Improvements in maternal health, in addition to professional assistance at delivery, will require routine antenatal care, basic emergency obstetric care, including the availability of antibiotics, oxytocics, anticonvulsants, the ability to manually remove a retained placenta, perform instrumented deliveries, and postpartum care. Research has shown the most effective programmes are those focussing on patient and community education, prenatal care, emergency obstetrics (including access to cesarean sections) and transportation. As with women's health in general, solutions to maternal health require a broad view encompassing many of the other MDG goals, such as poverty and status, and given that most deaths occur in the immediate intrapartum period, it has been recommended that intrapartum care (delivery) be a core strategy. New guidelines on antenatal care were issued by WHO in November 2016.
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.
If you thought texting changed your love life, imagine what it could do for your waistline. When people received motivational text messages promoting exercise and healthy behaviors twice a week (i.e., “Keep in the fridge a Ziploc with washed and precut vegetables 4 quick snack. Add 1 string cheese 4 proteins”), they lost an average of about 3 percent of their body weight in 12 weeks. Participants in the Virginia Commonwealth University study also showed an improvement in eating behaviors, exercise, and nutrition self-efficacy, and reported that the texts helped them adopt these new habits. Find health-minded friends and message each other reminders, or program your phone to send yourself healthy eating tips.
Obviously, the best treatment plan for poor nutrition is to change your diet. Most Americans eat too little of what they need and too much of that they don't. For many women, decreasing fat and sugar consumption and increasing fruit, vegetables and grains in your diet can make a big difference. Many women also need to boost consumption of foods containing fiber, calcium and folic acid. Compare your diet to that suggested by the food pyramid and compare your nutrient intake to the suggested daily levels. Adjust accordingly, and you may be able to dramatically improve your health.
Adopting a plant-based diet could help tip the scales in your favor. A five-year study of 71,751 adults published in the Journal of the Academy of Nutrition and Dietetics found that vegetarians tend to be slimmer than meat-eaters even though both groups eat about the same number of calories daily. Researchers say it may be because carnivores consume more fatty acids and fewer weight-loss promoting nutrients, like fiber, than herbivores do. Go green to find out if it works for you.
It takes a lot of discipline to turn down a cupcake or roll out of your warm bed for a cold morning run. To make staying on track easier, it's important to make a real connection with your motivation, says Tara Gidus, R.D., co-host of Emotional Mojo. So think less about fitting into your skinny jeans or spring break bikini and more about emotional ties to the people you love. “Your relationships will grow stronger when you are physically healthy and taking care of yourself,” she says.
Iron: Essential for healthy blood cells, iron becomes especially important when girls begin to menstruate. With each period, a woman loses small amounts of iron. “About 10% of American women are iron deficient,” says Dorothy Klimis-Zacas, PhD, a professor of nutrition at the University of Maine and co-editor of Nutritional Concerns of Women (CRC Press, 2003). “About 5% have iron deficiency anemia.” Symptoms of low iron include fatigue, impaired immunity, and poor performance at school or work.
Family planning and birth spacing can influence the nutrition of adolescent girls, women of reproductive age, and women with young children by reducing the number of adverse outcomes associated with pregnancy and abortion. For adolescent girls, in particular, pregnancy is associated with increased risk of birth complications, anemia, hindered linear growth, and loss of educational attainment (8, 107). Delaying early child marriages and providing access to family planning, particularly for young wives, allow girls to achieve their maximum growth potential (8, 142). However, for women with young children, there was scarce evidence from observational studies to suggest that greater birth spacing had any impact on anthropometric status (BMI, weight), micronutrient status (anemia, as well as serum zinc, copper, magnesium, and folate), and maternal mortality outcomes (13, 107, 143–147). Findings were mixed, which was attributed to sample size and other confounding factors such as maternal age, breastfeeding status, and supplementation status (146, 147). The strongest evidence of the impact of birth spacing on women's nutrition was related to increased risk of preterm delivery and maternal anemia in interpregnancy intervals <6 mo (14, 146, 147) and increased risk of pre-eclampsia in intervals >5 y (107).
B12: Like folic acid, B12 is essential for healthy nervous system development and function. Pregnant women who are vegans or vegetarians may fall short on B12, since it is present in animal protein and to a lesser extent in dairy. Teenage and adult women need 2.4 mcg. Recommended levels rise to 2.6 mcg for pregnant women and 2.8 mcg for lactating women.
Social protection programs typically target the most marginalized members of communities and typically families with children (5, 196). Cash transfers are often targeted to women in these households because they more often invest the transfers in household and food expenditures than men do (192, 202, 204, 205). Cash transfer programs were also targeted to older adults through government-coordinated programs (196, 198, 206). The delivery of transfers involved community centers (town halls, post offices) and banks, as well as locations associated with other services, e.g., schools or health centers (192, 206, 207). These latter platforms were relevant not only for the distribution of social protection programs (i.e., the receipt of transfers), but also for enrollment in and “conditions” of those programs. Conditional transfers required that recipients had access to certain delivery platforms (e.g., schools and health centers) in order to meet the “conditions” of their transfer, and this was a limitation in very rural areas. Although social protection programs are intended for the most vulnerable populations, their delivery platforms can serve as barriers to individuals’ receipt of services, particularly if they require engagement with health care, school, or work-related systems.
There has been an international effort to reduce this practice, and in many countries eighteen is the legal age of marriage. Organizations with campaigns to end child marriage include the United Nations and its agencies, such as the Office of the High Commissioner for Human Rights, UNFPA, UNICEF and WHO. Like many global issues affecting women's health, poverty and gender inequality are root causes, and any campaign to change cultural attitudes has to address these. Child marriage is the subject of international conventions and agreements such as The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW, 1979) (article 16) and the Universal Declaration of Human Rights and in 2014 a summit conference (Girl Summit) co-hosted by UNICEF and the UK was held in London (see illustration) to address this issue together with FGM/C. Later that same year the General Assembly of the United Nations passed a resolution, which inter alia
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.).