The extent to which interventions target women more generally, as opposed to just mothers, is not well documented. It requires reflecting on “Who is the woman in women's nutrition?” to identify which women are actually targeted in nutrition interventions, which are not, how they are reached, and gaps in policies and interventions to reach women who are missed. To address this, in this comprehensive narrative review, we 1) summarize existing knowledge about interventions targeting women's health and nutrition in low- and middle-income countries, 2) identify gaps in current delivery platforms that are intended to reach women and address their health and nutrition, and 3) determine strategies to reshape policies and programs to reach all women, at all stages of their lives, with a particular focus on women in low- and middle-income countries.
Anaemia is a major global health problem for women. Women are affected more than men, in which up to 30% of women being found to be anaemic and 42% of pregnant women. Anaemia is linked to a number of adverse health outcomes including a poor pregnancy outcome and impaired cognitive function (decreased concentration and attention). The main cause of anaemia is iron deficiency. In United States women iron deficiency anaemia (IDA) affects 37% of pregnant women, but globally the prevalence is as high as 80%. IDA starts in adolescence, from excess menstrual blood loss, compounded by the increased demand for iron in growth and suboptimal dietary intake. In the adult woman, pregnancy leads to further iron depletion.
The U.S. Department of Agriculture's (USDA) food pyramid system (www.mypyramid.gov) provides a good start by recommending that the bulk of your diet come from the grain group—this includes bread, cereal, rice and pasta— the vegetable group; and the fruit group. Select smaller amounts of foods from the milk group and the meat and beans group. Eat few—if any—foods that are high in fat and sugars and low in nutrients. The amount of food you should consume depends on your sex, age and level of activity.
Micronutrient supplementation Health clinics ↓ anemia and Fe-deficiency anemia, ↑ Hgb, ↓ soil-transmitted helminth infection, ↑ cognitive function ↓ anemia and Fe-deficiency anemia, ↑ Hgb, ↑ serum ferritin, ↓ soil-transmitted helminth infection ↓/NC anemia, ↑/NC MN status (Hgb, folate, zinc, retinol), ↑ MN status [ferritin, B-12, 25(OH)D], ↓/NC gestational hypertension and pre-eclampsia, NC gestational diabetes, ↓/NC hyperthyroidism, ↓/NC night blindness, ↓ bone mineral content, ↑ weight gain (among underweight women), ↓ maternal mortality, ↓/NC placental malaria, NC parasitemia, NC maternal infection, ↓/NC depression and perceived stress
The increasing focus on Women's Rights in the United States during the 1980s focused attention on the fact that many drugs being prescribed for women had never actually been tested in women of child-bearing potential, and that there was a relative paucity of basic research into women's health. In response to this the National Institutes of Health (NIH) created the Office of Research on Women's Health (ORWH) in 1990 to address these inequities. In 1993 the National Institutes of Health Revitalisation Act officially reversed US policy by requiring NIH funded phase III clinical trials to include women. This resulted in an increase in women recruited into research studies. The next phase was the specific funding of large scale epidemiology studies and clinical trials focussing on women's health such as the Women's Health Initiative (1991), the largest disease prevention study conducted in the US. Its role was to study the major causes of death, disability and frailty in older women. Despite this apparent progress, women remain underepresented. In 2006 women accounted for less than 25% of clinical trials published in 2004, A follow up study by the same authors five years later found little evidence of improvement. Another study found between 10–47% of women in heart disease clinical trials, despite the prevalence of heart disease in women. Lung cancer is the leading cause of cancer death amongst women, but while the number of women enrolled in lung cancer studies is increasing, they are still far less likely to be enrolled than men.
A related issue is the inclusion of pregnant women in clinical studies. Since other illnesses can exist concurrently with pregnancy, information is needed on the response to and efficacy of interventions during pregnancy, but ethical issues relative to the fetus, make this more complex. This gender bias is partly offset by the iniation of large scale epidemiology studies of women, such as the Nurses' Health Study (1976), Women's Health Initiative and Black Women's Health Study.
For healthy bones and teeth, women need to eat a variety of calcium-rich foods every day. Calcium keeps bones strong and helps to reduce the risk for osteoporosis, a bone disease in which the bones become weak and break easily. Some calcium-rich foods include low-fat or fat-free milk, yogurt and cheese, sardines, tofu (if made with calcium sulfate) and calcium-fortified foods including juices and cereals. Adequate amounts of vitamin D also are important, and the need for both calcium and vitamin D increases as women get older. Good sources of vitamin D include fatty fish, such as salmon, eggs and fortified foods and beverages, such as some yogurts and juices.
In the United States, infertility affects 1.5 million couples. Many couples seek assisted reproductive technology (ART) for infertility. In the United States in 2010, 147,260 in vitro fertilization (IVF) procedures were carried out, with 47,090 live births resulting. In 2013 these numbers had increased to 160,521 and 53,252. However, about a half of IVF pregnancies result in multiple-birth deliveries, which in turn are associated with an increase in both morbidity and mortality of the mother and the infant. Causes for this include increased maternal blood pressure, premature birth and low birth weight. In addition, more women are waiting longer to conceive and seeking ART.
The prevalence of Alzheimer's Disease in the United States is estimated at 5.1 million, and of these two thirds are women. Furthermore, women are far more likely to be the primary caregivers of adult family members with depression, so that they bear both the risks and burdens of this disease. The lifetime risk for a woman of developing Alzeimer's is twice that of men. Part of this difference may be due to life expectancy, but changing hormonal status over their lifetime may also play a par as may differences in gene expression. Deaths due to dementia are higher in women than men (4.5% of deaths vs. 2.0%).
Our review highlighted how a focus on delivery platforms could indicate who is missed by different nutrition interventions, by evaluating where there is overlap or divergence in where interventions are delivered (as represented in the Venn diagram in Figure 1). Our findings showed that a large proportion of nutrition-specific interventions were delivered at clinic-based settings or community-based health posts. Health centers are important delivery platforms, particularly for pregnant and lactating women (113, 210). However, only half of women worldwide even attend the appropriate number of antenatal care visits (with nearly 86% of women attending 1 visit) and only 59% receive appropriate postnatal care (211). Other delivery platforms, such as schools and universities, were more effective at reaching some adolescents and women of reproductive age. However, interventions delivered at “facilities” (schools, health clinics, health posts) require participation with those facilities, and participation is often limited because of time, costs, distance, and other responsibilities, including work and childcare (116). Facilities-based care is also more likely to miss certain groups, including older women.
Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
You should eat a healthful, well-balanced diet during pregnancy. However, you should avoid certain foods, including raw or undercooked fish, poultry and meat; raw or partially cooked eggs or foods containing raw eggs; unpasteurized juices; raw sprouts; unpasteurized milk products; and some soft cheeses (cream cheese is OK). Avoid deli meats and frankfurters unless they have been reheated to steaming hot before eating. To prevent food-borne illnesses, take the following precautions:
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).
In addition, more research is needed to evaluate the impact of targeting women alone compared with targeting women alongside other members of their families and communities (e.g., with groups of other women, men, husbands, children, parents, in-laws, other family members, other community members, etc.). Interventions that targeted women with their children during child health visits or alongside other members of their communities through community mobilization and mass media campaigns showed improvements in knowledge and some health and nutrition behaviors of women. The inclusion of boys and men, for instance, as well as the inclusion of other family and community members, could enhance the impact and delivery of nutrition interventions for women through support of certain practices, reminders, time-savings, and normalization of nutrition behaviors. However, more research is needed to identify effective targeting mechanisms (i.e., alone or alongside other members of households and communities) and we expect that these will likely need to be context- and content-specific.
Home visits ↓/NC anemia, ↑/NC Hgb, ↑ serum ferritin, ↑/NC serum retinol, ↓ vitamin A deficiency ↓/NC anemia and Fe-deficiency anemia, ↑/NC Hgb, ↑/NC serum ferritin, ↑ serum folate, ↑ serum zinc, NC serum retinol ↓ anemia, ↑ Hgb, ↑ serum ferritin, ↑/NC serum retinol, ↑ erythrocyte thiamine diphosphate concentrations, ↓ night blindness, ↑/NC weight gain ↓ anemia, ↑/NC Hgb, ↑ serum ferritin, NC serum retinol, ↑ serum calcium, ↑ 25(OH)D concentrations, ↓ PTH, ↓ bone turnover
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Educational interventions most often targeted school-age children and adolescent girls, and there were few examples of programs targeting women of reproductive age (174). The majority of education interventions were delivered in formal school-based settings (174). However, this is a “selective” delivery platform given that not all adolescents attend schools (193). School fees and distance to school are major barriers to school enrollment (174, 194). Educational interventions need to be sensitive to the reasons why girls are not in school, e.g., work, and to the hours and locations that might make education interventions more accessible (193). Nonformal education, alternative education, mobile schools, and literacy programs can target women and girls not in school, although these approaches were less common and not as well evaluated (174). Interventions that target girls who are no longer in school provide valuable examples about how such interventions could be delivered to hard-to-reach groups (182).
In addition to death occurring in pregnancy and childbirth, pregnancy can result in many non-fatal health problems including obstetrical fistulae, ectopic pregnancy, preterm labor, gestational diabetes, hyperemesis gravidarum, hypertensive states including preeclampsia, and anemia. Globally, complications of pregnancy vastly outway maternal deaths, with an estimated 9.5 million cases of pregnancy-related illness and 1.4 million near-misses (survival from severe life-threatening complications). Complications of pregnancy may be physical, mental, economic and social. It is estimated that 10–20 million women will develop physical or mental disability every year, resulting from complications of pregnancy or inadequate care. Consequently, international agencies have developed standards for obstetric care.
Trans fatty acids, also known as trans fats, are solid fats produced artificially by heating liquid vegetable oils in the presence of metal catalysts and hydrogen. They also pose a health risk, increasing LDL or "bad" cholesterol and increasing your risk of coronary heart disease. They are often found in cookies, crackers, icing and stick margarine, and in small amounts in meats and dairy products. Beginning in January 2006, all food manufacturers had to list the amount of trans fatty acids in foods, resulting in a significant reduction in the amount of these fats used in prepared foods. In its guidelines, the American Heart Association notes that trans fats increase risk of heart disease by raising "bad" LDL cholesterol and should be avoided as much as possible. In addition, research has shown that trans fats can also decrease "good" HDL cholesterol, increase inflammation, disrupt normal endothelial cell function and possibly interfere with the metabolism of other important fats—even more evidence that they are very bad for overall health.
Johnson, Paula A.; Therese Fitzgerald, Therese; Salganicoff, Alina; Wood, Susan F.; Goldstein, Jill M. (3 March 2014). Sex-Specific Medical Research Why Women's Health Can't Wait: A Report of the Mary Horrigan Connors Center for Women's Health & Gender Biology at Brigham and Women's Hospital (PDF). Boston MA: Mary Horrigan Connors Center for Women's Health & Gender Biology.
We live in a modern world with amazing advancements in technology, yet our soil lacks minerals that it once contained causing whatever grows out of it (i.e. fruits, vegetables, and whole foods) to be significantly lower in minerals than it once was. Not only is our soil different, but our food takes a long time to get to us! Unless we’re growing our own whole food in our gardens, picking it out with our bare hands, and washing it off before eating, most likely our produce has been picked weeks before it reaches your grocery store and is purchased by you. This entire process can take weeks and cause nutrients to be depleted from the whole food (2).
In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
A number of health and medical research advocates, such as the Society for Women's Health Research in the United States, support this broader definition, rather than merely issues specific to human female anatomy to include areas where biological sex differences between women and men exist. Women also need health care more and access the health care system more than do men. While part of this is due to their reproductive and sexual health needs, they also have more chronic non-reproductive health issues such as cardiovascular disease, cancer, mental illness, diabetes and osteoporosis. Another important perspective is realising that events across the entire life cycle (or life-course), from in utero to aging effect the growth, development and health of women. The life-course perspective is one of the key strategies of the World Health Organization.
Although creating financial incentives to lose weight isn't a new idea, now we know cashing in to stay motivated works long-term. In the longest study yet on this topic, Mayo Clinic researchers weighed 100 people monthly for one year, offering half the group $20 per pound lost plus a $20 penalty for every pound gained. Those in the monetary group dropped an average of nine pounds by the end of the year, while non-paid participants shed about two pounds. If you’re ready to gamble away weight, consider sites such as Healthywage, FatBet, or stickK.
When you do high-intensity interval training (and if you’re not, you should be!), follow a 2:1 work-to-rest ratio, such as sprinting one minute followed by 30 seconds of recovery. [Tweet this secret!] According to several studies, the most recent out of Bowling Green State University, this formula maximizes your workout results. The BGSU researchers also say to trust your body: Participants in the study set their pace for both running and recovery according to how they felt, and by doing so women worked at a higher percentage of their maximum heart rate and maximum oxygen consumption than the men did.
Income-generation activities Home visits ↑ health knowledge, ↑ health care utilization, ↓ poverty ↑ nutrition and knowledge, ↓ anemia, ↓/NC night blindness, ↑ intake of vitamin A–rich foods, ↑/NC intake of vegetables, ↑ intake of ASF, ↓ underweight, ↑ health care utilization, ↓ poverty ↑ health knowledge, ↑ health care utilization, ↓ poverty
Women's health is positioned within a wider body of knowledge cited by, amongst others, the World Health Organization, which places importance on gender as a social determinant of health. While women's health is affected by their biology, it is also affected by their social conditions, such as poverty, employment, and family responsibilities, and these aspects should not be overshadowed.
There are a number of cultural factors that reinforce this practice. These include the child's financial future, her dowry, social ties and social status, prevention of premarital sex, extramarital pregnancy and STIs. The arguments against it include interruption of education and loss of employment prospects, and hence economic status, as well as loss of normal childhood and its emotional maturation and social isolation. Child marriage places the girl in a relationship where she is in a major imbalance of power and perpetuates the gender inequality that contributed to the practice in the first place. Also in the case of minors, there are the issues of human rights, non-consensual sexual activity and forced marriage and a 2016 joint report of the WHO and Inter-Parliamentary Union places the two concepts together as Child, Early and Forced Marriage (CEFM), as did the 2014 Girl Summit (see below). In addition the likely pregnancies at a young age are associated with higher medical risks for both mother and child, multiple pregnancies and less access to care with pregnancy being amongst the leading causes of death amongst girls aged 15–19. Girls married under age are also more likely to be the victims of domestic violence.
The trick to biking uphill is to look ahead and anticipate. “Try to plan for what's coming,” says Georgia Gould, a LUNA pro athlete and 2012 Olympic bronze medalist in women's mountain biking. “Start shifting down one gear at a time for a smooth, energy-saving transition. Ideally your cadence should stay the same as you transition from harder to easier gears.”
Low-fat diets also can help you lose weight.16 But the amount of weight lost is usually small. You can lose weight and lower your risk for heart disease and stroke if you follow an overall healthy pattern of eating that includes more fruits, vegetables, whole grains and beans that are high in fiber, nuts, low-fat dairy and fish, in addition to staying away from trans fat and saturated fat.
Women who have very low levels of sunlight exposure or have naturally very dark skin are at risk of vitamin D deficiency. Those affected may include women who cover most of their body when outdoors, shift workers, those who are unable to regularly get out of their house or women in residential care. Women who have certain medical conditions or are on some medications may also be affected.
Integrated health care, which integrates curative and preventive interventions, can improve nutrition outcomes for women across the life course through improved access to counseling, vaccinations, and screening and treatment of illnesses (103–107). Access to primary health care positively contributed to the prevention, diagnosis, and management of both communicable and noncommunicable disease (108). Distribution of insecticide-treated bed nets, condoms, screening and testing for disease, and delivery of medical treatments were often associated with integrated health initiatives and improved health and nutrition outcomes (13, 109). Access to health care was associated with the delivery of nutrition-specific interventions to manage pregnancy-induced hypertension, diabetes, pre-eclampsia, and hemorrhage (106, 107, 110). However, some studies showed that integrated services increased knowledge, but did not result in changes in health or nutrition outcomes (103). In addition, in many settings, quality of care was inadequate (107) and incorrect diagnoses and treatments were common (111).
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).
The impact of income-generation interventions on women's nutrition has not been sufficiently evaluated. Income-generating interventions were associated with increases in women's income, empowerment, and household decision-making (161, 164–166). However, these gains were often at the expense of more work for women (5). Income-generation interventions have been associated with increased food-related expenditures, improved household food security, and greater household dietary diversity (160, 161, 165–168). Income-generating interventions targeting adolescents improved their social status; however, these showed no impact on their access to food, nor on individual and household food security (169). There was also limited evidence of impacts of income-generating interventions on women's anthropometric and biochemical nutrition outcomes (5, 169, 170). Increased income was associated with reductions in maternal underweight and anemia, but the reductions were modest (171). Studies suggested that the limited impact was related to continued poor access to health services (167), poor measurement, and the need for longer evaluation periods (164, 165, 167, 169).
The social view of health combined with the acknowledgement that gender is a social determinant of health inform women's health service delivery in countries around the world. Women's health services such as Leichhardt Women's Community Health Centre which was established in 1974 and was the first women's health centre established in Australia is an example of women's health approach to service delivery.
Oils. When cooking try to use oils from plants instead of solid fats like butter, margarine, or coconut oil. See this list of oils and fats to see how healthy each type of cooking oil and solid fat is. Most women eat too much solid fat through packaged foods like chips or salad dressing, and not enough healthy fats like olive oil or the type of fat in seafood.
Mom, wife, daughter, nana, sister, aunt – women play many important roles throughout the years. From screening for common conditions that affect women to advanced medical and surgical care, the healthcare providers at Baylor Scott & White provide the comprehensive services you need as a woman. At Baylor Scott & White Health, you've got a women's health partner for life.
We conducted a comprehensive narrative review to synthesize the existing literature on interventions targeting women's nutrition (11). We searched the PubMed database and Google Scholar from 1990 to December 2017 for peer-reviewed articles, systematic reviews, and grey literature that reported on a set of nutrition-specific and nutrition-sensitive interventions, outlined in what follows. We also reviewed the cited sources of key articles. When available, we used existing reviews to identify studies. Some of the review articles that emerged from our search included both high-income countries and low- and middle-income countries. When possible, we specified the delivery platforms for low- and middle-income countries. For review articles that did not explicitly describe the intervention delivery platforms, we reviewed the cited primary sources to identify the delivery platform for the discussed interventions.
Use MyPlate (PDF – 281 KB) as a guide to build a healthy diet. Think about filling your plate with foods from the five food groups — fruits, vegetables, grains, proteins, and dairy — at each meal. Snacks can be a good way to fill in fruits and whole grains you might have missed at meals. Most of us don’t need complicated calorie counting programs or special recipes for healthy eating.
To optimise women's control over pregnancy, it is essential that culturally appropriate contraceptive advice and means are widely, easily, and affordably available to anyone that is sexually active, including adolescents. In many parts of the world access to contraception and family planning services is very difficult or non existent and even in developed counties cultural and religious traditions can create barriers to access. Reported usage of adequate contraception by women has risen only slightly between 1990 and 2014, with considerable regional variability. Although global usage is around 55%, it may be as low as 25% in Africa. Worldwide 222 million women have no or limited access to contraception. Some caution is needed in interpreting available data, since contraceptive prevalence is often defined as "the percentage of women currently using any method of contraception among all women of reproductive age (i.e., those aged 15 to 49 years, unless otherwise stated) who are married or in a union. The “in-union” group includes women living with their partner in the same household and who are not married according to the marriage laws or customs of a country." This definition is more suited to the more restrictive concept of family planning, but omits the contraceptive needs of all other women and girls who are or are likely to be sexually active, are at risk of pregnancy and are not married or "in-union".
Of the few studies evaluating nutrition education interventions for women and adolescent girls who were overweight and obese, many were “facility-based” and involved delivery platforms such as health clinics (13, 22), worksites (30), and schools (26, 27, 29). Delivery platforms targeting women and adolescents who were undernourished similarly involved facility-based settings (13), but also included community outreach (16, 28), home visits, community kitchens (15, 28), and text messaging platforms (32). Such community-based platforms could provide additional opportunities for the delivery of nutrition education interventions addressing overweight, obesity, and associated noncommunicable disease in the future.
For once we're not talking about breakfast but rather the recovery meal after your workout. “So many women skip post-exercise nutrition because they don’t want to 'undo the calories they just burned,'” says Amanda Carlson-Phillips, vice president of nutrition and research for Athletes’ Performance and Core Performance. “But getting a combination of 10 to 15 grams of protein and 20 to 30 grams of carbohydrates within 30 minutes of your workout will help to refuel your body, promote muscle recovery, amp up your energy, and build a leaner physique.”
Systematically report and evaluate women's nutrition outcomes in research and program evaluation documents in low- and middle-income countries, including outcomes for adolescents, older women, and mothers (as opposed to reporting on women's nutrition as child nutrition outcomes alone). When possible, report and evaluate differences by setting (e.g., rural compared with urban) and socioeconomic status.