The U.S. Department of Health and Human Services declared last week National Women’s Health Week (May 14-20th), but in reality we should be taking care of ourselves and have this awareness all year round, right? To kick this month off inspired by women’s health, let’s talk about health, nutrition, and of course answer your questions from Instagram, Twitter, and email from over this year!
UN Women believe that violence against women "is rooted in gender-based discrimination and social norms and gender stereotypes that perpetuate such violence", and advocate moving from supporting victims to prevention, through addressing root and structural causes. They recommend programmes that start early in life and are directed towards both genders to promote respect and equality, an area often overlooked in public policy. This strategy, which involves broad educational and cultural change, also involves implementing the recommendations of the 57th session of the UN Commission on the Status of Women (2013). To that end the 2014 UN International Day of the Girl Child was dedicated to ending the cycle of violence. In 2016, the World Health Assembly also adopted a plan of action to combat violence against women, globally.
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Micronutrient supplementation programs for vitamin A, iron and folic acid, calcium, zinc, and multiple micronutrients effectively impacted the micronutrient status of pregnant and lactating women, as well as women of reproductive age and adolescent girls (13, 14, 33, 35–48). Interventions making use of multiple micronutrients were more effective at changing plasma micronutrient concentrations than interventions focused solely on 1 nutrient alone (38, 42). In countries with comprehensive programs for iron supplementation during pregnancy, anemia prevalence dropped (1, 49). Positive health impacts of supplementation were most notable among pregnant women who were deficient and at risk of low intake (43, 50). However, there were some studies that showed inconsistent or limited evidence for the effectiveness of supplementation on other maternal health outcomes (31, 51–58).
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.).
Second, the scope of nutrition-specific and nutrition-sensitive approaches was largely focused on undernutrition. There were major research and programming gaps in studies targeting overweight, obesity, and noncommunicable disease. In our review, the interventions addressing overweight, obesity, and noncommunicable disease were limited to nutrition education and integrated healthcare. However, overweight and obesity were identified as potential concerns for interventions targeting undernutrition, including food supplementation, and in-kind and cash transfers. This might be a result of the types of interventions that were evaluated, but also speaks to the need to broaden the scope of nutrition interventions that are commonly assessed (5, 13, 14) to explicitly address overweight, obesity, and noncommunicable disease as nutrition outcomes, and not just as unintended consequences. Globally, there is limited evidence of large-scale interventions that effectively prevent, treat, or correctly classify adiposity-related noncommunicable diseases, and this is a growing area of concern around the world (208). Future evaluations of nutrition interventions might also include interventions that influence women's time and physical environment, and that encourage physical activity or change in access to and affordability of certain foods, as these might also influence overweight, obesity, and noncommunicable disease outcomes for women.
There remain significant barriers to accessing contraception for many women in both developing and developed regions. These include legislative, administrative, cultural, religious and economic barriers in addition to those dealing with access to and quality of health services. Much of the attention has been focussd on preventing adolescent pregnancy. The Overseas Development Institute (ODI) has identified a number of key barriers, on both the supply and demand side, including internalising socio-cultural values, pressure from family members, and cognitive barriers (lack of knowledge), which need addressing. Even in developed regions many women, particularly those who are disadvantaged, may face substantial difficulties in access that may be financial and geographic but may also face religious and political discrimination. Women have also mounted campaigns against potentially dangerous forms of contraception such as defective intrauterine devices (IUD)s, particularly the Dalkon Shield.
Vitamin D: Over the past decade, dozens of studies have revealed many important roles for vitamin D, the nutrient that skin cells produce when they are exposed to sunlight. The recommended daily intake of Vitamin D is 600 IU per day, although recommended levels are under review. If you avoid the sun or live in the northern half of the U.S., ask your doctor whether your vitamin D level should be tested.
What's a man to do? Fortunately, he does not have to choose between his bones and his prostate. The solution is moderation. The Baltimore Longitudinal Study of Aging, for example, found no link between a moderate consumption of calcium (about 800 mg a day, two-thirds of the RDA) and prostate cancer. In addition, a randomized clinical trial of calcium supplements of 1,200 mg a day found no effect on the prostate, but only 327 men were in the calcium group, and the supplementation lasted just four years. Finally, the Harvard scientists speculate that a high consumption of vitamin D may offset the possible risks of calcium, so a daily multivitamin may also help.
Sleeping seven to nine hours a night for five days straight may stave off bags under your eyes as well as saddlebags on your thighs. When women get enough sleep, they don’t take in extra, unnecessary calories to stay awake, according to a study published in the Proceedings of the National Academy of Sciences. Read: Adequate beauty rest can help you pass up pick-me-up snacks and head off added pounds.
The extent to which interventions target women more generally, as opposed to just mothers, is not well documented. It requires reflecting on “Who is the woman in women's nutrition?” to identify which women are actually targeted in nutrition interventions, which are not, how they are reached, and gaps in policies and interventions to reach women who are missed. To address this, in this comprehensive narrative review, we 1) summarize existing knowledge about interventions targeting women's health and nutrition in low- and middle-income countries, 2) identify gaps in current delivery platforms that are intended to reach women and address their health and nutrition, and 3) determine strategies to reshape policies and programs to reach all women, at all stages of their lives, with a particular focus on women in low- and middle-income countries.
Infrastructure ↓ water point distance, ↑ time savings, ↑/NC women's hygiene, ↑/NC water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence, ↑ school attendance, NC wage employment ↓ water point distance, ↑ time savings, ↑/NC women's hygiene, ↑/NC water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence, NC wage employment, ↑ participation in income-generating activities ↓ maternal mortality, ↓ water point distance, ↑ time savings, ↑/NC women's hygiene, ↑/NC water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence, NC wage employment, ↑ participation in income-generating activities ↓ water point distance, ↑ time savings, ↑/NC women's hygiene, ↑/NC water quality, ↓/NC diarrheal morbidity, ↓ intestinal parasite prevalence, NC wage employment, ↑ participation in income-generating activities
We only included studies that reported on women's health and nutrition outcomes, and excluded studies that were targeted to women but that reported only on health and nutrition outcomes of children (including birth outcomes). We included outcomes for adolescent girls ages 10–19 y, pregnant and lactating women, nonpregnant and nonlactating women of reproductive age (>19 y), and older women. Studies that described interventions targeting a wider age range of adolescent girls (e.g., ages 8–24 y) were also included but adolescent girls aged >19 y were reported in this review as nonpregnant and nonlactating women of reproductive age. Although many adolescents in low- and middle-income countries are married and bearing children, adolescents (10–19 y) as reported in this review reflect girls who are nonpregnant and nonlactating. The few interventions in low- and middle-income countries that target pregnant and lactating adolescents are reported under pregnant and lactating women. A description of the articles included in this review can be found in Supplemental Table 1.
Globally, cervical cancer is the fourth commonest cancer amongst women, particularly those of lower socioeconomic status. Women in this group have reduced access to health care, high rates of child and forced marriage, parity, polygamy and exposure to STIs from multiple sexual contacts of male partners. All of these factors place them at higher risk. In developing countries, cervical cancer accounts for 12% of cancer cases amongst women and is the second leading cause of death, where about 85% of the global burden of over 500,000 cases and 250,000 deaths from this disease occurred in 2012. The highest incidence occurs in Eastern Africa, where with Middle Africa, cervical cancer is the commonest cancer in women. The case fatality rate of 52% is also higher in developing countries than in developed countries (43%), and the mortality rate varies by 18-fold between regions of the world.
Community centers (including banks, town halls, post offices) ↑ knowledge about health and nutrition, ↑ food expenditures, ↑/NC food share, ↑ HH food consumption, ↑ dietary diversity, ↑ intake of MN (except for heme-Fe), ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets, ↑ weight gain (greater among high BMI), ↑ participation in social networks, ↑ self-confidence, ↑ control over resources ↑ knowledge about health and nutrition, ↑ HH food security, ↑ food expenditures, ↑/NC food share, ↑ HH food consumption, ↑ dietary diversity, ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets, ↑ participation in social networks, ↑ self-confidence, ↑ control over resources, ↑ ANC coverage ↑ knowledge about health, NC hypertension, ↓/NC missed meals, NC food sufficiency, ↑ health care utilization
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. 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.
Fourth and finally, there was a general lack of focus on the relevant delivery platforms for nutrition interventions. Many studies were not explicit about how and where interventions were delivered, and we had to cross-reference multiple sources to identify the delivery platform for many interventions. Delivery platforms are important and relevant information in terms of replicability, but also for identifying who is effectively reached and missed. Information about delivery platforms is also instrumental in understanding gaps in implementation. A greater emphasis on delivery platforms could enhance the reach of nutrition interventions and could also strengthen the capacity to mobilize resources more effectively. For instance, organizing and grouping interventions by delivery platform (e.g., antenatal care, community centers, schools, clinics) or by the relevant stakeholders required for delivery (e.g., ministries, health care providers, teachers, administrators, transporters, etc.) could have the potential to more efficiently deliver nutrition interventions.
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.
The U.S. Public Health Service recommends that all women of childbearing age consume 400 mcg of folic acid (a B vitamin) daily to reduce their risk of having a pregnancy affected with spina bifida or other neural-tube defects. Women who are actively trying to get pregnant should consume 600 mcg, and lactating women should consumer 500 mcg. Women of childbearing age should also take care to meet the daily requirements for calcium, fiber, iron, protein and vitamin D. Discuss supplements with a health care professional, however. Iron and vitamin D in particular can be dangerous in high amounts.
Women who have very low levels of sunlight exposure or have naturally very dark skin are at risk of vitamin D deficiency. Those affected may include women who cover most of their body when outdoors, shift workers, those who are unable to regularly get out of their house or women in residential care. Women who have certain medical conditions or are on some medications may also be affected.
Gahagan, Jacqueline (15 August 2016). "Commentary on the new sex and gender editorial policy of the Canadian Journal of Public Health". Canadian Journal of Public Health. 107 (2): e140–1. doi:10.17269/cjph.107.5584. PMID 27526209. Lay summary – Jon Tattrie. Canadian Journal of Public Health tells researchers to address sex, gender in trials: Research 'excluding 50 per cent of the population' isn't best return for taxpayers, says Jacqueline Gahagan. Canadian Broadcasting Corporation News: Nova Scotia (7 December 2016).
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Nutrition education interventions were often implemented in conjunction with other programs, and it was difficult to identify the effects of nutrition education alone. In addition, many studies reported on one-on-one counseling and group education, and it was not possible to differentiate the impact. The effects of nutrition education were often greater when combined with other resource-based interventions, such as micronutrient supplementation (31, 32), home gardening (28), food supplementation (33), and water provision (22). For nutrition education programs targeting mothers, those who were more educated or of higher socioeconomic status more often translated the intervention to nutritional outcomes (33). This suggests that the effectiveness of nutrition education might relate to individuals’ ability to access resources and implement information received.