastfeed. The Taliban have remained indifferent to the immense suffering and profound impact on the health and well-being of women and their children and are moving forward with further acts to support their brutal gender apartheid.

In China, the forced sterilization of Uyghur women is part of the larger Uyghur genocide being committed by the Chinese Communist Party. It deprives women of one of the most basic and cherished functions of their sex — the ability to carry a child.

In Venezuela, the regime — well aware of the country’s collapsing health infrastructure and its impact on maternal and infant mortality – has taken notable steps to bury any information on the rapid decline in women’s health. A New York Times report documented desperate mothers traveling for miles while in labor in search of hospitals willing to help them.

In Myanmar, half the respondents to a United Nations Development Programme survey conducted a year after the 2021 coup by the military junta, reported women’s access to health care services was becoming more difficult. About 10 percent had a pre- or postnatal issue for which they couldn’t access health care services.

Despite the immense cost of instability on their physical and mental health, women remain resolute and courageous in these and other locations around the world. The global community must do more to support their well-being.

First, women’s unique health requirements around menstruation and for contraception and mental health must be considered and meaningfully responded to when crafting humanitarian interventions.

Too often, gender-specific health needs are inadequately acknowledged in response to crisis and conflict. Women’s regular menstrual cycles don’t take a break when chaos ensues, and assisting governments and relief organizations must ensure that women have the resources they need to manage monthly periods.

Around half of women of reproductive age worldwide depend on access to contraception, while another 218 million have an unmet need for family planning. During times of conflict, consistent access remains important. Women use contraception not only for family planning, but to manage other health-related conditions.

Conflict and gender-focused oppression have also created a significant and overlooked need for access to mental health support.

Second, female health care workers and women’s health advocates must be meaningfully included around decision-making tables. They must have adequate access to resources and support — especially those working at grassroots levels. Women working in their own communities will have the best inroads to make progress and reach their peers who most need their care.

Third, the criminals who weaponize women’s well-being must be held to account for their actions. The global community must purposefully follow through on its commitments to confront war crimes with particular emphasis on those against women and children and the utilization of sexual violence in conflict. Accountability is still widely lacking in too many instances in which women’s bodies are often referred to as “spoils of war.”

The outright brutal oppression of women and children is one of the most grotesque distortions of authority. It’s used by those who must give the illusion of power to stay in control but can signal that a regime is very shaky.

The international community can’t forget how vulnerable women and their children can become in conflict zones and must take them into account. Only then can we achieve peace, resolution, and respect for human rights for all, and accountability for the transgressors.

Natalie Gonnella-Platts serves as the director of the Women’s Initiative at the George W. Bush Institute.

Crystal Cazier serves as senior program manager for the Global Health Initiative at the George W. Bush Institute.