Mary, I agree with you that it is very difficult to break the social and economic standards in these poor countries and to actually empower their women. However, I don't think Sen is "discrediting the importance of being a 'patient.'" He states, in the same section you drew your quotes from on p. 185, "The fact that the agent may have to see herself as a patient as well does not alter the additional modalities and responsibilities that are inescapably associated with the agency of a person." He does recognize that being a "patient" is crucial to women's advancement, but he is saying that being a "patient" alone is not nearly enough.

I believe what Sen is calling for is accountability for the human race as a whole. On that same page, he says, "we -- women and men -- must take responsibility for doing things or not doing them." While being female "patients" has brought a certain amount of rights to women and attention to the broad feminist movement, society has reached a point where that is no longer adequate for the further advancement of women -- and society as a whole. Women and men need to actively participate in the advancement of themselves and others for the agency of women to grow. Of course, cultural stereotypes and taboos will not change overnight, but the more women that act as agents, and who hold relative positions of power, the easier it will be for other women to do the same. In this sense, equality exponentially increases. Also, if more women are in positions of power, particularly governmental positions, the accountability of officials will increase by necessity. If societal mindsets shift to consider all to be equal, then all should be held equally accountable.

Social change on a scale as grand as what Sen is proposing is difficult to comprehend in its preliminary stages, but gender equality could have benefits beyond what he has explained as well. One in particular is a stronger tie between governments and their citizens, which goes along with accountability. Since the progression towards equality inherently requires the unification of all, or at least most, men and women, it follows that governments would be more willing to work with its citizens for positive change. Greediness and prejudice would be decreased in governments.