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.
Complementing income-generating interventions with interventions that more directly target women's nutrition has potential to have greater impacts on women's nutritional status (171). Integrated interventions were associated with improvements in health knowledge and behaviors, as well as increased intake of nutrient-rich foods (5, 164, 169, 170, 172). In Bangladesh and Cambodia, the aforementioned EHFP program was associated with increased income, decision-making power in the household, food expenditure (including on oils, salts, spices, fish, rice, and meat), and consumption of fruits and vegetables from home gardens (160, 173). There was also limited, but mixed, evidence of income-generating interventions and behavior change communication causing improvements in maternal anemia and BMI (164, 168, 170).
Social protection interventions are intended to support vulnerable households by providing them with in-kind (e.g., food) or cash transfers. The impact of social protection on women's nutrition was nuanced, as such interventions were associated with protecting against adverse nutrition outcomes, but were also associated with excess weight gain in some settings. In-kind transfers, including food baskets, fortified foods, and school lunches, improved women's and adolescent girls’ energy and micronutrient intakes, as described in the preceding sections. Both CCTs and unconditional cash transfers were common around the world and were associated with improvements in health care utilization and increased food expenditures (5, 14, 195, 196). CCTs were dependent on “conditions” such as school attendance and health care utilization. For children in Burkina Faso, CCTs were associated with greater numbers of preventative health visits compared with unconditional cash transfers (197), and this could be relevant to adult women's health care utilization as well. Unconditional cash transfers, such as old-age pensions, were also common, including in low- and middle-income countries (5, 198). Older women who received pensions had fewer missed meals (199), although evidence was mixed (200). In South Africa, granddaughters who cohabitated with women who received pensions had improved anthropometric measures and fewer missed meals, indicating spillover effects of pension transfers (199, 201).