From Outrage to Courage: Women Taking Action for Health and Justice

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In her book From Outrage to Courage: Women Taking Action for Health and Justice, Anne Firth Murray undertakes a comprehensive study that concludes: being born female is dangerous to one’s health. “Of the 68 million girls born around the world annually, the majority are greeted with varying degrees of disappointment by relatives hoping for a boy,” Murray writes.

From conception to death, females are more likely to be terminated during sex selective abortions, left to die as unwanted newborns, sold as child sex workers, contract AIDS during adolescence, be victims domestic violence, die as casualties of war and be forgotten in old age. In poor households, food and medical care are given to male children first. Girls are less likely to be educated: worldwide, 25 million boys and 90 million girls don’t go to school.

Because poverty aggravates poor health, Murray focuses on women’s health issues in developing countries. Though she faults patriarchy as the underlying cause, the book seems to confirm the notion that developing countries are more likely to exhibit misogynistic cultural practices because they aren’t as well educated as the west. A more in-depth analysis might determine that imperialistic practices of western patriarchal colonizers are equally or more to blame for the misery in developing countries than indigenous cultural practices. Murray does thoroughly document how the experience of being female increases risks for poor health.

FGM and Sexual Abuse

In many African and Middle Eastern countries, girls’ health is put at risk by female genital mutilation (FGM), a brutal rite of passage linked to girls dropping out of school and women, experiencing serious lifelong medical problems that are exacerbated by sexual relations and childbirth.

Murray gives lengthy documentation to FGM but fails to mention how Western medicine subjects nearly every woman giving birth in a hospital to another kind of genital mutilation: unnecessary episiotomy. How is it that lay midwives attending homebirths never cut but rarely see a serious tear during childbirth? But in hospital, nearly every woman who gives birth vaginally has to recover from a surgical procedure that can lead to infection, sexual dysfunction and urinary incontinence.

Girls’ health is also put at risk because of sexual abuse. Murray writes, “In some areas of the world–for example, Nepal, the Philippines, Thailand, Central and Eastern Africa, and some regions of Latin America–poverty and the devaluing of girls drives parents and relatives to sell girls into slavery, sexual or otherwise.”

This practice maroons hundreds of thousands of girls in brothels–until they become ill and are dumped in the streets to fend for themselves. In addition to acquiring HIV/AIDS and other STDs, these women and girls experience depression, posttraumatic stress disorder and substance abuse.

Girls are also more likely to fall victim to sex abuse at home and in school. In East Africa, adolescent girls commonly depend on “sugar daddies” to finance their educations in return for sexual favors. Transactional sex is often the only way for young women in many developing countries to earn money for basic needs. The health impact includes STDs that can cause sterility or problems during pregnancy as well as HIV/AIDS.

Another form of child sexual abuse is child marriage. In some countries, girls as young as 11 years old are married off. Pressured to bear children before their bodies are ready, these girls experience high maternal mortality rates and lifelong medical problems as a result of giving birth at such a young age.


Women contract HIV/AIDS more readily than men because soft vaginal tissues are more apt to become infected and the concentration of the virus in sperm is higher than in other body fluids. Worldwide, teenage girls are contracting HIV/AIDS at twice the rate of teenage boys. In some developing countries, being a married woman is a risk factor for AIDS. In addition, women in these countries are less likely to receive medical treatment for HIV/AIDS than are men.

Pregnancy and Childbirth

Another unique health challenge women face is childbearing. While healthy, well nourished mothers can in most cases give birth naturally without complications, those who live in poverty, are malnourished or live in environments fraught with violence–domestic or otherwise–face high health risks. They are more likely to develop toxemia, give birth prematurely, hemorrhage after birth or develop infections postpartum. Their babies face higher mortality and morbidity rates, as well.

Torture in the Home: Domestic Violence

“The Center for Gender Equity describes violence against women as ‘the most pervasive yet least recognized human rights abuse in the world,'” Murray relates. She goes on to state that one out of every three women in the world experiences domestic violence at some point in their lives. “Women are shoved, slapped, punched, beaten, burned, kicked and killed every day in every country of the world,” she affirms. Obviously, a wide range of health problems, physical, mental and emotional, results from this violence.

Honor killings and dowry death are two more kinds of domestic violence inflicted upon girls and women. “The practice is mostly centered in the Middle East, but it has also been documented in Bangladesh, Brazil, Ecuador, Egypt, Uganda and Turkey. In 1999, an estimated two-thirds of all murders in the Gaza strip and West Bank were likely honor killings,” Murray writes.

One has to wonder how Israel’s continuing barrage against the Palestinian people living here has exacerbated this horrific practice.

The Risks of War

Civilians (mostly women and children) are the new casualties of war. At the turn of the century, 5% of war casualties were civilians. Today that number has risen to as high as 90% in certain conflicts.

“Women’s health, already under siege during times of peace, is profoundly affected during times of war: rape, forced marriages, domestic violence, widowhood and the sudden necessity for heading households without the necessary resources intensify the already catastrophic effects of conflict,” Murray writes.

In refugee camps, women are victims of rape, exposed to disease and lack medical attention during childbirth. Murray points out how The Lost Boys of Sudan were regaled by the media but no one ever heard about The Lost Girls.

Added Risks of Aging

In cultures where patriarchy has reduced women to the roles of laborer, sex object and mother, older women are seen as having no value. Whereas older men can take on younger wives and assume the position of the wise elder, older women are often cast aside. As developing countries become more industrialized, these women are often left behind to fend for themselves–and often, to care for grandchildren whose parents have gone to work in the cities.

This scenario brings up another point Murray makes, though she does not make it strongly enough. Globalization has negatively impacted women’s health in developing countries. While she brings forth several examples of how globalization has displaced people from their farms and thrown them into factory settings where they cannot make enough money to survive, she fails to see that these tragedies are a price that the imperialistic capitalist forces behind globalization are more than happy to pay.

She writes, “Globalization has opened opportunities for women–for paid employment and a way out of very restrictive lives. At the same time, may believe that work in the new global economy is exploitive, and in some sense makes life more difficult than it was before the surge of globalization.”


In every chapter of From Outrage to Courage, Murray also includes many shining examples of how women have empowered themselves and helped each other lay claim to better health. Women around the world are creating organizations that shelter domestic violence victims, teach trades to former sex workers, provide displaced women with small business loans and a host of other creative responses to dealing with the many horrific results of discrimination against women.

From Outrage to Courage, Women Taking Action for Health and Justice lays an excellent foundation for understanding how women of all ages are discriminated against in ways relevant to their health. However, this writer would like to see the underlying cause of this discrimination, i.e. patriarchy, be more fully addressed as concerns women in all countries of the world. While most women and girls in the United States do not face the health perils experienced by their sisters in Africa, South America and Asia, we are mistreated by a for-profit, patriarchal medical system that seeks to disempower us during pregnancy and childbirth, disbelieve us in middle age and target us as for an ever increasing number of aesthetic procedures and prescription medications as we age.

That being said, From Outrage to Courage comprehensively documents the health risks half the world’s population faces simply because they were born female. Murray has collected an amazing amount of data from a great many sources to create a book that shows why women and men must continue to take action for peace, health and justice.

Anne Firth Murray, From Outrage to Courage: Women Taking Action for Health and Justice, (Common Courage Press, 2007).

Author: mediamouse

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