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.[53] 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.[39][53][54] 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.[11][55][53] The UNFPA has made prevention of OF a priority and is the lead agency in the Campaign to End Fistula, which issues annual reports[56] and the United Nations observes May 23 as the International Day to End Obstetric Fistula every year.[57] Prevention includes discouraging teenage pregnancy and child marriage, adeaquate nutrition, and access to skilled care, including caesarian section.[11]
Also known as “myofascial release,” foam rolling is an easy way to benefit your entire body. “While stretching addresses the length of muscle fiber, rolling improves the quality of the tissue,” says Rob Sulaver, CEO and founder of Bandana Training. This leads to tension- and pain-free muscles, which function better so you perform better. Be sure to roll for five minutes before your workout. Not sure what to do? Try these 10 ways to use a foam roller.
Three related targets of MDG5 were adolescent birth rate, contraceptive prevalence and unmet need for family planning (where prevalence+unmet need = total need), which were monitored by the Population Division of the UN Department of Economic and Social Affairs.[64] Contraceptive use was part of Goal 5B (universal access to reproductive health), as Indicator 5.3.[65] The evaluation of MDG5 in 2015 showed that amongst couples usage had increased worldwide from 55% to 64%. with one of the largest increases in Subsaharan Africa (13 to 28%). The corollary, unmet need, declined slightly worldwide (15 to 12%).[37] In 2015 these targets became part of SDG5 (gender equality and empowerment) under Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights, where Indicator 5.6.1 is the proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care (p. 31).[66]
Dietary fiber is found in plant foods like whole-grain breads and cereals, beans and peas, and other vegetables and fruits. At least one study suggests that women who eat high amounts of fiber (especially in cereal) may have a lower risk for heart disease. High-fiber intake is also associated with lower cholesterol, reduced cancer risk and improved bowel function. And one long-term study found that middle-aged women with a high dietary fiber intake gained less weight over time than women who ate more refined carbohydrates, like white bread and pasta.
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.
If YOU want to join other like-minded women who are supportive and encouraging, you need to consider participating in this elite group. BellaBabes is for women of all ages and physical abilities. Each participant receives individual attention and programming. Whether you are looking for a quick start to your fitness journey or are a seasoned athlete - BellaBabes will help you reach your goals faster and more effectively.
 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 
Nutrition is particularly important during pregnancy to ensure your health and the health of the baby. It's normal to gain weight during pregnancy—not just because of the growing fetus, but because you'll need stored fat for breast-feeding. The Institute of Medicine (IOM) recommends a gain of 25 to 35 pounds in women of normal weight when they get pregnant; 28 to 40 pounds in underweight women; and at least 15 pounds in women who are overweight when they get pregnant. The IOM has not given a recommendation for an upper limit for obese women, but some experts cap it as low as 13 pounds. If you fit into this category, discuss how much weight you should gain with your health care professional.
Omega-3s: These essential fatty acids, EPA and DHA, play many roles in the body, including building healthy brain and nerve cells. Some studies show that omega-3s, especially DHA, can help prevent preterm births. Even women who don't plan to have children should be sure to get plenty of omega-3s. These healthy oils have been shown to reduce the risk of heart disease, the number one killer of women.
Oils. When cooking try to use oils from plants instead of solid fats like butter, margarine, or coconut oil. See this list of oils and fats to see how healthy each type of cooking oil and solid fat is. Most women eat too much solid fat through packaged foods like chips or salad dressing, and not enough healthy fats like olive oil or the type of fat in seafood.

Women's experience of health and disease differ from those of men, due to unique biological, social and behavioural conditions. Biological differences vary all the way from phenotype to the cellular, and manifest unique risks for the development of ill health.[1] The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".[2] Women's health is an example of population health, the health of a specific defined population.[3]
For healthy bones and teeth, women need to eat a variety of calcium-rich foods every day. Calcium keeps bones strong and helps to reduce the risk for osteoporosis, a bone disease in which the bones become weak and break easily. Some calcium-rich foods include low-fat or fat-free milk, yogurt and cheese, sardines, tofu (if made with calcium sulfate) and calcium-fortified foods including juices and cereals. Adequate amounts of vitamin D also are important, and the need for both calcium and vitamin D increases as women get older. Good sources of vitamin D include fatty fish, such as salmon, eggs and fortified foods and beverages, such as some yogurts and juices.

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Anemia can deplete your energy, leaving you feeling weak, exhausted, and out of breath after even minimal physical activity. Iron deficiency can also impact your mood, causing depression-like symptoms such as irritability and difficulty concentrating. While a simple blood test can tell your doctor if you have an iron deficiency, if you’re feeling tired and cranky all the time, it’s a good idea to examine the amount of iron in your diet.
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.”
Also known as “myofascial release,” foam rolling is an easy way to benefit your entire body. “While stretching addresses the length of muscle fiber, rolling improves the quality of the tissue,” says Rob Sulaver, CEO and founder of Bandana Training. This leads to tension- and pain-free muscles, which function better so you perform better. Be sure to roll for five minutes before your workout. Not sure what to do? Try these 10 ways to use a foam roller.
Women need more of this mineral because they lose an average of 15 to 20 milligrams of iron each month during menstruation. Without enough iron, iron deficiency anemia can develop and cause symptoms that include fatigue and headaches. After menopause, body iron generally increases. Therefore, iron deficiency in women older than 50 years of age may indicate blood loss from another source and should be checked by a physician.
First off, if you suspect you have a vitamin deficiency or you fall into one of those groups, you should definitely chat with your doctor or dietitian to determine which are lacking in your diet. And like I stated earlier, if you want to be sure you getting the recommended levels of vitamins and nutrients, I recommend a multivitamin like New Chapter’s Every Woman’s One Daily Multivitamin. It’s expertly formulated for active women with nutrients for energy, stress, immune, heart and bone support*. My favorite thing about them is that they’re made with superfood herbal blends that include ginger, organic turmeric, chamomile and European elderberry. The cool thing about New Chapter’s supplements is that they’re fermented with probiotics and whole foods, so they’re gentle enough to take on an empty stomach.** They’re also Non-GMO Project Verified, gluten-free, and vegetarian, which is great for so many lifestyles.
  Community centers  ↑ MN provision, ↑ health care utilization, ↑ knowledge about FP, ↑/NC use of FP  ↑ MN provision, ↑ health care utilization, ↑ knowledge about FP, ↑/NC use of FP  ↑ knowledge about nutritional needs, ↑ MN provision, ↓/NC maternal mortality, ↓ parasitemia, ↑ health care utilization, ↑ hospital deliveries, ↑ knowledge about FP, ↑/NC use of FP, ↑ STI testing   
Folic acid: This form of B vitamin helps prevent neural tube defects, especially spina bifida and anencephaly. These defects can be devastating and fatal. Many foods are now fortified with folic acid. Most women get enough as part of their diet through foods such as leafy greens, a rich source of folic acid. However, some doctors recommend that women take a pregnancy supplement that includes folic acid, just to make sure they are getting the recommended 400 to 800 micrograms.
Something else to remember: an estimated 90 to 95 percent of dieters who lose weight regain all or part of it within five years, and the consequences can be even worse than simply being overweight. Those who exercise regularly as part of a weight loss diet and maintenance program are more likely to keep the weight off. Also note that an overly restrictive diet can lead to more overeating, a natural reaction to food deprivation.
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. 
Omega-3s: These essential fatty acids, EPA and DHA, play many roles in the body, including building healthy brain and nerve cells. Some studies show that omega-3s, especially DHA, can help prevent preterm births. Even women who don't plan to have children should be sure to get plenty of omega-3s. These healthy oils have been shown to reduce the risk of heart disease, the number one killer of women.
Omega-3s: These essential fatty acids, EPA and DHA, play many roles in the body, including building healthy brain and nerve cells. Some studies show that omega-3s, especially DHA, can help prevent preterm births. Even women who don't plan to have children should be sure to get plenty of omega-3s. These healthy oils have been shown to reduce the risk of heart disease, the number one killer of women.

A number of health and medical research advocates, such as the Society for Women's Health Research in the United States, support this broader definition, rather than merely issues specific to human female anatomy to include areas where biological sex differences between women and men exist. Women also need health care more and access the health care system more than do men. While part of this is due to their reproductive and sexual health needs, they also have more chronic non-reproductive health issues such as cardiovascular disease, cancer, mental illness, diabetes and osteoporosis.[7] Another important perspective is realising that events across the entire life cycle (or life-course), from in utero to aging effect the growth, development and health of women. The life-course perspective is one of the key strategies of the World Health Organization.[8][9][10]
Health care experts haven't reached a consensus on the issue of vitamin and mineral supplements. Many say that if you are healthy and eat a well-balanced diet, you don't need any. But not all of us eat a well-balanced diet. And sometimes, you may follow a nutritious diet and still be deficient. Many women fail to get the adequate amount of vitamins and minerals. Stress increases your need for vitamins and minerals, especially C, B-complex and zinc.
While the rates of the leading causes of death, cardiovascular disease, cancer and lung disease, are similar in women and men, women have different experiences. Lung cancer has overtaken all other types of cancer as the leading cause of cancer death in women, followed by breast cancer, colorectal, ovarian, uterine and cervical cancers. While smoking is the major cause of lung cancer, amongst nonsmoking women the risk of developing cancer is three times greater than amongst nonsmoking men. Despite this, breast cancer remains the commonest cancer in women in developed countries, and is one of the more important chronic diseases of women, while cervical cancer remains one of the commonest cancers in developing countries, associated with human papilloma virus (HPV), an important sexually transmitted disease. HPV vaccine together with screening offers the promise of controlling these diseases. Other important health issues for women include cardiovascular disease, depression, dementia, osteoporosis and anemia. A major impediment to advancing women's health has been their underrepresentation in research studies, an inequity being addressed in the United States and other western nations by the establishment of centers of excellence in women's health research and large scale clinical trials such as the Women's Health Initiative.
In that way it differs from Title Nine, an athletic clothing line that favors “real people” as models, and boasts on its website that its photo shoots are “on-the-fly” affairs with “no makeup kits.” However, all these real people are incredibly fit, and list things like “19 days rafting in the Grand Canyon” under “last adventure” and “first Boston Marathon qualification” under “next proudest accomplishment.”
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]
All of the identified studies focused on LNSs for pregnant and lactating women through antenatal care–based and –affiliated delivery platforms (97–101). These studies relied on antenatal care to recruit mothers but delivered the intervention through home visits. There was no evidence evaluating use of LNSs for women who were not pregnant or lactating. The majority of studies evaluating LNS interventions involved children with severe or moderate acute malnutrition. Although LNS supplementation could be an intervention to provide essential nutrients to women and girls, it is expensive. Filling energy gaps using local foods or other commodities can often be done at a lower cost (97). LNS supplementation should be limited to contexts in which cheaper, more sustainable solutions are not available.

Women, as we age, are also more susceptible to the breakdown of our bones, which may result in osteoporosis over time. Genetically, women have a particularly high risk of osteoporosis compared to men, so it’s recommended that women monitor their calcium intake to be sure they’re getting enough. Weight training is another great way (and my favorite!) to build bone density, which is another great reason you should hit the weights!


By contrast, ovarian cancer, the leading cause of reproductive organ cancer deaths, and the fifth commonest cause of cancer deaths in women in the United States, lacks an effective screening programme, and is predominantly a disease of women in industrialised countries. Because it is largely asymptomatic in its earliest stages, more than 50% of women have stage III or higher cancer (spread beyond the ovaries) by the time they are diagnosed, with a consequent poor prognosis.[121][6]
Women's menstrual cycles, the approximately monthly cycle of changes in the reproductive system, can pose significant challenges for women in their reproductive years (the early teens to about 50 years of age). These include the physiological changes that can effect physical and mental health, symptoms of ovulation and the regular shedding of the inner lining of the uterus (endometrium) accompanied by vaginal bleeding (menses or menstruation). The onset of menstruation (menarche) may be alarming to unprepared girls and mistaken for illness. Menstruation can place undue burdens on women in terms of their ability to participate in activities, and access to menstrual aids such as tampons and "sanitary pads". This is particularly acute amongst poorer socioeconomic groups where they may represent a financial burden and in developing countries where menstruation can be an impediment to a girl's education.[113]
Something else to remember: an estimated 90 to 95 percent of dieters who lose weight regain all or part of it within five years, and the consequences can be even worse than simply being overweight. Those who exercise regularly as part of a weight loss diet and maintenance program are more likely to keep the weight off. Also note that an overly restrictive diet can lead to more overeating, a natural reaction to food deprivation.
Although canola oil appears to be good for the cardiovascular system, two Harvard studies have raised concerns that ALA might be bad for the prostate. In 1993, the Health Professionals Follow-up Study of 47,781 men published a major evaluation of dietary fat and prostate cancer. It found that saturated fat from animal sources such as red meat and whole-fat dairy products was linked to a 2.6-fold increase in prostate cancer. But the study also provided some disquieting news about ALA: Men who consumed the most ALA were 3.4 times more likely to be diagnosed with prostate cancer than those who had the lowest dietary intake.
 	Community centers 	↑ MN provision, ↑ health care utilization, ↑ knowledge about FP, ↑/NC use of FP 	↑ MN provision, ↑ health care utilization, ↑ knowledge about FP, ↑/NC use of FP 	↑ knowledge about nutritional needs, ↑ MN provision, ↓/NC maternal mortality, ↓ parasitemia, ↑ health care utilization, ↑ hospital deliveries, ↑ knowledge about FP, ↑/NC use of FP, ↑ STI testing 	 

The location is convenient, right in the middle of downtown so that was a plus for me as it's right on the way home. I came in and the person who signed me in (who also happened to be the instructor that led the bodyshred class) welcomed me and gave me a form to sign. She told me where the class was going to be held and what equipment I would need. She was super friendly and made me feel at home. The locker area was dingy, but I'm not the kind of person that changes at the gym, I always come in with my workout gear on, so that kind of amenities is more of a nice to have than anything.

Omega-3s: These essential fatty acids, EPA and DHA, play many roles in the body, including building healthy brain and nerve cells. Some studies show that omega-3s, especially DHA, can help prevent preterm births. Even women who don't plan to have children should be sure to get plenty of omega-3s. These healthy oils have been shown to reduce the risk of heart disease, the number one killer of women.


  Home visits  ↓ anemia, ↑ Hgb, ↑ food consumption, ↑ weight gain (underweight adolescents), NC mortality, ↓ fatigue  ↓ anemia, ↑ serum folate, ↑ serum B-12, NC mortality, NC depression  ↓ anemia, ↑ MN status (Hgb, ferritin, folate, B-12, zinc, riboflavin), ↑/NC serum retinol, ↓/NC night blindness, ↑ weight gain, NC maternal mortality, NC depression   
WHO (1948). "WHO definition of Health". Archived from the original (Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.) on 7 July 2016. Retrieved 6 July 2016., in WHO (2016)
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.

Studies link high sodium intake to higher blood pressure, and evidence suggests that many people at risk for high blood pressure can reduce their risk by consuming less salt or sodium, as well as following a healthy diet. Most Americans consume more sodium than they need. The recommended amount is less than 2,300 mg per day for children and adults to age 50. The limit drops to 1,500 mg per day for those 51 and older or those of any age who are African American or have hypertension, diabetes or chronic kidney disease. You get 2,300 mg in just one teaspoon of salt. One good way to reduce your sodium intake is to eat fewer prepared and packaged foods.

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.[11] 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.[41] 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.[39] New guidelines on antenatal care were issued by WHO in November 2016.[51]
For this comprehensive narrative review, we evaluated both nutrition-specific and nutrition-sensitive interventions. Nutrition-specific approaches are those that address the immediate determinants of nutrition (e.g., food and nutrient intake, diet-related practices and behaviors, disease, etc.), whereas nutrition-sensitive approaches are those that address the underlying determinants of nutrition (e.g., food security, access to resources, safe and hygienic environments, adequate health services, etc.) (5, 12). We evaluated the following nutrition-specific interventions described by Bhutta et al. (13, 14): nutrition counseling and education, micronutrient supplementation and fortification, protein and energy supplementation, and lipid-based supplementation. We also included the following nutrition-sensitive approaches described by Ruel and Alderman (5) and Bhutta et al. (14): health care; family planning; water, sanitation, and hygiene (WASH); empowerment; income-generation; education; and social protection. For each intervention, we 1) described the scale and coverage of the intervention, when available; 2) summarized the evidence of effectiveness for women's health and nutrition outcomes; and 3) described and evaluated the target population and delivery platforms, as described in the published articles and as summarized in Table 1. The delivery of interventions included the physical platforms, as well as the adherence and the implementation challenges of the different interventions.

WASH interventions, such as toilet facilities, access to improved and safe water supply, and hand washing are associated with improved nutrition and health of entire communities (13, 14, 125–128). For women and adolescent girls, WASH interventions were associated with improved menstrual hygiene (126), reduced diarrhea and intestinal worm infections (128–131), and reduced maternal mortality (132). Women and young girls are also more affected by the physical and time burdens of collecting water (126), and harassment and violence associated with inadequate and unsafe toilet facilities (133, 134). Closer water points and sanitation facilities eased these gendered burdens (126, 135). WASH interventions and perceived water availability were associated with less time spent on water-related chores, and improved school attendance, women's empowerment, and self-esteem (126, 135, 136).
Diseases such as chlamydia and gonorrhoea are also important causes of pelvic inflammatory disease (PID) and subsequent infertility in women. Another important consequence of some STIs such as genital herpes and syphilis increase the risk of acquiring HIV by three-fold, and can also influence its transmission progression.[75] Worldwide, women and girls are at greater risk of HIV/AIDS. STIs are in turn associated with unsafe sexual activity that is often unconsensual.[74]

Health care experts haven't reached a consensus on the issue of vitamin and mineral supplements. Many say that if you are healthy and eat a well-balanced diet, you don't need any. But not all of us eat a well-balanced diet. And sometimes, you may follow a nutritious diet and still be deficient. Many women fail to get the adequate amount of vitamins and minerals. Stress increases your need for vitamins and minerals, especially C, B-complex and zinc.
As the science of nutrition continually evolves, researchers recognize that nutrients needed to maintain a healthy lifestyle must be tailored to the individual for maximum effectiveness. Recognizing that people are not all alike and that one size does not fit all when it comes to planning and achieving a healthful diet, the Institute of Medicine's dietary guidelines, titled "Dietary Reference Intakes for Macronutrients," stress the importance of balancing diet with exercise and recommends total calories based on an individual's height, weight and gender for each of four different levels of physical activity.
I also took a Zumba with Sarah. I didn't like this class as much, unfortunately. I was excited to try it because I love incorporating dance into a workout. She knew what she was doing and looked great doing it but there was little to no instruction. She didn't really teach, she just did her thing and everyone was to follow. Sarah is filled with energy and I really loved her attitude but the lack of guidance overshadowed it for me.
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).
Iron helps to create the hemoglobin that carries oxygen in your blood. It’s also important to maintaining healthy skin, hair, and nails. Due to the amount of blood lost during menstruation, women of childbearing age need more than twice the amount of iron that men do—even more during pregnancy and breastfeeding. However, many of us aren’t getting nearly enough iron in our diets, making iron deficiency anemia the most common deficiency in women.
Our findings identified gaps and limitations in the evaluation, scope, targeting, and delivery platforms of nutrition interventions in low- and middle-income countries. First, the monitoring and evaluation of nutrition programs that reported on women's nutrition outcomes was generally inadequate. Many of the studies we identified included small-scale efficacy trials. Although there were many large-scale programs that targeted women and adolescent girls with nutrition-specific and nutrition-sensitive approaches, they lacked rigorous evaluation. Whether the evidence about women's outcomes was limited because they are not systematically measured or because they are not well reported is not clear. Negative results are often not published, and many evaluations of nutrition interventions that are conducted by the same groups responsible for implementing them are typically presented positively. This may have also skewed our findings. More intentional research-quality program evaluation, including of large-scale programs, would provide a stronger evidence base. Of the studies identified in this review, many reported on short-term findings such as changes in knowledge, dietary behaviors, and program coverage. They were limited in their ability to report clinical and anthropometric outcomes for women, the duration of those outcomes, and the feasibility of scaling up programs. There is also a need for systematic, long-term evaluations of interventions whose effects on nutrition outcomes are more distal (e.g., nutrition education compared with micronutrient supplementation). The effects of multisectoral interventions are even more complex to measure. However, frameworks exist to evaluate complex interventions (102) and could be utilized to evaluate the impact of interventions across the life course.
In our review, we found that fortification interventions that provided fortified foods reached women of all life stages through home visits, community distribution centers, local markets, and retail stores. Delivery of fortified foods in school-based programs, at work, and in maternal–child health centers were also used to target school-age children, women of reproductive age, and pregnant and lactating women that were engaged with those facilities (37, 72–74, 84). There was mixed evidence that consumption of fortified foods reached all socioeconomic groups. Some studies showed differences in consumption between nonpoor and extremely poor, and between urban and rural stakeholders (33, 64, 85). Women who have restricted access to markets, depend largely on locally grown foods, are in areas with underdeveloped distribution channels, or have limited purchasing power, might have limited access to fortified foods (64). Additional research is needed to address implementation gaps and to determine the best platforms for reaching high-risk populations.
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