1. Women’s information needs in developing countries<br />Lack of information is the denial of choices and opportunities for living better lives.<br />Introduction<br />This paper is a literature review of studies that deal with the problems of women and health care information seeking behavior in several developing countries. The World Bank (2010) defines countries with low income economies as those with a gross national income per capita of $975 or less, lower middle income economies as those with a gross national income per capita of $976 -$3855, upper-middle-income those with a gross national income per capita of $3,856 - $11,905; and high income, $11,906 or more. (World Bank, Group Definition section).<br />The process of finding information to address problems that arise in everyday life situations is complex. Different factors determine and affect an individual’s behavior when the information need occurs. Among the various things to be considered would be, education, social structure, psychology, politics, economics, physical ability, gender issues and work environments. The literature review examined in this paper focuses on the health issues of women in developing countries and how they behave when they have information needs as well as what are their information sources. <br />Accessibility of Information Sources in Developing Countries<br />Different methods have been developed to understand the process of information seeking behavior: Dervin’s sense-making model (Dervin, 1983), Wilson’s information behavior model (Wilson, 1999), Taylor’s information use environment model (Taylor, 1991), and Savolainen’s everyday life information seeking (ELIS) concept (Savolainen, 1995). When searching for information people are influenced by many factors that can be seen in the time-space (situation) elements described by Dervin. A complex array of dimensions shape people's information seeking and use behaviors. Individuals are influenced by a number of factors including education, social structures, psychology, politics, economics, physical, gender issues and work environments. <br />Available literature focusing on the social factors affecting information behavior has stressed the importance of interpersonal communication and the quality of social networks in facilitating access to information. People often prefer personal sources when seeking information, but what happen when people have small, sparse networks, as in the case of the poor? How these personal authority affect people and aid them find the information they need (Chatman, 1996).<br />In the sense making approach, when the problem arises the individual interprets his/her situation in relation to the individual context as well as the broader environment (Dervin, 1983; Taylor, 1986; Savolainen, 2006).The answer to the problem comes from the individual perspective of needing/seeking/using information as well as from the context/environment surrounding him. With the everyday life information seeking (ELIS) approach, Savolainen (1995) explores complementary aspects to the "situation-gap-help" sense-making metaphor (Dervin 1992), stating that socio-cultural factors affect the cognitive competencies of individuals. <br />Many studies have been carried out on the information behavior of people in developing countries. Unfortunately those studies often concentrate on educated individuals. Most of the research has been conducted in universities setting involving scholars and has looked at physicians’ information seeking behavior. Often those studies are in connection with technology and retrieval systems being used. Those same studies reveal profound similarities between the information needs and information-seeking behavior of educated urban residents in developing countries and information needs and information-seeking behavior of educated urban residents in developed countries. Some studies have considered the effectiveness of recent education and ICT projects in addressing women’s information needs in rural areas of developing countries for overcoming restrictive situations (Bakar, 2009). <br />Few studies have approached the information needs of women in rural dwellings in developing countries. Health seeking behavior is not only dependent on individual’s choice or circumstances; it is largely affected by the dynamics of communities (MacKian, 2001). The literature review shows the disparity between educated urbanities in poor countries and the illiterate rural population, who do not have a voice in society. <br />There is a need to design advocacy campaigns to help women and in particular those living in rural areas. Policymakers can also help by designing policies that take into account these women seeking health information and their use behavior. This paper examines health information behavior in developing countries focusing on women, but without focusing on a particular geographic region.<br />The Health Care Delivery System in Developing Countries<br />The literature review reported in this paper focuses on the role of the socio-demographic factors (education status, and family role) and the social networks and how they affect access to information. Also examined in this paper is how the social capital and the resources are made available to individuals through their social networks and how these influence the success women may or may not have in finding the information they need. <br />Areas reviewed and examined in this paper include: Africa, Southeast Asia, and India, which are some of the poorest countries in the world. <br />Studies done in Malawi (Uta, 1993), examine how health information is disseminated to the rural population in Malawi, which is considered to be the poorest country in the world. The paper reports on two studies done in 1991 and 1992. The first study took place in fourteen out of the twenty public health information agencies in the country. The second study consisted of a survey of 275 respondents from fifteen villages in Southern Malawi. The studies showed that dissemination of health information to the public is often uncoordinated.<br />Many of the health agencies seemed to be competing with one another and they were often giving contradictory information. The radio is considered to be the best media by which information in general can be disseminated to rural populations. However the radio has limitations such as bad timing, wrong language, poor quality of messages, and high cost of radios and batteries. Uta suggested that dissemination of information to rural dwellers could be more effective if delivered through audio-visual materials, posters, and traditional communication methods like songs and dramas. <br />Although studies (Momodu, 2002) demonstrated that educated villagers and school children considered the rural library a good source of information, the use is still limited. Radio, television, and newspapers are considered less reliable communication media since many believe these forms of information are influenced by the government’s interests. For this reason informal networks are considered the best way to dispense authentic information. <br />Studies on rural communities observed that traditional beliefs concerning health issues are solved by indigenous traditional healers due to the modern medical failure. Illiterate women consult graduate doctors while illiterate women consult traditional practitioners. <br />Cultural and local beliefs can also become obstacles for women seeking health care in developing countries. Cultural and local belief often leads to self-care home remedies and traditional faith healers (Nyamongo, 2002; Chakrabarti, 2001). This approach to information seeking often results in dangerous delays in receiving appropriate medical consultation and treatment. This practice is largely observed among women not just in regard of their own health, but their children’s illnesses as well. <br />Illiteracy is another barrier to fulfilling information needs. But illiteracy cannot be overcome when lack of accessibility to information as well as by language barriers, exacerbate the situation. There is lack of materials in local languages. This is more complex when dealing with regions where there is not one local language but several ethnic groups with different dialects. <br />Traditional and complex medical systems is practiced throughout India, from allopathic medicine to ayurveda, the classical Hindu system. Other medical systems in use include Unani, favored by Muslims, and homeopathy. Women find these medical treatments much more accessible, affordable, and socially acceptable than Western style medicine.<br />In sensitive sexual issues women frequently turn to traditional practitioners and quacks for things such as abortions; the procedures used are usually unsafe and often lead to infections and other life-threatening complications. Women also consult these practitioners for help in dealing with infertility. The influence of traditional beliefs and social stigmas related to sex, have prevented people from attending AIDS awareness programs. <br />“Prevention work has become extremely difficult. Discussion of sensitive issues like extra marital sexual relationships, condom usage etc., has become highly impossible owing to the attitude and behavior of the illiterate people. <br />Various solutions for changing this mindset have been proposed: like introduction of sex education from high school levels, door to door counseling in removing various myths regarding sexual matters from the minds of the people, and extensive promotion of visual based awareness programs” (Todd, 2010).<br />The main factors that determine the failure of accessibility to good health are linked to taboos and stigma concerning specific information, in particular sexual matters. Financial constraints as well as distance, combined with awful and hazardous transportation methods, constitute strong barriers to information accessibility. In developing countries a lack of mobility means a lack of information.<br />Gender Issues and Women’s Rights<br />Autonomy for women seeking health care information is further limited by social custom. Studies have revealed that women in developing countries are often not allowed to visit health care facilities by themselves (Uchudi, 2001; Fatimi & Avan, 2002). <br />One characteristic that seems to occur in developing countries is the severity of inequality in welfare between men and women, specifically in regards to health, quality of life, workload, education, and legal rights. Women are generally poorer than men are. Studies have shown women in developing countries often live marginalized lives in the rural areas. These women have multiple roles in their society. Women are mothers and housewives, but also farmers, educators, water-bearers, and entrepreneurs. The result is they are overloaded with housework, raising children and are considered the less privileged in the community. These same women are isolated from getting access to information resources they would need to make their lives better. They have no time to seek information or to get into educational programs, even if those programs are available. <br />Bakar (2009) studies about health information provision in rural Malaysia among women reveal the importance of the health issue among them. Women living in rural dwellers are far behind that of their urban counterparts in terms of wealth and literacy. Although the government run its five years development plans dedicated to women still women in rural areas are left behind. <br />Mooko’s (2005) studies of information needs and information-seeking behavior of women in three rural villages in Botswana revealed that most of the information needs of these women are health-related. They seek information regarding particular diseases, how they are contracted, and how to treat them. Women in developing countries lack information they feel need the most: family planning and reproductive health.<br />Rutakumwa & Krogman’s (2000) study revealed the primary concern of women in Uganda was for information on reproductive health and birth control. They health needs were not being met by the local clinics and they were left on their own suffering many symptoms of diseases without having any source for education or advice. <br />The point where the user will seek out information and initiate the communication is the core of Kahlthau's theory. Will they choose to initiate conversation with a colleague, librarian, or search engine? In Mooko’s studies most of the participants turn to medical practitioners (such as village nurses and traditional doctors) for their needs, and they also depend on their prior experience. These Botswanan women also utilized informal networks, such as information from friends, neighbors, and relatives for what they believed to be reliable information. Would be interesting to know how women in rural areas of developing countries decided their personal authorities. What qualities make a person an authority figure within their community?<br />Radios were mentioned as a standard information source, as were village chiefs and community welfare officers. Because computer technology is scarce in these rural areas information sources remain primarily informal networks (family, friends, and colleagues). Unfortunately the women often get information that is outdated, unreliable, and inaccurate through these informal networks. The existing cultural and gender biases often deny women access to health care, education or influence in matters that can affect their lives. <br />Women in developing countries also have little or no access to reproductive health information or family planning services. Statistically, women make up two-thirds of the world's poor. This means women and girls lack the resources and education to change their environment, and are vulnerable to things such as sexual assault, prostitution and sexual slavery, all of which lead can lead to a possible HIV infection. Women in many developing countries get married at a very young age because of poverty; they do it so their parents can get a dowry. <br />As a consequence girls get pulled out of school and fail to get educated. Early marriages and repeated pregnancies further disadvantage them. “In rural Punjab, 21 percent of girls in poor families suffer severe malnutrition compared to 3 percent of boys in the same families. Indeed, poor boys are better fed than rich girls” (UNDP,1995). <br />In many African countries there is similar attitude towards girls. Old customs see sons stay at home with their parents while daughters are “given” in marriages. To save money often girls are pulled out of school while sons are provided with food and health care. This sets a disastrous pattern of dynamics between men and women later in life as domestic violence is something not seen as preventable (Jiyane &Ocholla, 2004), (Rutakumwa & Krogman, 2000). <br />While women's health issues have gained some international visibility in recent years a strong political commitment is going to be needed to enable women to live healthier lives over the long run in developing countries. Significant gender-based health disparities still remain in many of these countries. Limited access to education or employment, high illiteracy rates and increasing poverty levels are making health improvements for women exceedingly difficult (Jiyane & Ocholla, 2004).<br />Note these facts below as reported by the National Organization for Women Foundation (2002):<br /><ul><li>Developing countries report 95% of AIDS cases.
2. There has been a tremendous increase of infection in women between the ages of 15 - 24.
3. In the last ten years 4.3 million children have died from AIDS.
4. Six hundred thousand (600,000) infants have acquired the disease through mother to newborn transmission.
5. Every 14 seconds another child becomes an orphan due to AIDS-related deaths.</li></ul>Basic health care, family planning and obstetric services are essential for women yet they remain unavailable to millions. In many developing countries health clinics do not provide support to women neither for birth control nor for obstetrics. According to the Global Health Council, “the health of families and communities are tied to the health of women – the illness or death of a woman has serious and far-reaching consequences for the health of her children, family and community.” Yet every 100 seconds, a woman dies in pregnancy or during childbirth. The average Indian woman is 100 times more likely to die from complications related to pregnancy or childbirth than is a woman in the developed countries. About 15 percent of pregnant women in India develop life-threatening complications (Mahbub ul Haq Development Centre, 2000).<br />Although maternal mortality in India is declining, it remains high and is far from satisfaction. Estimated between 400 at 407 maternal deaths per 100,000 live births, is the result from infection, hemorrhage, obstructed labor, abortion, and anemia (Department of Family Welfare Ministry of Health and family welfare Govt. of India, 2003). Lack of appropriate care during pregnancy and childbirth, especially the inadequacy of services for detecting and managing complications, explains most maternal deaths.<br />Access and attitudes towards antenatal care to women are negative because pregnancy in many developing countries is not generally considered a condition that requires special treatment. Pregnant women receive little (if any) additional food and often no medical attention, even when complications arise. In rural areas of many developing countries, over 80 percent of deliveries occur at home, assisted by older household women and traditional birth attendants.<br />The unhygienic conditions in which rural deliveries usually occur, often leads to infection in mothers and newborns.<br />Very little progress has been made in promoting gender equality and empowerment of women. Regions with high maternal death rates are characterized by marginalization of women. Gender inequality is propagated by a lack of access to education (reflected in low literacy rates) and thus an absence of women in positions that can set opinion or policy.<br />There is also not much confidence in public health care providers due to long waiting times, restricted hours of operation, unavailability of drugs and the attitude of the practitioners themselves, who feel they are being under utilized (United Nations Development program, World Bank & World Health Organization, 1995).<br />Education is the way to empowerment and opportunity. Education can open the doors to life-saving information related to health issues for these women in need. Education is the conditio sine qua non to poverty alleviation. Lack of information and knowledge keep people in poverty. The female disadvantage in these developing countries is evident in the lack of education.<br />Government Impact on Women’s Health<br />Biased policies prevent health care from being provided in a format and with the adequate services that women need. In directing policies, it is important to take into account the specific needs of women to insure that they can have equitable and affordable access to information and services.<br />There is insufficient investment in the health sector by governments in the developing countries. (Shaikh, 2007). “More often than not, they [developing countries] are experiencing the consequences of political corruption, economic mismanagement, civil wars, tremendous poverty, and the complicated inheritance that colonizing nations have left behind” (Dutta, 2009). <br />Studies have tried to determine the pattern of utilization of health care services at both the community and health care facility level. Further studies have also investigated what the major factors are in shaping the health information seeking behavior. The outcome of these studies should be to have an impact and to really improve coordination and planning for future programs. In this way the studies could assist in improving the effectiveness of health care in the developing countries. To achieve an educated, healthy population, access to information, such as news, education, and health care, is crucial. <br />Literature reviewed showed a similar pattern across a range of developing countries around the world. For example lack of access to health care due to high cost is perhaps the most common deterrent to optimal health care seeking. Health beliefs are major obstacles to health care seeking in addition to the woman ability to recognize the urgency of diseases symptoms. Information on the health seeking behavior of women in developing countries would help the policy makers set strategies to decrease the mortality rate due to common illnesses and diseases associated with women. But very few studies have actually been reported at that level. Most studies are difficult to access, because they are unpublished or published in obscure journals.<br />Women in Developing Countries and Digital Networking<br />The link between information, communication, and economic growth is well known. Telecommunications and information technology are slowly making their way into rural areas of developing countries. The cost of connectivity is the major impediment to the adoption of ICTs in developing countries. The question is will these women actually be able to access such technology when it’s available? If so, how will this affect the lives of these women?<br />Electronic networking is a powerful and rapid way to communicate and exchange information. The potential of information and communication technologies still has not been harnessed systematically to bring about important improvements in the health of populations, particularly among those who are poor and isolated in developing countries. <br />Bakar (2009) noted the disparity between urban and rural groups when it comes to the use of the Internet. The urban group results to be digital/information rich and the rural digital/information poor. Libraries play an important role in dispensing information for them. Newspapers, magazines, television and radio are preferred media while Internet makes the bottom of the list of importance. Magazines are the principle source of health information. Those magazines are not professional journals but popular magazines with a health section. This choice is also dictated by the financial constraints. Popular magazines are the ones they can afford to buy.<br />The potential of advances in information and communication technologies to disseminate information and the availability of access to technology in developing countries needs to be further studied. These studies should include the issues of accuracy and the relevance of content. It is rare for a woman in a developing country to have access to the Internet, even in urban areas. However when they do have access to the Internet they often don’t have the adequate skills to access information. <br />Interestingly a study of young uneducated urbanities use of the Internet in Ghana found that regardless of ethnicity, gender, or school status, adolescent urban dwellers in Ghana consistently access the Internet for health information.<br />It is well known that most up-to-date information is available electronically thus these findings need to be further evaluated to understand how the use of the Internet can be improved. <br />In Africa also, which has a population of 700 million, less than one million people had access to the Internet in 1998, and of this number 80% were in South Africa. The financial barriers to Internet access are considerable. Even if the woman in the village has access to the Internet, she will not necessarily be able to use the information to improve her health because trying to get information from the Internet can be very challenging. There are barriers of literacy and language. Language is a common barrier, since most training packages, software, and electronic conferences and journals are in English. Many Internet postings are in English. And when these are not present assessment of the quality of the sites is one of the first obstacles they encounter. Despite retrieving accurate information, the woman in the village still has to decide if the information is relevant to her situation. There is a need of good information in the right quantity and in the most appropriate format. <br />Momodu for example observed that lack of information in the right quantity and format is the cause for 70% rural dwellers in Nigeria living in extreme poverty (2002). But lack of information means poor health and high mortality rate. <br />Information professionals must find new ways of helping illiterate people. Help them to “sort out the web” and help them distinguish reliable/trustable health information, and to guide people to reputable medical sources.<br />Unless specific measures are taken the information gap between developed and developing countries will widen. Rural women in particular will be marginalized and left behind.<br />Open access information is very important when talking about accessibility of information, which is a very different matter from availability of information. The cost of journal subscriptions would be unaffordable for those developing countries. One of the major factors brought by Web 2.0 is that information is not limited or controlled by private interests as much as it was before. Freed of publishing barriers, information can be dispensed on the Internet via blogs, wikis, etc. The futures such as RSS feeds can alert on the latest health issues. Surely there is a need of coordinating and reviewing the information, but this is another issue. <br />Web 2.0 would be extremely useful in dispensing health information in developing countries. Information professionals could come in the zone of intervention by bridging the gap between information and users. Information professionals need to learn how to use these tools because they will be responsible for dispensing appropriate websites, wikis, YouTubes videos, etc., for the delivery of relevant information.<br />The role of Libraries <br />Librarians advocate the right to access and share information. Extension workers and rural libraries in developing countries are considered good channels for finding good-quality information, but libraries are mostly limited to those who are literate, and extension workers are sporadically present in rural villages. Libraries where present in rural areas should be strategically located, for example near a market would be a good location. Access hours should be compatible with the women's busy daily schedule.<br />Most of the libraries we build in developing countries do not reflect the information needs of the specific communities, rather they are products of the Western model of librarianship. Policy makers in these developing countries do not invest in building libraries in every rural community, although having a library does not necessarily mean the resources are accessible. Most of the inhabitants of rural communities are illiterate, thus the use of library resources is limited. Moreover much information is delivered in English, which can constitute a barrier to accessing information. This creates the “zone of intervention” where the help of the librarian is required. "Between objective knowledge structures and the individual's subjective knowledge structure exists the intermediary's zone of intervention." (Talja, 1997) <br />“As professionals in the field, we must be able to recognize how to handle varying degrees of intervention zones and perhaps shave off some of the load that comes with the perception of a user having too much or to little information.” <br />The model [Kahlthau] does indeed provide a framework for diagnosing learning dilemmas and works with a dynamic array of feelings, cognitions, and actions (search behaviors and patterns)” (Todd, 2010). Information content and format should be tailored to reflect the needs of that particular group of users.<br />Library and information specialists can play a key role in improving user access to information. Consideration should be given to the oral tradition as studies have demonstrated it is the preferred method of sharing and transmitting information. Progress is possible if timely and relevant information is available to people. Information has to be offered in a manner that is accessible to those that face language barriers or illiteracy. On the web or on printed-paper, information professionals can translate, and convert the information in a different format so relevant content is available to the community. <br />In rural areas of developing countries, libraries could become important hubs where resources are available and accessible. Women should participate in designing these library services. The need for privacy in health issues is very important to them. <br />Through the library people will be able to take control of their lives and fulfill their potentials by acquiring information and knowledge. Libraries must be better equipped and librarians must also work with the population to better cater to their needs. Alemna (1995) reports studies done in Tanzania, Nigeria, and Kenya that reveal information needs in rural areas generally include information related to agricultural skills, marketing of produce, and basic health information. Alemna suggested that to respond to these needs does not necessarily require databases or advanced technologies. One other obstacle is that skilled information professionals are not willing to work in rural areas of developing countries because of the scarcity of resources and lack of basic human comforts. Rural libraries have to reinvent themselves and the information needs of rural areas communities must be understood to be able to develop libraries that will nurture literacy and offer sustainable resources. The library must find ways to communicate useful information to its community through non-traditional avenues. Alemna (1995) argues that the primary concerns of African librarians as well as donors are literacy and the number of books in libraries. African needs and the way Africans learn are different from the West. Accessibility to information can be achieved by adapting to their traditional forms of transmitting information, such as stories, drama, poetry, and songs. Instead of donating books the developed countries should donate basic technology such as radio and audio-visual equipment, which would sustain their “orality”.<br />Conclusion<br />This paper observed while a weak economy has a profound effect on the availability and accessibility of resources, the information and communication disparities is not defined as much by the economic status of a geographic location as it is by an individual user’s educational background. Globally, women are impoverished severely in developing countries. There have been some international attempts toward bridging the gender gap, but there is still a long way to go before women can take control of their own lives. To combat social isolation, both from people and from information, rural life in developing countries has to be improved: road infrastructure, electricity and phones. It has been suggested that the raising of awareness, training programs, and classes should be put into place to provide these women with useful information and to help them gain knowledge. Print sources should be accompanied with oral forms, such as group discussions, workshops, face-to-face interaction, storytelling, as well as poetry and drama.<br />By understanding the information behavior of rural women in developing countries, the government, the national library association, as well as NGOs would be able to develop better ways to meet these rural women’s needs.<br />Projects to gather information should be organized by governments, NGOs and libraries. Developing viable policies that promote equity in access to and use of information should not be delayed any longer. 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