Due to complex responsibilities, workplace conflict appears to have a serious impact on women's health. On the basis of the review, it is possible to determine the general issues of women's health in several countries, that women are mostly in a vulnerable position. In the conventional view of women's health, health requirements refer to the reproductive system and specific conditions of women.
In the community, other factors such as socio-economic and cultural must therefore be taken into account to describe women's health issues.
Environmental and cultural backgrounds affect women’s health
Women in rural areas, for example, mainly perform domestic work or take care of family and relatives. In addition, Artazcoz et.al (2004) clarify that from a traditional perspective, Spanish women should stay at home and take care of the family, because the community's beliefs are that work does not have a beneficial effect on the health of married women.
Gender issues, race and ethnic disparities through women’s health
It not only causes low self-esteem, but discrimination also affects stakeholders in making decisions for women's health. Another factor that may affect women's health status is ethnic and racial disparities, which are related to various health problems as well as divergences in health care services.
Women’s roles in social and economic life
With regard to the role of women in society, this paper focuses in the next section on how such roles may affect women's health and how public support is needed to maintain and promote women's health. It is argued that balanced stakeholder attention seems important to meet women's needs for health care facilities. Meleis and Im (2002) suggest that the importance of balanced access to and provision of health care and the discussion of women's health should relate to integration, transitions and the comparison of women's health needs.
Regarding women's role as money earner, some factors such as marital status, financial condition, number of children and education level can become motivating factors for women to be an employee or participate in labor markets. Work can increase women's financial income and bring positive impacts, but women's participation in the labor market and its various tasks or activities than can affect women's health status. Arber and Khlat (2002) assert that the combination of domestic roles and paid work contributed to work-family conflicts and affected women's health due to overload, work conflicts and inconsistencies.
In developing countries, women's participation in the labor force may be caused by women's eagerness to help their spouses and fulfill family needs. As an illustration of this, the monetary crisis in most Asian countries, including Indonesia, caused a surge in unemployment among male workers, and as a result, women's contribution to solving economic problems increased by working longer hours than before (BPS, BAPENAS and UNDP, 2001). As the percentage of women in the workforce tends to rise, discussion of women's health in relation to their roles in the labor markets becomes important.
Women in work markets and the implications
Literature Review: Specific women’s health issues in developing countries
Economic crisis and women’s health issues
But women's participation in the labor market is out of balance with the possibility of accessing health care. In the dimension of socioeconomic factors and health, Indonesian women may refuse medical and health needs due to expensive medical treatment. In relation to women as employees, working women in developing countries seem to experience unfavorable situations caused by several factors.
Other arguments presented are also that women may not engage in formal work due to discrimination and low levels of education (McKee, 1989, Lycetter and White, 1989 cited in Meng (1998). In addition, women may be involved in jobs with more complicated tasks due to the demands of employers and to respond to global demands for labor force Mainly, women in Asia participate in the formal labor market as in teaching and nursing (Anker & Heins, 1985, cited in Meng , 1996).
On the other hand, due to a low level of education, the majority of Asian women can be employed in low-wage informal jobs. Poverty, unemployment and lack of formal education are driving more and more women to migrate abroad (ADB, 2006). These jobs for Indonesian women are common and can put women in an unsafe working environment.
Illiteracy and women’s awareness to health
The data shows that Indonesian women are not allowed to go to the doctor until the illness or health condition is serious. As an illustration, 70% of women diagnosed with breast cancer in Indonesia came to the hospital at a late stage, compared to developed countries such as Japan, where only 13% came to a late stage (Sutjipto, 2007). There are several reasons that prevent Indonesian women from detecting breast cancer early: insufficient knowledge about cancer, lack of awareness of their own breasts, fear of the surgical procedures, more trust in traditional healers, socio-economic problems, taboo and unwillingness to showing breast to others (Sutjipto, 2007).
The authors list the top five cancers that affect women in developing countries: the largest is breast cancer, followed by cervical, stomach and lung cancer, and the lowest is colorectal cancer. Breast cancer prevention is a relevant program in the recent situation as the incidence of cases is increasing. The Global Cancer Survey in 2002 identified 28 cases of lung cancer per 100,000 inhabitants and 26 cases of breast cancer per 100,000 inhabitants in Indonesia (Pusat Promosi Kesehatan Depkes, 2007 ).
Poverty and lack of health care access
Cancer prevention health promotion programs for female subpopulations are available in Indonesia, but implementation needs to be improved. Poor socioeconomic status can lead to a reduced ability to meet life's needs, including the needs for nutrition, housing, education, and health care. Women and men have specific health needs, but it is important that both are given the same opportunity in terms of access to health care and options.
There are several influencing factors in developing countries, where women appear to face disproportionate barriers in implementing health care access and policies. While, on the other hand, policies that could be essential for women's well-being usually fail in their implementation. However, in real life the unequal social position of women is the main reason in developing countries.
Policy support may be required to facilitate better access and services in the community. Social support can be related to the attention and support of a group or community for women's well-being. Poor socio-economic life, illiteracy, gender issues and less political support can result in poor women's awareness and perception of health and health needs.
Women’s health promotion in the context of primary health care
The achievement of the target was only 4.5% at the end of 2007, especially in East Jakarta. This means that the effort of the early detection program needs to be greatly improved. To achieve better goals, it is essential to make women aware of participating in such programs.
As with other developing countries, women may have access to health care facilities supported by health insurance (ASKES in Indonesia) or social support for labor forces (JAMSOSTEK in Indonesia), but women seem reluctant to visit health care facilities due to time constraints, husband's power, and family barriers. Multi-professionals can be involved in prevention programs and nurses' contribution to health education and health promotion programs is important. In these circumstances, Binawan Institute Health Sciences (BIHS) Faculty of Nursing can engage in health promotion programs due to its relevance to the BIHS education subjects.
BIHS nursing courses taken in a community nursing setting can be beneficial because the course objectives cover the entire nursing process in the context of family and community health. Because of such importance, there is potential to develop integrated regular activities of students at the community level to engage with government programs in promoting women's and community's awareness of their own health through health education approaches.
Nurses’ roles in community nursing approaches
Unbalanced relationship between population and healthcare providers at the primary healthcare center (PUSKESMAS) as well as a lack of understanding by PUSKESMAS' staff have led to inappropriate healthcare services for families. In fact, poverty, illiteracy and lack of financial support can become barriers to Indonesian women's access to health information. As mentioned by WHO (2000), women's access to health information can be affected by their ability to understand and access the information.
In line with the health services for women in the society, lack of facilities and media as well as community education programs have contributed to the helpless situation of common people including women. For example, women in urban areas such as Jakarta can access health services for free due to support from local authorities; however, this facility appears limited in endemic cases such as dengue fever (DHF). In other cases, achieving better health seems impossible due to the unavailability of health facilities, health insurance and inadequate promotional programs.
The eagerness to participate in early detection or health prevention programs seems to be reduced due to lack of awareness and inability to access the health care facilities. Communities should be encouraged to be aware that preventive action can prevent seriousness and save costs. Brown et al (2006) mention that cancer prevention and treatment comes from studies developed in Western countries, while in developing countries it is still new and it is difficult to estimate the cost and cost-effectiveness.
Recommendation: Health education to promote women’s knowledge and community empowering
Conclusion
Women's health can be viewed from different perspectives: as humans, women have natural physiological functions, such as for reproduction. In social life, economic, social and educational levels can also affect women's access to health care facilities. Gender, racial and ethnic disparities are common issues in most developing countries that can contribute to a lack of support for women's health.
Women's participation in the workforce sometimes puts women in vulnerable positions due to discrimination and lack of education. To conclude, women's health can be described from different perspectives, but the change of women's roles in socio-economic terms becomes a challenging situation. In developing countries, the situation worsens due to a lack of knowledge about women, traditional societal values for women and inappropriate political support.
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