Women's health in developing countries: beyond an investment?

Most international programs and policies devised to improve women's health in developing countries have been shaped by powerful agencies and development ideologies, including the tendency to view women solely through the lens of instrumentalism (i.e., as a means to an end). In a literature review, the authors followed the trail of instrumentalism by reviewing the different approaches and paradigms that have guided international development initiatives over the past 50 years. The analysis focuses on three key approaches to international development: the economic development, public health, and women-gender approaches. The findings indicate that progressive changes have adopted a more inclusive development perspective that is potentially beneficial to women's health. On the other hand, most paradigms have largely viewed improving women's lives in general, and their health in particular, as an investment or a means to development rather than an end in itself. Public health strategies did not escape the instrumentalism entrenched in the broader development paradigms. Although there was an opportunity for progress in the 1990s with the emergence of the human development and human rights paradigms and critical advances in Cairo and Beijing promoting women's agency, the current Millennium Development Goals project seems to have relapsed into instrumentalism.