Food security and women’s health: A Feminist Perspective for International Social Work

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International Social Work
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The online version of this article can be found at:
DOI: 10.1177/0020872809104252
2009 52: 485International Social Work
Ruth Phillips
international social work
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International Social Work 52(4): 485–498
i s w
Sage Publications: Los Angeles, London, New Delhi, Singapore and Washington DC
DOI: 10.1177/0020872809104252
Food security and women’s health
A feminist perspective for international
social work
Ruth Phillips
There are many imperatives for social workers to adopt and engage with
international perspectives in the current context for social work prac-
tice. The interconnectedness of a world characterized and challenged
by globalization calls for integrated global perspectives on many issues
that affect social work’s capacity to be effective in a broad set of ser-
vices and interventions.
Increasingly, the intersections between environmental and political
crises across the world have a direct impact on local contexts. These
connections have emerged as part of the increasing global mobility of
people affected by conflict displacement and poverty across continents
and through humanitarian refugee programs. Refugee populations are
indicative of the borderless global issues that are now embedded in the
broad practice knowledge that should underpin contemporary social
work advocacy, activism and everyday local practice. For example,
the impact of social and economic conditions in sub-Saharan Africa is
played out daily in the experiences of social workers in African refugee
communities in the western suburbs of Sydney, Australia.
Mohan’s recent evaluation of international social work is that it is
a discipline and a field of practice, and that international social work
should be preoccupied with the ‘contours of social reality’ that indeed
‘represent human life in a divided world’ (2008: 13). Taking this lead,
Key words feminism food security global context social work research
and policy responses women’s health
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486 International Social Work volume 52(4)
this article seeks to enhance perspectives that link social work’s
diversity as a discipline with some clearly evolving relationships that
are inherent in global poverty. Bringing together the issues of food
security and women’s health demonstrates how the new global crisis of
food security is an old problem for women across the world. This leads
to an argument for a feminist analysis of food security and as an impor-
tant perspective on the health agenda for international social work.
The case for writing about food security and women’s health rests on
a global recognition of the importance of women and gender equality in
tackling poverty across the globe, as is exemplified by the inclusion of
gender equality in the United Nations Millennium Development Goals
(MDGs) (UNDP, 2005). If women are to lead poverty recovery at the
grassroots level, their health has to be a primary consideration. As will
be demonstrated in this article, women play a central role in food secu-
rity and therefore face a double jeopardy as food supply diminishes or,
through price rises, becomes inaccessible. Women are the first to stop
eating but their well-being is often the key for maintaining access to
and the supply of food to families. Further, if food security is poor and
of poor quality, women’s health is significantly compromised, making
them at risk of maternal death or at the greatest risk of obesity from
poor nutrition in a poverty environment (Aguirre, 2000).
The narrative of women and food security is not confined to the
developing world, as it is demonstrably played out in all communities
across the globe where poverty exists, including in some of the world’s
wealthiest nations (Riches, 1997: 65; Rideout et al., 2007).
It is not an objective in this article to explore the epidemiology or
pathologies of health outcomes for women affected by food security,
but rather to view women’s basic health, as achieved through adequate
nutrition, as a central concern in strategies that engage with food secu-
rity as a core issue. This article explores the nexus between the growing
global problem of food security and its impact on women’s health, and
asserts the importance of adopting a feminist framework for interna-
tional social work in addressing and understanding these issues.
What is food security?
Although world hunger statistics are alarming, at 815 million people
going hungry in 2001 (Hussein, 2002: 627), food security is not simply
about describing the availability of sufficient food resources to sustain
humans’ nutritional needs or address hunger. Although the World Bank
describes food security in global terms, ‘as access by all people at all
times to sufficient food, in terms of quality, quantity and diversity for
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Phillips: Food security and women’s health 487
an active and healthy life without risk of loss to that access’ (cited in
Hussein, 2002: 628), there is wide scholarship that sees food security as
a more complex set of problems. Concerns about food security include
issues such as population growth, control and mobility as well as the
distribution of resources, consumption of those resources, the produc-
tion of food, environmental management, climate change, economic
and social development, international trade issues, land ownership,
human rights and access to healthcare (PAHO, 2001).
Food security is also a key issue from a global political economy
perspective, where, as argued by policy-makers in international institu-
tions such as the World Trade Organization and the United Nations, it
is directly related to how developing countries can benefit from con-
stant changes in global agricultural trade. Trade patterns, terms of trade,
prices and trade reforms are now intrinsic to the strengths or weaknesses
of national economies and often determine their wealth and how it is
distributed across a nation. These elements of world trade can directly
affect access to food. Riemenschneider, of the North America Food and
Agriculture Organization of the United Nations, argues that ‘the case for
further trade liberalization rests on the potential for large global welfare
gains’ (2003: 1). In other words, a pure economic development perspec-
tive is insufficient in decisions about regulating global trade, as respon-
sibility for the fight against world hunger is now viewed as a global
problem in which all countries and international institutions must take
responsibility and in doing so ensure that all countries benefit from it.
Strategies for increasing benefits from global trade are complex as
they often mean supporting a shift from self-sustaining agriculture to
exportable foodstuffs that can be consumed by the rest of the world.
For example, it is argued that developing countries would benefit from
global trade reforms if ‘tariff escalation, specific consumer taxes and
domestic subsidies on selected tropical products, such as vegetable oils,
sugar, cotton or rice, were removed’ (Riemenschneider, 2003: 2), thus
allowing for the cheaper goods produced in developing countries to
compete in the global market.
Although there are claims that freer trade in agriculture has the poten-
tial to make a powerful contribution to rural development and hunger
reduction it is also recognized that this does not come automatically.
To address food security in the global economic context, developing
countries need companion policies that will increase agricultural pro-
ductivity and product quality to ensure that what they produce is com-
petitive in domestic and international markets (Riemenschneider, 2003:
2–3). To be able to compete in global markets developing countries
need to address very basic needs such as access to and management
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488 International Social Work volume 52(4)
of water resources, rural infrastructure such as roads, storage facilities,
gender-equal access to finance at the local level and so on. However,
a more primary need on the road to entering global markets as a means
of achieving wealth and food security is social protection. Developing
countries need to ensure that vulnerable individuals, households and
groups often disadvantaged by the initial impacts of trade reforms must
be supported by welfare infrastructure (Riemenschneider, 2003: 2–3). It
is at this level of development that food security is a day-to-day prob-
lem, especially for women.
International social work is engaged in many of the facets of food
security and, as Riches argues, it should be seen by social work
as ‘a pivotal ecological, economic and social justice issue for the
21st century’ (2000: 1). However, there are growing imperatives to
widen social work engagement. For example, including global warming
as a key issue for international social work is vital as evidence mounts
for extensive, worldwide food security issues in the future as global
temperatures rise (ABC, 2005; Rosegrant and Cline, 2003). It is now
generally agreed that climate change will increase the number of people
at risk of hunger from the current estimate of 500m to around 550m by
the middle of this century (ABC, 2005).
The impact of diminished lands for food production across the globe
means not only that people relying on local subsistence food consump-
tion will be affected, but also that millions of people who rely on food
exports from countries with smaller populations such as Australia will
lose food security. As these changes start to affect already poor coun-
tries and communities in particular, national and international organiza-
tions will have to plan and mobilize for the future. In considering the
potential implications of climate change, a diverse range of activities
could involve social work on an international scale. This would include,
for example, development planning, food production and distribution,
strategies to ensure access to water resources and for the conservation
of protected environments and, with the increase in climate-related
disasters such as droughts, flooding and hurricanes, emergency social
interventions (UNEP and UNFCCC, 2002: 13).
It is often cited that we produce enough food today to feed every-
one, even though more than 500m people (according to the UN Food
and Agriculture Organization) are estimated to be hungry, and that the
real issue is the inequitable distribution of food between wealthy and
poor countries (ABC, 2005; PAHO, 2001). This geographically sited
inequality of access to food will also be reflected in the impact of cli-
mate change in the near- and medium-term future. It is believed that
the worst aspects of climate change, on agriculture, are going to be in
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Phillips: Food security and women’s health 489
semi-arid parts of the world, particularly Africa, the Middle East and
possibly the Indian subcontinent. Addressing these potential problems
will require adaptive strategies, particularly in new technologies that
exist in the West, such as the genetic modification of plants that can
tolerate drought more effectively (ABC, 2005). This solution requires
technology transfers from the developed to developing parts of the
world and in turn, demands significant lobbying and advocacy within
the developed world by social change activists such as social workers.
For the poorer parts of the world, food insecurity often exists on an
annual cycle (Hadley et al., 2007). People who rely on subsistence
farming, for example, can expect that each year they will run short of
food, resulting in poor health outcomes for all and stunted physical
growth for children (Hadley et al., 2007). As key providers of food and
managers of crops, women will also experience a cycle of anxiety as
the burden of planning for the next year’s food often rests with them.
Feminist frameworks
Before discussing feminist frameworks, it is important to put forward
a definition of what is meant by feminism in any given context. It is
widely accepted by feminists that there are many feminisms. Given this
multiplicity, it is often hard to argue for a feminist framework for prac-
tice. However, in social work, and in international social work in par-
ticular, there is extensive literature that argues for feminist social work
and feminist development practice (Antrobus, 2004; Dominelli, 2002;
Mohanty, 2004; Tinker, 1997; Weeks, 2003).
Dominelli (2002), for example, asserts a feminist social work prac-
tice that utilizes key objectives and agendas that are intrinsic to femi-
nism. She not only establishes the significance of feminism in social
work theory and social work practice, but emphasizes dual imperatives
for feminist social work. These imperatives reside in the dominance of
women as social workers and as social work clients. In other words,
‘arguments about the purpose of social work are intricately bound up
with disputes over women’s position in the social order’ (Dominelli,
2002: 17). For Dominelli and others (Healy, 2005; Ife, 1997) feminism
has had a highly influential role in the development of social work
theory, questioning its positivist epistemological paradigms by, for
example, challenging dualist thinking, introducing identity politics and
raising gender–power relations (Dominelli, 2002: 17–18). Dominelli
(2002) slips easily back and forth between feminist-as-self practitioner,
feminist theory for analysis and feminist frameworks for action, ser-
vices and advocacy (Phillips, 2007: 57).
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490 International Social Work volume 52(4)
For the international context, Mohanty (2004: 3) provides an
appropriately dynamic understanding of feminism when she describes
her own feminist vision:
. . . a world where women and men are free to live creative lives, in security and
with bodily health and integrity, where they are free to choose whom they love,
and with whom they set up house, and whether they want to have or not have
children; a world where pleasure rather than just duty and drudgery determine our
choices, where free and imaginative exploration of the mind is a fundamental right; a
vision in which economic stability, ecological sustainability, racial equality, and the
redistribution of wealth form the material basis of people’s well-being . . .
Mohanty goes on to include socialist and democratic ideals and broad
political processes that she believes could facilitate her vision, but what
is of interest in this discussion (encapsulated above) is a right to a good
life. Food security and good health are central to this. This discus-
sion draws on the broad range of feminist demands for a good life for
women and argues that without this as a primary agenda and, indeed,
a prioritized component of any social, economic or political interven-
tion, the interwoven problems of poverty and gender inequality cannot
be addressed. Mohanty’s emphasis on equality and the redistribution of
wealth is, according to Midgley (2007: 613), a long-term goal of social
workers as they support the focus of reduction of inequality as a core
objective for poverty reduction.
It may, however, be an over-simplification to accept Mohanty’s equa-
tion of gender equality equalling a good life definition of feminism in
this context. Postcolonial feminists and many postmodernist feminists
would argue that the position of social work in a battle for women’s con-
trol of food security and economic and civic participation should come
under considerable scrutiny due to the inevitability of the unequal power
position between the ‘core and the periphery’ (Hill Collins, 2000: 44),
or those within the dominant economic framework and those excluded
from it. The challenge for feminists (social workers) from both wealthier
countries or higher social or economic positions in their own countries
is to facilitate support without diminishing the position of women on
the margins of life, whether this is determined by gender, race or social
or economic class. Indeed, as observed by Hill Collins of struggles by
African American women activists, ‘marginality operated as an import-
ant site of resistance for decentering unjust power relations’ (2000: 43).
This tension is well expressed by Aiwha Ong in a discussion about
‘strategic sisterhood’ as a means of describing North–South feminist
partnerships for intervention in countries where the gender gap is
extreme, where she observes that a gap exists between ‘cosmopolitan’
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Phillips: Food security and women’s health 491
feminism’s focus on the unequal distribution of gender rights across the
world and a focus on individualism that conflicts directly with ‘alterna-
tive ethics rooted in collective norms and goals’ (2006: 31). As ‘stra-
tegic sisterhood’ is based on a notion of gender citizenship achieved
through universalistic terms of individual freedom and equality, often
expressed in the North through the call for women’s rights as human
rights, other moral systems and visions of ethical living can be over-
looked (Ong, 2006: 31). Ong and other postmodern and postcolonial
feminists raise key questions for feminist approaches to development or
social work in developing countries. Ong suggests that the key question
of how to improve women’s conditions without being seen as the new
imperialists is often overlooked (2006: 32).
Women and food security: utilizing a feminist framework
Women make a vital contribution to food security. The following is a
summary of key targets for action made by the Pan American Health
Organization’s (PAHO) gender-specific analysis of this relationship:
a focus on reproductive health;
the need to recognize women’s productive labor;
a focus on women’s rights to resources such as land or livestock
ownership, access to water rights or borrowing money;
the disproportionate suffering of women and girls in poor house-
holds from poverty, and malnutrition, especially pregnant and lac-
tating women;
the need to address educational inequality.
(PAHO, 2001)
These points reinforce the need to adopt a women-centered, feminist
framework. However, despite nearly 40 years of the presence of femi-
nism, institutions and states consistently fail to acknowledge the impor-
tance of gender. This is not to suggest that a singularly focused feminist
approach would be comprehensive in addressing food security, poverty
and women’s health, but rather that within a feminist framework current
approaches can be enhanced and become more effective because the
transformations in the underlying structural and interpersonal status of
women must be supported. Ample models for broad intervention based
on political and civil rights, human rights and livelihood approaches
already exist (Hussein, 2002: 631) and are often compatible with femi-
nist frameworks seeking a ‘good life’ as reflected in Mohanty’s (2004)
vision above. What is different is that feminist approaches recognize
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492 International Social Work volume 52(4)
and acknowledge the specific limitations for women to fully participate
and have power to control their own destinies, which make women and
their children more vulnerable and at greater risk of ill health and loss
of rights than men.
Resisting the notion of a world flattened by globalization and globalized
problems, as Mohan (2008: 16) describes, drawing on Friedman (2005)
and Sachs (2005), as endemic to international social work, a feminist
analysis of the globalized world suggests many barriers to gender equal-
ity, freedom and good health. Although the MDGs have raised the need
for gender equality to be actively addressed by governments, formal
institutions and non-governmental organizations (NGOs) as funda mental
in the fight against poverty, there still appears to be a reticence to put
women at the center of the policy frame. This would not occur if femi-
nist frameworks were consistently adopted, as the central objective of a
feminist framework in the areas of poverty and development is to place
women at the center of the policy frame (Phillips, 2006: 27).
An example of this failure is the 2007 ‘Technical Report on Poverty’
by the Peruvian National Statistics Institute released in May 2008 and
celebrated by the Peruvian government. Velasco (2008) reported that,
despite some evidence in the report that the overall poverty rate had
dropped (5.2%), it failed to report on the situation for women. Accord-
ing to Velasco (2008), there is a total absence of data specifically con-
cerning women in the report. What Velasco finds most disturbing is
that the report indicates greater poverty among Indigenous-speaking
Peruvians and rural dwelling Peruvians, but at no point explores or
delineates women’s poverty. This occurred in a context where other
research shows women in Latin America experience significantly
greater poverty than men (PAHO, 2008: 69). There is also the key fac-
tor of a higher fertility rate among poorer households and that fewer
women from poorer households are economically active than women
from a higher socio-economic group (PAHO, 2008: 69).
In a feminist analysis, Arrigada (2002: 151) found that dependence on
the family for welfare in much of Latin America and the social and cul-
tural resistance to modernity that lies within the idea of family ensure
ongoing structural problems. She observed, ‘These are fundamental
issues when formulating policies and programs aimed at democratiz-
ing Latin American families, which need to alter the current balance
of men’s and women’s rights and obligations in their family domain’
(Arrigada, 2002: 151).
The failure to account for women’s specific experience of poverty in
reporting on poverty in Peru is counter to the agreed importance of rec-
ognizing gender as a key factor in poverty. It also ignores the critical
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Phillips: Food security and women’s health 493
role women are playing in combatting extreme poverty in Peru. For
example, Llana (2008) reports that there are 5000 community kitchens
run by women in Lima (Peru’s capital) that feed an estimated 500,000
people each day as a means of countering growing, widespread food
insecurity problems in Peru. The overall drop in poverty rates in Peru
is being reversed to some extent by rapidly rising prices for food and,
in the face of a lack of action by the government, poor women are tak-
ing on the burden of addressing extreme food security problems for the
poorest families through the provision of meals. Women in the groups
that run the kitchens are also involved in direct action and advocacy for
food subsidies for their projects from the government via street protests
(Llana, 2008).
With a further 5000 similar kitchens producing food for the poor
across the country, the ‘Food for the Poor’ program represents a grass-
roots women’s movement that engages women at what is often the crux
of survival in a poverty environment. Llana (2008) also reported on
extensive personal growth benefits for the women involved, bringing
them into active political participation and the experience of solidarity
as well as equipping them to engage in other struggles for their commu-
nities. These women, who have been criticized for not addressing the
structural causes of poverty, have achieved significant gains for their
26,000 members by producing a vehicle for participatory politics for
women, a key objective in MDG 3. The efficacy of this type of women’s
movement is a further argument for a feminist framework in addressing
the multiple causes and effects of poverty, and indicates a prime touch-
point for social work in supporting such women’s organizations.
In a report of research by Diaz et al. (2002) it can be seen that they
too have neglected a gendered breakdown in their social capital study in
very poor communities in the mountains of Peru. They found a correla-
tion between capacity to build social capital and access to food secu-
rity. They also found that where people were able to generate greater
social capital they had more security over their property. Although
these findings are interesting, again they do not tell us anything about
the status of women and whether targeting support for women engaging
in social capital in these communities may lead to improved long-term
outcomes.
As Hyder et al. (2005: 3) point out, women in sub-Saharan Africa,
where the most extensive absolute poverty exists, bear the brunt of
efforts to maintain food security due to a traditional role in feeding the
family; but also in more contemporary arrangements where men have
been employed in producing cash crops, women are responsible for
their own food production.
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494 International Social Work volume 52(4)
There are also illnesses related to poverty and poor nutrition that
cause women extreme suffering. For example, fistula, a disease largely
contained in the developed world since the latter part of the 19th century
(with improved obstetric care and the availability of caesarean sec-
tions), is an extensive problem in sub-Saharan Africa. According to
the Fistula Foundation (2007), in Ethiopia, for example, there are an
estimated 100,000 women suffering from untreated fistula, and another
9000 women who develop fistula each year. Apart from being a wom-
an’s disease due to its link to childbirth, ‘the root causes of fistula are
grinding poverty and the low status of women and girls. In Ethiopia,
the poverty and malnutrition in children contributes to the condition of
stunting, where the girl skeleton, and therefore pelvis as well, do not
fully mature. This stunted condition can contribute to obstructed labor,
and therefore fistula’ (Fistula Foundation, 2007).
The low status of women in cultures where fistula is common also
adds to their poverty and their children’s poverty, as the key symptom
of uncontrollable, constant incontinence commonly leads to women
being exiled from their homes and marriages, excludes them from any
form of employment and from using public transport. Although this can
be viewed as a medical problem that can be addressed by better obstet-
ric care, it is also a powerful gender issue. Child brides in polygamous
cultures are ejected by their husbands due to this condition and often
lose all rights as mothers and wives. Key factors such as poor nutri-
tion affecting development are compounded by being married off and
becoming pregnant at extremely young ages.
Child brides also represent an important poverty issue in many coun-
tries where women’s status is subordinate to men. Increasingly, the fact
that girls as young as 9–12 years old are forced into marriage is directly
related to grinding poverty, as families struggle to survive in the con-
text of soaring inflation rates and high food prices (Hill, 2008). A coun-
try where the practice of child brides is most prevalent is Yemen, which
is heavily dependent on food imports, with global price changes affect-
ing food security. Health implications for girls undergoing this practice
include a high risk of death during childbirth (Hill, 2008).
The cases above demonstrate the need for a feminist approach to
women and food security. The extreme vulnerability of girls’ health
is related to three factors: poverty and lack of nutrition in their early
development; intergenerational poverty within their families and com-
munities; and early pregnancies resulting from the practice of child
brides. However, the underlying cause for poverty leading to extreme
health risk for young girls and young women in these communities is
the entrenched patriarchal cultures that are organized primarily in the
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Phillips: Food security and women’s health 495
interests of men. Women have unequal status and little power to resist
culture and tradition or indeed men’s interpretations of religious texts.
Support for self-advocacy and for transformations in law that recog-
nize the basic human rights of protection of children and women and
women’s equal participation in civic, social and economic life is a
framework that social workers in the international context could adopt.
Research on food security has shown that good social networks
(Hadley et al., 2007) and strong social capital (Diaz et al., 2002) result
in greater resilience to food insecurity. These findings, even though
from vastly different contexts, are also borne out in the network of
Peruvian kitchens for the Food for the Poor organization across Peru,
where social support and solidarity from other poor women has not only
resulted in addressing the immediate alleviation of dire food insecurity,
but empowered women to take control of a crisis in their communi-
ties, take political action and provide skills development for women
who join the movement (Llana, 2008). Strong community development
practice and recognition of women’s specific circumstances of inequal-
ity of oppression appear to be central to addressing food insecurity in
very poor communities. The extremely diverse ways in which women
experience exclusion from decision-making and civic life can lead to
life-changing outcomes for women and their communities. If we return
to Mohanty’s (2004) feminist vision, social workers across the inter-
national spectrum can promote clear agendas for women’s right to have
a good life by adopting women-centered frameworks for practice and
research on food security.
Conclusion
International knowledge and research on core social policy issues have
traditionally informed improvements in local social work practice as
much as innovations in the local context have informed global responses
to key social problems. Based on this framework of interrelatedness,
this article has explored the implications of the increasing problem of
food insecurity and its specific implications for women’s health, and
argues that to achieve effective outcomes for the most vulnerable, femi-
nist frameworks should be adopted in international social work.
In international social work women’s well-being has to be a core
objective in community, family and individual social work practice.
Women not only bear the brunt of poverty more than men, they form
the majority of carers for children and older people and they are almost
always responsible for taking care of nutrition in households. Examples
of women’s specific relationships and experiences of food insecurity
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496 International Social Work volume 52(4)
demonstrate a need for strong advocacy at both grassroots and
international levels. Midgley’s (2007) call for social workers to
enhance their advocacy efforts in the international arena are echoed in
this article. It is vital for social workers and their associations to join
forces with other international organizations (Midgley, 2007: 624), but
in order to address women’s access to food security and a reduction in
poverty, there should be a focus on women’s NGOs and women-focused
development agencies.
It is also noted that in recent research conducted by Norman and
Hintze (2005) on international practice variations, social workers in
South Africa and Thailand (two countries with severe poverty) identify
community work and working with NGOs as important themes. They
conclude from their study that issues such as starvation and poverty will
‘surely require macro- as well as the micro-efforts of social workers
globally’ (Norman and Hintze, 2005: 565). This supports collaborative
international efforts by social workers and social work organizations to
address the issue of food security.
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Ruth Phillips is Senior Lecturer in Social Work and Policy Studies in the Faculty
of Education and Social Work, Education Building (A35), University of Sydney,
NSW 2006, Australia. [email: r.phillips@edfac.usyd.edu.au]
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