However, many fortification programs in low- and middle-income countries are regional or voluntary and, thus, might have a limited nutritional impact at the national level (76). Although many efficacy trials show benefits of fortification interventions, scaling up fortification is limited by inadequate coverage and resources (13, 77, 78). Evidence for impact is also affected by suboptimal programming, low-bioavailability fortificants (e.g., reduced iron powder), poor consumption rates, weak enforcement mechanisms, and inadequate monitoring (76, 79, 80). More research is needed to evaluate the long-term impact of fortification and biofortification programs (75). In addition, there is also growing concern about fortifying and promoting food vehicles that have adverse health consequences when consumed in excess, such as salt and sugar, given the rising prevalence of overweight, obesity, and noncommunicable disease (81–83).
Gender differences in susceptibility and symptoms of disease and response to treatment in many areas of health are particularly true when viewed from a global perspective. Much of the available information comes from developed countries, yet there are marked differences between developed and developing countries in terms of women's roles and health. The global viewpoint is defined as the "area for study, research and practice that places a priority on improving health and achieving health equity for all people worldwide". In 2015 the World Health Organization identified the top ten issues in women's health as being cancer, reproductive health, maternal health, human immunodeficiency virus (HIV), sexually transmitted infections, violence, mental health, non communicable diseases, youth and aging.
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.
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.
Women have also been the subject of abuse in health care research, such as the situation revealed in the Cartwright Inquiry in New Zealand (1988), in which research by two feminist journalists revealed that women with cervical abnormalities were not receiving treatment, as part of an experiment. The women were not told of the abnormalities and several later died.
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).
Getting enough water also is important. Many experts recommend at least eight 8-ounce glasses of water daily—more if you exercise frequently or are exposed to extremes of heat and cold. The 2010 Dietary Guidelines for Americans emphasize drinking more water and other calorie-free beverages, along with fat-free or low-fat milk and 100 percent fruit juices, instead of calorie-packed regular sodas.