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. 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. 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. The UNFPA has made prevention of OF a priority and is the lead agency in the Campaign to End Fistula, which issues annual reports and the United Nations observes May 23 as the International Day to End Obstetric Fistula every year. Prevention includes discouraging teenage pregnancy and child marriage, adeaquate nutrition, and access to skilled care, including caesarian section.
When trying to adopt new healthy habits, it's important to work around other long-standing practices that could sabotage your efforts if overlooked. For example, if you are a morning person, working out in the a.m. is likely best, but if you’re a night person, exercise after work, says Tara Stiles, owner of Strala Yoga in New York City. [Tweet at Tara!]“Don't try to become one or the other if it's not natural to you. You're more likely to stick to it if you like the time of day and the whole experience.”
All youth need calcium to build peak (maximum) bone mass during their early years of life. Low calcium intake is one important factor in the development of osteoporosis, a disease in which bone density decreases and leads to weak bones and future fractures. Women have a greater risk than men of developing osteoporosis. During adolescence and early adulthood, women should include good food sources of calcium in their diets This is when bone growth is occurring and calcium is being deposited into the bone. This occurs in women until they are 30 to 35 years of age. Women 25 to 50 years of age should have 1,000 mg of calcium each day, while women near or past menopause should have 1,200 mg of calcium daily if they are taking estrogen replacement therapy; otherwise, 1,500 mg per day is recommended. Women older than 65 years of age should have 1,500 mg per day.
You can get calcium from dairy products like milk, yogurt and cheese, canned fish with soft bones (sardines, anchovies and salmon; bones must be consumed to get the benefit of calcium), dark-green leafy vegetables (such as kale, mustard greens and turnip greens) and even tofu (if it's processed with calcium sulfate). Some foods are calcium-fortified; that is, they contain additional calcium. Examples include orange juice, certain cereals, soy milk and other breakfast foods. Talk to your health care professional about whether you should take calcium supplements if you don't think you're getting enough calcium from food sources.
In low- and middle-income countries, health care services often respond to acute health needs and many focus on maternal–child health (105, 106, 110, 112). The use of preventative care is limited, and there are concerns about the capacity of health systems to address noncommunicable diseases, such as diabetes, in low- and middle-income settings (108, 112). This has implications for the reach of integrated health care interventions across the life course. Maternal and reproductive health care is often sought by women when they are pregnant and in the early years of their children's lives (3, 113). Even so, many women visit health facilities late in their pregnancy or not at all (114–116). For adolescents and adult women, care is often not sought until they are sick (3, 117, 118). This is problematic for older women, in particular, as screening and treatment for age-related health issues, such as diabetes, cancer, and hypertension, require access to preventative health care services (3).
Iron is one of the keys to good health and energy levels in women prior to menopause. Foods that provide iron include red meat, chicken, turkey, pork, fish, kale, spinach, beans, lentils and some fortified ready-to-eat cereals. Plant-based sources of iron are more easily absorbed by your body when eaten with vitamin C-rich foods. So eat fortified cereal with strawberries on top, spinach salad with mandarin orange slices or add tomatoes to lentil soup.
Young adults. Teen girls and young women usually need more calories than when they were younger, to support their growing and developing bodies. After about age 25, a woman’s resting metabolism (the number of calories her body needs to sustain itself at rest) goes down. To maintain a healthy weight after age 25, women need to gradually reduce their calories and increase their physical activity.
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.).