Academic journal article Journal of Health Population and Nutrition

Potential Impact of Adjustment Policies on Vulnerability of Women and Children to HIV/AIDS in Sub-Saharan Africa

Academic journal article Journal of Health Population and Nutrition

Potential Impact of Adjustment Policies on Vulnerability of Women and Children to HIV/AIDS in Sub-Saharan Africa

Article excerpt

INTRODUCTION

The social and economic impact of the adjustment programmes of the International Monetary Fund (IMF) and the World Bank in developing countries has been a source of heated debate over the last two decades. Research on the effects of these policies has led to contradictory conclusions. [In this review, adjustment policies or programmes refer to stabilization policies implemented by the International Monetary Fund and structural adjustment policies implemented by the World Bank. Both are designed to reduce basic imbalances in the economy. Stabilization policies reduce imbalances in the external accounts, while structural adjustment policies are designed to reduce imbalances in domestic resources use.] A number of World Bank evaluations indicate that 'adjuster countries' generally succeed in improving health, education, and social welfare programmes compared to 'non-adjusters' (1-3). Based on such studies, the World Bank concludes that adjustment programmes do not necessarily adversely affect vulnerable populations. Furthermore, the World Bank believes that reforms that include these reforms are necessary for poverty eradication in developing countries. On the other hand, publications from UNICEF and from representatives of academic institutions and non-governmental organizations (NGOs) indicate that adjustment policies may be particularly harmful for the most vulnerable populations. In "Adjustment with a human face", UNICEF reports studies from several developing countries which indicate that adjustment policies have negatively affected the health status of women and children (4). Evidence suggests that the adjustment programmes may also create conditions favouring societal vulnerability to HIV/AIDS (5). Unfortunately, no study, to date, has systematically evaluated the relationship between IMF/World Bank economic reforms and the vulnerability of women and children to HIV/ AIDS. This paper reviews what is known regarding the social and economic consequences of adjustment policies on maternal and child welfare and explores the potential impact such consequences may have on the vulnerability of women and children to HIV/AIDS.

We approach the impact of macroeconomic adjustment policies from a conceptual perspective. Our theoretical framework illustrates how adjustment policies may influence the predisposing factors for impoverishment of women and exposure of children to HIV/AIDS in sub-Saharan Africa. A set of causal pathways that relate the implementation of these macroeconomic measures to increased vulnerability to well-established HIV-related risk factors among mothers, infants, and young adolescents is proposed. The underlying assumption is not that adjustment is the only cause of vulnerability of women and children to HIV/AIDS. Antecedent predisposing factors, such as poverty and inequality, are responsible for the vulnerability of women and children to HIV/ AIDS in the first place. However, adjustment policies may further contribute to a socioeconomic environment that facilitates the exposure of women and children to HIV/AIDS, especially when their implementation is not accompanied by specific measures protecting the most vulnerable populations. A substantial proportion of studies addressing the social and economic changes accompanying adjustment programmes are reviewed here to assess the plausibility of the hypotheses of the theoretical framework.

METHODOLOGICAL OBSTACLES TO EVALUATING ADJUSTMENT POLICIES

The validity of studies analyzing the effects of adjustment policies on vulnerable populations is often limited by a number of methodological obstacles. In general, the different approaches used in such evaluations are judged in terms of their ability to provide estimates of the counterfactual. Two types of designs--pre- and post-adjustment assessment and cross-country analyses--have been widely used. Both designs have limitations. The pre- and post-adjustment assessment design cannot separate the effect of the adjustment programmes from exogenous factors, such as wars, natural disasters, and social tensions. …

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