It has affected more than 200 million women and girls who are alive today. The practice is concentrated in some 30 countries in Africa, the Middle East and Asia.[77] FGC affects many religious faiths, nationalities, and socioeconomic classes and is highly controversial. The main arguments advanced to justify FGC are hygiene, fertility, the preservation of chastity, an important rite of passage, marriageability and enhanced sexual pleasure of male partners.[11] The amount of tissue removed varies considerably, leading the WHO and other bodies to classify FGC into four types. These range from the partial or total removal of the clitoris with or without the prepuce (clitoridectomy) in Type I, to the additional removal of the labia minora, with or without excision of the labia majora (Type II) to narrowing of the vaginal orifice (introitus) with the creation of a covering seal by suturing the remaining labial tissue over the urethra and introitus, with or without excision of the clitoris (infibulation). In this type a small opening is created to allow urine and menstrual blood to be discharged. Type 4 involves all other procedures, usually relatively minor alterations such as piercing.[78]

SOURCES: Elaine Turner, PhD, RD, associate professor, department of Food Science and Human Nutrition, University of Florida, Gainesville. Sharon B. Spalding, MEd, CSCS, professor, physical education and health; and associate director, Virginia Women's Institute for Leadership, Mary Baldwin College Staunton, Va. American Dietetic Association web site. Institute of Medicine at the National Academies web site.


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.[34] 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.[39] Consequently, international agencies have developed standards for obstetric care.[52]
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.
 Integrated health care  Health clinics  ↑ knowledge about FP, NC use of FP  ↑ knowledge about diabetes, ↓ incidence of diabetes, ↑ glycemic control, ↑ hypertension screening and Tx, ↓ hypertension, NC mortality (from coronary artery disease), ↓ depression, ↑/NC health care utilization, ↑ knowledge about FP, ↑/NC use of FP, ↑/NC STI screening, NC STI incidence, ↑ cervical cancer screening, ↑ mammography  ↓/NC anemia, ↑ Hgb, ↑ glycemic control, ↑ hypertension screening and Tx, ↓ hypertension, ↓ pre-eclampsia, ↓ maternal mortality, ↓/NC placental malaria, ↓ parasitemia, ↓/NC depression, NC health care utilization, ↑/NC hospital deliveries, NC cesarean delivery, ↑/↓ knowledge about FP, ↑/NC use of FP, ↑ STI screening, ↓ STI incidence, ↑ cervical cancer screening, ↑ mammography  ↑ knowledge about diabetes, ↓ diabetes, ↑ glycemic control, ↑ hypertension screening and Tx, ↓ hypertension, NC mortality (from coronary artery disease), ↑ health care utilization, ↓ depression, ↑ mammography, ↑ cervical cancer screening 
Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).
Most experts recommend 1,300 mg of calcium a day for girls aged 9 through 19. Natural sources of calcium, such as low-fat dairy products, are the smartest choice, because they also contain vitamin D and protein, both required for calcium absorption. Milk, yogurt, and cheese contribute most of the calcium in our diets. Some vegetables are also good sources, including broccoli, kale, and Chinese cabbage. Many foods are supplemented with calcium, including some brands of orange juice and tofu. The daily intake for Vitamin D is 600 IU per day for most children and healthy adults.

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.
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.
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