Pergamon Health & Place, Vol. 2, No. 1, 1-13, 1996 pp. Copyright 0 1996 Elsevier Science Ltd Printed in Great Britain. All rights reserved 1353-8292/96 $15.00 + 0.00 Women’s health and women’s empowerment: a locality perspective Sheena Asthana zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Department of Geography, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, UK There is growing support for the view that real improvements in women’s health will not be achieved until the issue of women’s empowerment is addressed. However, if empowerment is defined as a grassroots political process which results in a redistribution of power in society, substantive examples of women’s empowerment are few and far between. This paper argues that if the potential of the empowerment approach is to be assessed realistically, attention should be paid to the context within which grassroots movements emerge. To this end, a conceptual framework for the analysis of women’s empowerment is presented. Applying the framework to a case study of women’s organization in Visakhapatnam, India, the paper finds that a complex mixture of national, regional and local factors affect women’s capacity for organization and political mobilization. This suggests that the scope for empowerment strategies may be highly place-specific. Keywords: empowerment strategies and women’s health, place-specificity of grassroots mobilization, India Women’s health and women’s empowerment: theoretical considerations The past decade has witnessed increased concern about the health of women in the third world (Stinson, 1986; Winikoff, 1988; Royston and Armstrong, 1989; Smyke, 1991; Koblinksky et al., 1993; Davies Lewis and Kieffer, 1994; Paolisso and Leslie, 1995; Santow, 1995). The recognition that women’s health problems are inextricably linked to their lack of social, economic and pol- itical autonomy has strengthened suggestions that health policy should move from a traditional welfare approach to one which stresses women’s empowerment. Despite its popularity, however, empowerment is notoriously difficult to define. Whilst it is generally agreed that the process involves group or community organization, the methods, objectives and outcomes of such organ- ization are disputed. The lack of a clear definition of empowerment has resulted in the widespread misuse of the term (evidenced by the growing tendency to use ‘participation’ and ‘empower- ment’ interchangeably). Thus, before considering factors that influence empowerment in practice, it is necessary to have a clear understanding of what the term means and entails. Notwithstanding the growing tendency of health planners and professionals to adopt a language of empowerment when describing methods of involving community members in the design, implementation or management of com- munity health care programmes (WHO, 1991; MacCormack, 1992) empowerment theorists re- ject the ‘top-down’ mobilization of community efforts in favour of ‘bottom-up’ or autonomous community action (Pearse and Stiefel, 1979; Ghai, 1988). The belief that empowerment must come from within and cannot be given to a community stems in part from a distrust of ‘top- down’ or official intervention. Arguing that even seemingly ‘progressive’ governments have lacked either the political will or practical means to confront women’s subordination, proponents of women’s empowerment suggest that real im- provements in the status (and therefore health) of women will come about only through the mobil- ization of women themselves (Sen and Grown, 1985; Moser, 1993). Support for ‘bottom-up’ approaches also re- flects a humanistic concern with the psychological benefits that accrue from community develop- ment (Hollnsteiner, 1977, 1982; Hasson, 1985). According to this perspective, collective organiz- ation provides women with the opportunity to share knowledge, to offer mutual support, and to 1