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.
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.
The delivery platforms of birth spacing and family planning interventions were often associated with health clinics and community health posts (148–150). Many interventions targeted lactating women during the follow-up with their young children (148, 151–153). Home visits by community health workers and service provision at community health posts and mobile clinics were also used to target women and adolescents who were married, and were found to be effective at increasing use of contraception (150, 154). School-based programs were also effective at reaching adolescent girls and increased their knowledge about contraceptives and sexually transmitted infections, use of contraception, and treatment of sexually transmitted infections (155). In high-income settings, school-based interventions were most effective at reducing pregnancies and repeated pregnancies among adolescents when contraception was also available on-site (107). This might have implications for their effectiveness in low- and middle-income countries, as well. In addition, formative work of 2 ongoing studies suggested that mass media, mobile devices, texting, and community mobilization could also be used as platforms to reach adolescent girls and women of reproductive age (156, 157). Community-based programs that target men, families, and communities, beyond those that reach married and postpartum women alone, have potential to change cultural norms and enhance women's health outcomes; however, these are not well captured in the literature.
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Our review highlighted how a focus on delivery platforms could indicate who is missed by different nutrition interventions, by evaluating where there is overlap or divergence in where interventions are delivered (as represented in the Venn diagram in Figure 1). Our findings showed that a large proportion of nutrition-specific interventions were delivered at clinic-based settings or community-based health posts. Health centers are important delivery platforms, particularly for pregnant and lactating women (113, 210). However, only half of women worldwide even attend the appropriate number of antenatal care visits (with nearly 86% of women attending 1 visit) and only 59% receive appropriate postnatal care (211). Other delivery platforms, such as schools and universities, were more effective at reaching some adolescents and women of reproductive age. However, interventions delivered at “facilities” (schools, health clinics, health posts) require participation with those facilities, and participation is often limited because of time, costs, distance, and other responsibilities, including work and childcare (116). Facilities-based care is also more likely to miss certain groups, including older women.
To help you learn how to eat healthfully, start with the U.S. Department of Agriculture's (USDA) dietary guidelines system, which you can find at http://www.mypyramid.gov. The MyPyramid system, which looks somewhat like the familiar food pyramid of old, offers guidance based on individual needs and replaces "serving" recommendations with actual amounts of food. It also emphasizes the importance of balancing nutritious (and tasty!) food choices from all food groups every day with daily physical activity.
“Whole grains help with digestion and are excellent for your heart, regularity [because of the fiber content], and maintaining a steady level of blood sugar,” says Hincman. “They are also a great source of energy to power you throughout the day.” Whole grains, such as oats, also help improve cholesterol levels. While food manufacturers are adding fiber to all sorts of products, whole grains, like whole wheat, rye, and bran, need to be the first ingredient on the food label of packaged foods, she stresses. Watch your serving sizes, however. Current guidelines are for six one-ounce equivalent servings per day (five if you’re over 50). One ounce of whole-wheat pasta (weighed before cooking) is only one-half cup cooked.
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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.
Women and men have approximately equal risk of dying from cancer, which accounts for about a quarter of all deaths, and is the second leading cause of death. However the relative incidence of different cancers varies between women and men. In the United States the three commonest types of cancer of women in 2012 were lung, breast and colorectal cancers. In addition other important cancers in women, in order of importance, are ovarian, uterine (including endometrial and cervical cancers (Gronowski and Schindler, Table III). Similar figures were reported in 2016. While cancer death rates rose rapidly during the twentieth century, the increase was less and later in women due to differences in smoking rates. More recently cancer death rates have started to decline as the use of tobacco becomes less common. Between 1991 and 2012, the death rate in women declined by 19% (less than in men). In the early twentieth century death from uterine (uterine body and cervix) cancers was the leading cause of cancer death in women, who had a higher cancer mortality than men. From the 1930s onwards, uterine cancer deaths declined, primarily due to lower death rates from cervical cancer following the availability of the Papanicolaou (Pap) screening test. This resulted in an overall reduction of cancer deaths in women between the 1940s and 1970s, when rising rates of lung cancer led to an overall increase. By the 1950s the decline in uterine cancer left breast cancer as the leading cause of cancer death till it was overtaken by lung cancer in the 1980s. All three cancers (lung, breast, uterus) are now declining in cancer death rates (Siegel et al. Figure 8), but more women die from lung cancer every year than from breast, ovarian, and uterine cancers combined. Overall about 20% of people found to have lung cancer are never smokers, yet amongst nonsmoking women the risk of developing lung cancer is three times greater than amongst men who never smoked.
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.
Poor nutrition may be one of the easiest conditions to self-diagnose. Look at the food pyramid and the suggested servings. Look at your diet. Are you getting the recommended daily amounts of fruits and vegetables? Enough calcium? Read the labels and compare what you eat to what you need. You may discover that even if your weight is ideal, you are not getting enough nutrition.
There were also supplementation programs that targeted nonpregnant women. National supplementation programs that provided food baskets to low-income families increased maternal BMI and improved household food insecurity (92, 93). However, there were some unintended consequences. In Mexico, food transfer programs disproportionately increased weight gain in overweight women compared with underweight women (93), and 1 study in Bangladesh found that food transfers had larger impacts on men's intake than women's intake, except with less preferred foods (94). Adolescents who received protein-energy supplementation at school showed an increase in weight gain during supplementation, as well as improvements in school attendance and mathematics scores (46, 95). However, the impact of supplementation on micronutrient deficiencies and, specifically, hemoglobin concentration, was limited (46).
Weighing yourself too often can cause you to obsess over every pound. Penner recommends stepping on the scale or putting on a pair of well-fitting (i.e. not a size too small) pants once a week. “Both can be used as an early warning system for preventing weight gain, and the pants may be a better way to gauge if those workouts are helping you tone up and slim down.” [Tweet this tip!]
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
If you usually head to the gym after work, take heed: Mental exhaustion can make you feel physically exhausted, even when you have plenty of energy, reports a Medicine & Science in Sports & Exercise study. When people played a brain-draining computer game before exercising, they reported a subsequent workout as being harder, yet their muscles showed the same activity as they did doing the same workout after an easy mental game. So if you think you can’t eke out those last 10 minutes on the rowing machine, remember: You can! [Tweet this motivation!]
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.