The delivery platforms of birth spacing and family planning interventions were often associated with health clinics and community health posts (148–150). Many interventions targeted lactating women during the follow-up with their young children (148, 151–153). Home visits by community health workers and service provision at community health posts and mobile clinics were also used to target women and adolescents who were married, and were found to be effective at increasing use of contraception (150, 154). School-based programs were also effective at reaching adolescent girls and increased their knowledge about contraceptives and sexually transmitted infections, use of contraception, and treatment of sexually transmitted infections (155). In high-income settings, school-based interventions were most effective at reducing pregnancies and repeated pregnancies among adolescents when contraception was also available on-site (107). This might have implications for their effectiveness in low- and middle-income countries, as well. In addition, formative work of 2 ongoing studies suggested that mass media, mobile devices, texting, and community mobilization could also be used as platforms to reach adolescent girls and women of reproductive age (156, 157). Community-based programs that target men, families, and communities, beyond those that reach married and postpartum women alone, have potential to change cultural norms and enhance women's health outcomes; however, these are not well captured in the literature.
Nutrition is particularly important when you are pregnant. Weight gain during pregnancy is normal—and it's not just because of the growing fetus; your body is storing fat for lactation. The National Academy of Sciences/Institute of Medicine (NAS/IOM) has determined that a gain of 25 to 35 pounds is desirable. However, underweight women should gain about 28 to 40 pounds, and overweight women should gain at least 15 pounds. The IOM has not given a recommendation for an upper limit for obese women, but some experts cap it as low as 13 pounds. If you fit into this category, discuss how much weight you should gain with your health care professional. Remember that pregnancy isn't the time to diet. Caloric restriction during pregnancy has been associated with reduced birth weight, which can be dangerous to the baby.
“It was a privilege to have taken the course with you. Already, I have used the cueing methods on 2 clients. I have also taken the initiative to ask one of my post-natal client today about her birthing journey and she was so open and excited to share with me. It struck me that usually nobody asks them about it as more attention is focused on the baby.”
The U.S. Public Health Service recommends that all women of childbearing age consume 400 mcg of folic acid (a B vitamin) daily to reduce their risk of having a pregnancy affected with spina bifida or other neural-tube defects. Women who are actively trying to get pregnant should consume 600 mcg, and lactating women should consumer 500 mcg. Women of childbearing age should also take care to meet the daily requirements for calcium, fiber, iron, protein and vitamin D. Discuss supplements with a health care professional, however. Iron and vitamin D in particular can be dangerous in high amounts.
Three related targets of MDG5 were adolescent birth rate, contraceptive prevalence and unmet need for family planning (where prevalence+unmet need = total need), which were monitored by the Population Division of the UN Department of Economic and Social Affairs. Contraceptive use was part of Goal 5B (universal access to reproductive health), as Indicator 5.3. The evaluation of MDG5 in 2015 showed that amongst couples usage had increased worldwide from 55% to 64%. with one of the largest increases in Subsaharan Africa (13 to 28%). The corollary, unmet need, declined slightly worldwide (15 to 12%). In 2015 these targets became part of SDG5 (gender equality and empowerment) under Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights, where Indicator 5.6.1 is the proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care (p. 31).
Schools (and universities) ↓/NC anemia, ↓ Fe-deficiency anemia, ↑/NC MN status [Hgb (↑ if anemic), ferritin, zinc, retinol], ↑ MN status [folate, riboflavin, 25(OH)D, iodine], ↓ PTH, ↓ goiter prevalence, ↓ MN deficiency (vitamin A, B-12, C), ↑ bone mineral accretion, ↑/NC weight gain/BMI, ↑ MUAC, ↑ gut inflammation, ↓/NC respiratory symptoms and diarrheal morbidity, ↑ fitness (for Fe-deficient subjects), ↑/NC short-term cognitive function ↑ Hgb (↑ if anemic), ↑ serum ferritin, ↑ total body Fe, ↑ urinary iodine concentration, ↑ serum zinc, ↑ aerobic power, NC net energetic efficiency
Social protection programs typically target the most marginalized members of communities and typically families with children (5, 196). Cash transfers are often targeted to women in these households because they more often invest the transfers in household and food expenditures than men do (192, 202, 204, 205). Cash transfer programs were also targeted to older adults through government-coordinated programs (196, 198, 206). The delivery of transfers involved community centers (town halls, post offices) and banks, as well as locations associated with other services, e.g., schools or health centers (192, 206, 207). These latter platforms were relevant not only for the distribution of social protection programs (i.e., the receipt of transfers), but also for enrollment in and “conditions” of those programs. Conditional transfers required that recipients had access to certain delivery platforms (e.g., schools and health centers) in order to meet the “conditions” of their transfer, and this was a limitation in very rural areas. Although social protection programs are intended for the most vulnerable populations, their delivery platforms can serve as barriers to individuals’ receipt of services, particularly if they require engagement with health care, school, or work-related systems.
Iodine is needed for normal mental development of the baby, but it can be difficult to get enough from food. Ways of increasing iodine intake include using iodised salt, eating fish and seafood weekly (see your health professional for advice about safe types and amounts of fish), or using a multivitamin supplement that contains iodine and is safe for pregnancy.
A healthy vegetarian diet falls within the guidelines offered by the USDA. However, meat, fish and poultry are major sources of iron, zinc and B vitamins, so pay special attention to these nutrients. Vegans (those who eat only plant-based food) may want to consider vitamin and mineral supplements; make sure you consume sufficient quantities of protein, vitamin B12, vitamin D and calcium. You can obtain what you need from non-animal sources. For instance:
Delivery platforms for women across the life course. This Venn diagram represents the delivery platforms for different interventions by target population. The overlapping regions indicate delivery platforms that are shared by the target groups: adolescent girls, women of reproductive age, pregnant and lactating women, mothers of young children, and older women.
Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked health insurance. In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the poverty line are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (e.g. midwives, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits. A lack of healthcare providers, facilities, and resources such as formularies all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted diseases and cervical cancer.