The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with obesity and diabetes amongst women in these countries and increasing the risks of cardiovascular disease and other NCDs.[11][20]

Amongst non-governmental organizations (NGOs) working to end child marriage are Girls not Brides,[106] Young Women's Christian Association (YWCA), the International Center for Research on Women (ICRW)[107] and Human Rights Watch (HRW).[108] Although not explicitly included in the original Millennium Development Goals, considerable pressure was applied to include ending child marriage in the successor Sustainable Development Goals adopted in September 2015,[105] where ending this practice by 2030 is a target of SDG 5 Gender Equality (see above).[109] While some progress is being made in reducing child marriage, particularly for girls under fifteen, the prospects are daunting.[110] The indicator for this will be the percentage of women aged 20–24 who were married or in a union before the age of eighteen. Efforts to end child marriage include legislation and ensuring enforcement together with empowering women and girls.[92][93][95][94] To raise awareness, the inaugural UN International Day of the Girl Child[a] in 2012 was dedicated to ending child marriage.[112]

The World Health Organization (WHO) estimates that 35% of women in the world have experienced physical or sexual violence over their lifetime and that the commonest situation is intimate partner violence. 30% of women in relationships report such experience, and 38% of murders of women are due to intimate partners. These figures may be as high as 70% in some regions.[138] Risk factors include low educational achievement, a parental experience of violence, childhood abuse, gender inequality and cultural attitudes that allow violence to be considered more acceptable.[139]
Equally challenging for women are the physiological and emotional changes associated with the cessation of menses (menopause or climacteric). While typically occurring gradually towards the end of the fifth decade in life marked by irregular bleeding the cessation of ovulation and menstruation is accompanied by marked changes in hormonal activity, both by the ovary itself (oestrogen and progesterone) and the pituitary gland (follicle stimulating hormone or FSH and luteinizing hormone or LH). These hormonal changes may be associated with both systemic sensations such as hot flashes and local changes to the reproductive tract such as reduced vaginal secretions and lubrication. While menopause may bring relief from symptoms of menstruation and fear of pregnancy it may also be accompanied by emotional and psychological changes associated with the symbolism of the loss of fertility and a reminder of aging and possible loss of desirability. While menopause generally occurs naturally as a physiological process it may occur earlier (premature menopause) as a result of disease or from medical or surgical intervention. When menopause occurs prematurely the adverse consequences may be more severe.[114][115]
To help you learn how to eat healthfully, start with the U.S. Department of Agriculture's (USDA) dietary guidelines system, which you can find at http://www.mypyramid.gov. The MyPyramid system, which looks somewhat like the familiar food pyramid of old, offers guidance based on individual needs and replaces "serving" recommendations with actual amounts of food. It also emphasizes the importance of balancing nutritious (and tasty!) food choices from all food groups every day with daily physical activity.
Choline: Some studies link low choline levels to increased risk of neural tube defects. Recommended levels have been established for this nutrient, but it's easy to get enough in your diet. Eggs are an excellent source of choline, for example. “Eating a few eggs a week should give you all you need,” Frechman says. “Most people can eat the equivalent of an egg a day without worrying about cholesterol.” Other choline-rich food sources include milks, liver, and peanuts.
These challenges are included in the goals of the Office of Research on Women's Health, in the United States, as is the goal of facilitating women's access to careers in biomedicine. The ORWH believes that one of the best ways to advance research in women's health is to increase the proportion of women involved in healthcare and health research, as well as assuming leadership in government, centres of higher learning, and in the private sector.[155] This goal acknowledges the glass ceiling that women face in careers in science and in obtaining resources from grant funding to salaries and laboratory space.[178] The National Science Foundation in the United States states that women only gain half of the doctorates awarded in science and engineering, fill only 21% of full-time professor positions in science and 5% of those in engineering, while earning only 82% of the remuneration their male colleagues make. These figures are even lower in Europe.[178]

Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the industrial revolution. [6] Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.[18]

Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the industrial revolution. [6] Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.[18]


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Even if you are the most independent exerciser around, give a group fitness class a shot at least once a week—you may find that you enjoy it more than sweating solo. “Happiness and health are shared through social connectedness and closeness,” says Greg Chertok, director of sport psychology at the Physical Medicine and Rehabilitation Center in New Jersey. “Geography and proximity are predictors of how contagious emotions can be, and this may translate into an athletic environment too.” Sign up for Bikram, CrossFit, spin, or Zumba, and you could find yourself—gasp!—smiling at the gym thanks to your classmates.
Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don't know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.
Many WASH interventions targeted mothers and their caregiving behaviors for children. However, these interventions were applied to entire households and not individual household members. Larger community-based hygiene and sanitation initiatives broadly reached more people in the community (131). However, certain populations such as the elderly and young children might have limited access to public infrastructure, such as public latrines, particularly if there are physical and economic barriers to accessing them (136).
After 40, your hormone levels (estrogen) drop. This causes your insulin (hormone that helps your body use sugar) rise. Your thyroid levels go down. This combination makes you hungrier. You end up eating more and burning fewer calories. Much of the weight gain occurs around your belly. Eat more foods with fiber (berries, whole grains, nuts) to fill you up and help you eat less. Aim for 25 grams of fiber each day after the age of 40. Other ways to increase your metabolism include:

The best training tool you're not using: a jump rope. “It may seem a little juvenile until you think of all the hot-bodied boxing pros who jump rope every single day,” says Landon LaRue, a CrossFit level-one trainer at Reebok CrossFit LAB in L.A. Not only is it inexpensive, portable, and easy to use almost anywhere, you’ll burn about 200 calories in 20 minutes and boost your cardiovascular health while toning, he adds.
For a strong backside that will turn heads wherever you go, Marta Montenegro, a Miami-based exercise physiologist and strength and conditioning coach, recommends completing 100 kettlebell swings nonstop with a moderate weight at the end of a legs workout. [Tweet this tip!] If you can’t access a kettlebell, do deadlifts and hip-thrusters instead. “Women tend to overemphasize the quadriceps even when they think they are working the butt. With these two exercises, you'll have no problem engaging the glutes and posterior muscles of the legs,” Montenegro says.
Pregnancy presents substantial health risks, even in developed countries, and despite advances in obstetrical science and practice.[34] Maternal mortality remains a major problem in global health and is considered a sentinel event in judging the quality of health care systems.[35] Adolescent pregnancy represents a particular problem, whether intended or unintended, and whether within marriage or a union or not. Pregnancy results in major changes in a girl's life, physically, emotionally, socially and economically and jeopardises her transition into adulthood. Adolescent pregnancy, more often than not, stems from a girl's lack of choices. or abuse. Child marriage (see below) is a major contributor worldwide, since 90% of births to girls aged 15–19 occur within marriage.[36]
Not surprisingly, many integrated health services were delivered in health clinics and facilities. Many women faced barriers to health facility–based care for nutrition, such as distance, time, quality of care, stocking of supplies, and the capacity and nutrition knowledge of healthcare professionals (105, 119). These barriers need to be taken into consideration to enhance the coverage of integrated health care services. Universal health care mitigated cost barriers to seeking health care, but did not address all of the barriers noted here (105, 109, 114, 120–123). 

Most vegetarians eat milk products and eggs, and as a group, these lacto-ovo-vegetarians enjoy good health. A healthful vegetarian diet falls within the food pyramid 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) should consult a health care professional about adding vitamin and mineral supplements; make sure you consume sufficient quantities of protein, vitamin B12, vitamin D and calcium.
  Markets and retail  ↓/NC anemia, ↑ MN status (Hgb, Fe stores, ferritin, folate, iodine), ↓/NC goiter prevalence, ↓ folate deficiency, NC retinol-binding protein, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)  ↓/NC anemia, ↑ Hgb, ↑/NC Fe stores, ↑/NC serum ferritin, ↑ serum folate, ↑ urinary iodine, ↓ goiter prevalence, ↓ folate deficiency, NC retinol-binding protein, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)  ↓/NC anemia, ↑ serum folate, ↓ folate deficiency, ↑ urinary iodine concentration, ↓ goiter prevalence, ↑ mean adequacy ratio of diet, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, vitamin B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe)  ↑/NC Fe stores, ↑/NC serum ferritin, ↑ serum folate, NC B-12 deficiency, ↑ dietary adequacy, ↑ intake of nutrient-rich foods (vitamin A, B-6, thiamin, iodine, riboflavin, niacin, folate, and Fe) 
CCTs have been more thoroughly evaluated for nutrition outcomes, particularly in Latin American countries. They were associated with improvements in women's knowledge of health and nutrition, as well as their self-esteem, participation in social networks, control over resources, and decision-making power (5, 202). Although intrahousehold allocation for women is not clear, CCTs increased household food expenditure and were associated with improved household dietary diversity, including increased household consumption of animal protein, fruits, and vegetables, and reduced consumption of staples and grains (14, 192, 202). There was also some evidence that household expenditure on fats and sweets also increased significantly (202). However, these findings were not consistent and some evaluations showed no significant increase (14, 202, 203). Despite this, in Mexico, there was evidence that in-kind and cash transfer programs resulted in excess weight gain in women who were not underweight (5, 93). This warrants future research given the burden of overweight and obesity among women.
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.[93][94] 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).[95] 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[96][11][93] 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.[92]
Research findings can take some time before becoming routinely implemented into clinical practice. Clinical medicine needs to incorporate the information already available from research studies as to the different ways in which diseases affect women and men. Many "normal" laboratory values have not been properly established for the female population separately, and similarly the "normal" criteria for growth and development. Drug dosing needs to take gender differences in drug metabolism into account.[6]
WASH interventions were typically community-based. WASH interventions were delivered to households and communities through community mobilization, mass media, home visits, and infrastructural development (126, 130, 136–138). There were some examples of facility-based delivery of WASH interventions, such as in health clinics and schools (139, 140); however, this was not representative of the majority of delivery platform coverage. Health clinic delivery platforms had limited reach, often targeting pregnant women and women with young children. In an evaluation of WASH interventions delivered in India (141), more demanding behavioral practices, such as handwashing and consistent use of latrines, required more intense contact (e.g., multiple home visits) than less intense interventions, such as sweeping of courtyards, that could be effectively delivered in small group meetings such as those in health clinics and community centers. More research is needed to evaluate the benefits and barriers of different delivery platforms for women across the life course.
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.
A workout partner not only keeps you accountable, she also may help you clock more time at the gym and torch more fat. A British survey of 1,000 women found that those who exercise with others tend to train six minutes longer and burn an extra 41 calories per session compared to solo fitness fanatics. [Tweet this fact!] Women with Bikram buddies and CrossFit comrades said they push themselves harder and are more motivated than when they hit the gym alone.
  Microcredit institution  NC HH food security, NC individual food security, NC food expenditures, NC food consumption, ↑ social status, ↑ self-confidence  ↑ health knowledge, NC health status, NC HH food security, NC individual food security, ↑/NC food expenditures, NC food consumption, NC school enrollment, ↑/NC empowerment, ↑ self-confidence, ↑/NC decision-making, ↑ social status, ↑/NC health care utilization  ↑ health knowledge, NC health status, ↑/NC food expenditures, NC school enrollment, ↑/NC empowerment, ↑/NC decision-making power, ↑ self-confidence, ↑/NC health care utilization  NC health status, ↑/NC food expenditures, ↑/NC empowerment, ↑/NC decision-making power, ↑ self-confidence, NC health care utilization 
Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
 Nutrition education  Health clinics  ↑ knowledge, NC Hgb, ↑ intake of fruits and vegetables, ↓/NC intake of fats, sweets, and sugar-sweetened beverages  ↑ knowledge, NC Hgb, ↑ intake of fruits and vegetables, ↓/NC intake of fats, sweets, and sugar-sweetened beverages  ↑ knowledge, NC urinary iodine, ↑ intake of nutrient-rich foods, ↑ intake of protein, ↑ weight gain, ↑/NC weight loss postpartum (obese women) with diet and exercise   
Our women’s fitness programs are designed for women from the ground up. We teach from the female anatomy and physiology, the feminine psyche and include all the subtle bodies – the emotional, mental and spiritual that have an impact on the physical. We understand the different needs of the woman as she exercises through pregnancy, postnatal, menopause and the later years of her life and how these changes affect her women’s fitness needs and goals.
Omega-3 fatty acids are essential for the neurological and early visual development of your baby and for making breast milk after birth. Aim for two weekly servings of cold water fish such as salmon, tuna, sardines, herring, or anchovies. Sardines are widely considered the safest and most sustainable fish to eat, while seaweed is a rich vegetarian source of Omega-3s.
Folic acid: This form of B vitamin helps prevent neural tube defects, especially spina bifida and anencephaly. These defects can be devastating and fatal. Many foods are now fortified with folic acid. Most women get enough as part of their diet through foods such as leafy greens, a rich source of folic acid. However, some doctors recommend that women take a pregnancy supplement that includes folic acid, just to make sure they are getting the recommended 400 to 800 micrograms.

Many WASH interventions targeted mothers and their caregiving behaviors for children. However, these interventions were applied to entire households and not individual household members. Larger community-based hygiene and sanitation initiatives broadly reached more people in the community (131). However, certain populations such as the elderly and young children might have limited access to public infrastructure, such as public latrines, particularly if there are physical and economic barriers to accessing them (136).
Nutrition-sensitive approaches are difficult to link to women's nutritional status (5, 102). This is due to limited measurement of benefits to program beneficiaries, families, households, and communities, limited timeframes to evaluate long-term impact, logistical and political realities that make implementation difficult, and different priorities of different stakeholders in multisectoral programs (102). Many nutrition-sensitive approaches, as will be described, thus focus on more distal measures of impact (e.g., coverage, knowledge) and not more proximal measures of women's nutritional status (e.g., BMI, anemia status, etc.).
At Women's Fitness Company, we strive everyday to support and empower women to change their lives through fitness and education. We do this by focusing on relationships with you, our member and by providing the highest quality of service and the most knowledgeable staff in the valley. You do not have to feel alone in reaching your fitness goals because everything we do starts and ends with you!
  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 
Piranha Fitness Studio welcomes all comers to join our group classes so we can help you achieve your fitness goals. We offer Cycling, Power Training, Kickboxing, HIIT, Cardio Dancing, and Abs-So-Glute classes 6 days a week, providing you with the best instructors and newest equipment at an exceptional value. Most importantly, we will have fun getting fit, and you will find an amazingly supportive family here.

Before and during pregnancy. You need more of certain nutrients than usual to support your health and your baby’s development. These nutrients include protein, calcium, iron, and folic acid. Many doctors recommend prenatal vitamins or a folic acid supplement during this time. Many health insurance plans also cover folic acid supplements prescribed by your doctor during pregnancy. You also need to avoid some foods, such as certain kinds of fish. Learn more about healthy eating during pregnancy in our Pregnancy section.
In addition to diet, exercise and other lifestyle factors can also play an important role in bone health. Smoking and drinking too much alcohol can increase your chances of developing osteoporosis, while weight-bearing exercise (such as walking, dancing, yoga, or lifting weights) can lower your risk. Strength or resistance training—using machines, free weights, elastic bands, or your own body weight—can be especially effective in helping to prevent loss of bone mass as you age.
Long-term goals are imperative, but they can make you feel overwhelmed or discouraged at times. Instead of thinking about how many dress sizes smaller you want to be in four months, focus on small everyday victories, suggests Michael Snader, BodyAware specialist and nutritionist at The BodyHoliday, a health and wellness resort in St. Lucia. “For example, today you are going to eat breakfast, fit in a workout, and drink more water,” he says. Stay focused on the present, and your future will be successful. 
After menopause. Lower levels of estrogen  after menopause raise your risk for chronic diseases such as heart disease, stroke, and diabetes, and osteoporosis, a condition that causes your bones to become weak and break easily. What you eat also affects these chronic diseases. Talk to your doctor about healthy eating plans and whether you need more calcium and vitamin D to protect your bones. Read more about how very low estrogen levels affect your health in our Menopause section. Most women also need fewer calories as they age, because of less muscle and less physical activity. Find out how many calories you need based on your level of activity.
“The more colorful the vegetables — and fruits — the more nutrients you’re going to get in your diet,” says Hincman. And green leafy veggies, like turnip, collard and mustard greens, kale, Chinese cabbage, and spinach, all rich sources of vitamins and minerals, are a great place to start. Many are also a good source of iron, important for women’s health, especially after menopause. One serving of cooked leafy greens — a half a cup — is not a lot, considering that just around two and one half cups of veggies, or five servings in total, is all you need each day.
Adult women, and particularly women with children, were the primary targets for empowerment interventions. Empowerment interventions were predominantly delivered through community-based programs, including home visits, community groups, and community centers (5, 161, 163). There was some evidence that empowerment interventions that included delivery platforms such as radio and television, as a complement to the community- and home-based delivery platforms (5), could have some impact on reaching a wider audience. Adolescent girls were largely not the target of empowerment interventions, except for those relating to reproductive health (158), and could potentially benefit from them.
According to researchers who recently reviewed the risks associated with coronary heart disease (CHD) in women, a poor diet was linked to 20 percent of all cases of heart disease. Factor in diet’s effect on other chronic diseases like diabetes and osteoporosis, and it’s obvious that good nutrition has huge women's health benefits. One way to immediately turn your health situation around is through the foods you choose to eat. Here are nine foods that you'll want to make part of your daily diet.

Salt, caffeine and alcohol intake may interfere with the balance of calcium in the body by affecting the absorption of calcium and increasing the amount lost in the urine. Moderate alcohol intake (one to two standard drinks per day) and moderate tea, coffee and caffeine-containing drinks (no more than six cups per day) are recommended. Avoid adding salt at the table and in cooking
Wood, Susan F.; Dor, Avi; Gee, Rebekah E.; Harms, Alison; Mauery, D. Richard; Rosenbaum, Sara J.; Tan, Ellen (15 June 2009). Women's health and health care reform: the economic burden of disease in women'. D. Richard. Washington DC: George Washington University, School of Public Health and Health Services, Jacobs Institute of Women's Health. Retrieved 17 July 2016.
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.[119] Deaths due to dementia are higher in women than men (4.5% of deaths vs. 2.0%).[6]
For girls and adult women, educational interventions are considered a powerful means of improving their health and nutritional status throughout their lives. Education level is often associated with maternal caregiving practices and the nutritional outcomes of their children (174, 175). Few studies, however, evaluated the impact of education as an intervention on women's nutrition outcomes. Instead, many studies used survey data and reported on associations between education and nutrition. For instance, in low- and middle-income countries, higher levels of education were associated with lower prevalence of underweight and higher prevalence of overweight among women (176, 177). However, this depended on the type of employment in which women participated (178, 179). In addition, in many high-income settings, the converse was true (177). Level of literacy was also associated with improved anthropometric measures. In southern Ethiopia, literate mothers were 25% less likely to be undernourished than were illiterate women (180). One econometric analysis suggested that doubling primary school attendance in settings with low school attendance was associated with a 20–25% decrease in food insecurity (181). Overall, though, these associations were limited in their ability to draw conclusions about causality and the effect of education interventions on nutrition outcomes.
Nutritionists recommend choosing a rainbow of fruits and vegetables because each one provides a unique blend of nutrients. Within the color spectrum, yellow or orange veggies are great sources of vitamin A for skin and eye health and better immunity against infection. At the top of the list are carrots, sweet potatoes, pumpkin, and the many types of squash. While it takes just one whole carrot or six baby carrots to make one serving (one-half cup), you’ll need only half a starchy sweet potato.
Food fortification is one of the most cost-effective strategies to improve micronutrient status through a variety of food vehicles, including staples, condiments, and processed foods (63, 64). Common fortifiable micronutrients include iron, folic acid, vitamin A, vitamin D, vitamin E, and iodine, although B vitamins and vitamin C are also used as fortificants (33, 64). Food fortification reduced anemia and iron deficiency anemia, and improved vitamin A, folate, niacin, thiamin, vitamin B-6, vitamin B-12, zinc, and iodine status of women of reproductive age and adolescents (13, 46, 61, 63–74). Vitamin D and calcium fortification were found to reduce the risk of osteoporosis among older women, especially for those exposed to inadequate sunlight (63, 64). Biofortification efforts, including those that involved breeding or genetic modification of plants to improve micronutrient content, have also shown improvements in the vitamin A and iron status of women (64, 75). Similar to micronutrient supplementation, women and girls with low micronutrient status were most likely to benefit.
Of near miss events, obstetrical fistulae (OF), including vesicovaginal and rectovaginal fistulae, remain one of the most serious and tragic. Although corrective surgery is possible it is often not available and OF is considered completely preventable. If repaired, subsequent pregnancies will require cesarian section.[53] While unusual in developed countries, it is estimated that up to 100,000 cases occur every year in the world, and that about 2 million women are currently living with this condition, with the highest incidence occurring in Africa and parts of Asia.[39][53][54] OF results from prolonged obstructed labor without intervention, when continued pressure from the fetus in the birth canal restricts blood supply to the surrounding tissues, with eventual fetal death, necrosis and expulsion. The damaged pelvic organs then develop a connection (fistula) allowing urine or feces, or both, to be discharged through the vagina with associated urinary and fecal incontinence, vaginal stenosis, nerve damage and infertility. Severe social and mental consequences are also likely to follow, with shunning of the women. Aprt from lack of access to care, causes include young age, and malnourishment.[11][55][53] The UNFPA has made prevention of OF a priority and is the lead agency in the Campaign to End Fistula, which issues annual reports[56] and the United Nations observes May 23 as the International Day to End Obstetric Fistula every year.[57] Prevention includes discouraging teenage pregnancy and child marriage, adeaquate nutrition, and access to skilled care, including caesarian section.[11]
Child marriage (including union or cohabitation)[91] is defined as marriage under the age of eighteen and is an ancient custom. In 2010 it was estimated that 67 million women, then, in their twenties had been married before they turned eighteen, and that 150 million would be in the next decade, equivalent to 15 million per year. This number had increased to 70 million by 2012. In developing countries one third of girls are married under age, and 1:9 before 15.[92] The practice is commonest in South Asia (48% of women), Africa (42%) and Latin America and the Caribbean (29%). The highest prevalence is in Western and Sub-Saharan Africa. The percentage of girls married before the age of eighteen is as high as 75% in countries such as Niger (Nour, Table I).[11][92] Most child marriage involves girls. For instance in Mali the ratio of girls to boys is 72:1, while in countries such as the United States the ratio is 8:1. Marriage may occur as early as birth, with the girl being sent to her husbands home as early as age seven.[11]
  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     
 	Community centers 	NC HH or individual food security, NC food expenditures, NC food consumption, ↑ social status, ↑ self-confidence 	↑ health and knowledge, ↓ anemia, ↑/NC HH food security, NC individual food security, NC food expenditures, ↑/NC food consumption, ↑/NC dietary diversity, ↑ MN-rich foods (Fe, vitamin A, vitamin C, calcium), ↑/NC intake of protein, ↑ ASF intake, ↑/NC BMI, ↑ weight gain, ↑ social status, ↑ self-confidence, ↑/NC decision-making 	↑ health and nutrition knowledge, ↓/NC anemia, ↑/NC HH food security, ↑/NC food expenditures, ↑/NC HH food consumption, ↑/NC dietary diversity, ↑ nutrient-rich foods (Fe, vitamin A), NC intake of protein, ↑/NC intake of vegetables and ASF, ↑/NC BMI, ↓ underweight, ↑ weight gain, NC diarrheal morbidity, ↑ self-confidence, ↑/NC decision-making, ↑ control HH resources 	↑ health knowledge, ↑/NC HH food security, ↑/NC HH food consumption, ↑ dietary diversity, ↑ self-confidence, ↑/NC decision-making  
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