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.
Not surprisingly, many integrated health services were delivered in health clinics and facilities. Many women faced barriers to health facility–based care for nutrition, such as distance, time, quality of care, stocking of supplies, and the capacity and nutrition knowledge of healthcare professionals (105, 119). These barriers need to be taken into consideration to enhance the coverage of integrated health care services. Universal health care mitigated cost barriers to seeking health care, but did not address all of the barriers noted here (105, 109, 114, 120–123).
Third, of the interventions that were evaluated, many interventions targeted women who were pregnant, lactating, or with young children <5 y of age. We do not refute the important focus on mothers and their children as a group deserving of special attention, given women's increased nutrient needs during pregnancy and lactation and the intergenerational consequences during this period. However, even the interventions that focused on maternal nutrition often only reported on birth and nutrition outcomes of the child, and not those of the mother. In addition, although there were interventions that targeted adolescent girls and women of reproductive age, they were fewer and less well evaluated than interventions that targeted women as mothers. This aligns with findings from other research which illustrated a higher proportion of programs targeting pregnant and lactating women and women with young children (209). We also found major gaps in the targeting of interventions for older women. With growing rates of overweight, obesity, and noncommunicable diseases, in addition to undernutrition and micronutrient deficiencies, it is essential to think outside of the maternal-focused paradigm to reach women at all life stages.
The tiny gender differences in minerals other than calcium and iron depend on body size. But while the dietary requirements for selenium fit this rule, men may benefit from supplements of about 200 micrograms a day, a level about four times above the RDA. That's because both a clinical trial and an observational study suggest that selenium may reduce the risk of prostate cancer. It's far from proven, but it's something for men to consider.

  Microcredit institution  NC HH food security, NC individual food security, NC food expenditures, NC food consumption, ↑ social status, ↑ self-confidence  ↑ health knowledge, NC health status, NC HH food security, NC individual food security, ↑/NC food expenditures, NC food consumption, NC school enrollment, ↑/NC empowerment, ↑ self-confidence, ↑/NC decision-making, ↑ social status, ↑/NC health care utilization  ↑ health knowledge, NC health status, ↑/NC food expenditures, NC school enrollment, ↑/NC empowerment, ↑/NC decision-making power, ↑ self-confidence, ↑/NC health care utilization  NC health status, ↑/NC food expenditures, ↑/NC empowerment, ↑/NC decision-making power, ↑ self-confidence, NC health care utilization 
 Nutrition education  Health clinics  ↑ knowledge, NC Hgb, ↑ intake of fruits and vegetables, ↓/NC intake of fats, sweets, and sugar-sweetened beverages  ↑ knowledge, NC Hgb, ↑ intake of fruits and vegetables, ↓/NC intake of fats, sweets, and sugar-sweetened beverages  ↑ knowledge, NC urinary iodine, ↑ intake of nutrient-rich foods, ↑ intake of protein, ↑ weight gain, ↑/NC weight loss postpartum (obese women) with diet and exercise   
Fluids: Fluid needs increase as women age. The reason: Kidneys become less efficient at removing toxins. “Drinking more fluids helps kidneys do their job,” Schwartz says. “Unfortunately, thirst signals often become impaired with age, so people are less likely to drink enough water and other fluids.” Rather than fret about how many glasses to drink, Frechman says, check the color of your urine. "It should be clear or very pale colored. If it becomes darker, you need more fluid.” 

Complementing income-generating interventions with interventions that more directly target women's nutrition has potential to have greater impacts on women's nutritional status (171). Integrated interventions were associated with improvements in health knowledge and behaviors, as well as increased intake of nutrient-rich foods (5, 164, 169, 170, 172). In Bangladesh and Cambodia, the aforementioned EHFP program was associated with increased income, decision-making power in the household, food expenditure (including on oils, salts, spices, fish, rice, and meat), and consumption of fruits and vegetables from home gardens (160, 173). There was also limited, but mixed, evidence of income-generating interventions and behavior change communication causing improvements in maternal anemia and BMI (164, 168, 170).
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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.
When women reach childbearing age, they need to eat enough folate (or folic acid) to help decrease the risk of birth defects. The requirement for women who are not pregnant is 400 micrograms (mcg) per day. Including adequate amounts of foods that naturally contain folate, such as citrus fruits, leafy greens, beans and peas will help increase your intake of this B vitamin. There also are many foods that are fortified with folic acid, such as breakfast cereals, some rices and breads.  Eating a variety of foods is recommended to help meet nutrient needs, but a dietary supplement with folic acid also may be necessary. This is especially true for women who are pregnant or breast-feeding, since their daily need for folate is higher, 600 mcg and 500 mcg per day, respectively. Be sure to check with your physician or a registered dietitian nutritionist before taking any supplements., .
Trying to balance the demands of family and work or school—and coping with media pressure to look and eat a certain way—can make it difficult for any woman to maintain a healthy diet. But the right food can not only support your mood, boost your energy, and help you maintain a healthy weight, it can also be a huge support through the different stages in a woman’s life. Healthy food can help reduce PMS, boost fertility, make pregnancy and nursing easier, ease symptoms of menopause, and keep your bones strong. Whatever your age or situation, committing to a healthy, nutritious diet will help you look and feel your best and get the most out of life.

You don’t have to spend a lot of money, follow a very strict diet, or eat only specific types of food to eat healthy. Healthy eating is not about skipping meals or certain nutrients. Healthy eating is not limited to certain types of food, like organic, gluten-free, or enriched food. It is not limited to certain patterns of eating, such as high protein.


 Nutrition education  Health clinics  ↑ knowledge, NC Hgb, ↑ intake of fruits and vegetables, ↓/NC intake of fats, sweets, and sugar-sweetened beverages  ↑ knowledge, NC Hgb, ↑ intake of fruits and vegetables, ↓/NC intake of fats, sweets, and sugar-sweetened beverages  ↑ knowledge, NC urinary iodine, ↑ intake of nutrient-rich foods, ↑ intake of protein, ↑ weight gain, ↑/NC weight loss postpartum (obese women) with diet and exercise   
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.
Carbohydrates should provide 45%–65% of your daily calories. Most of those calories should come from the complex carbohydrates in high-fiber and unrefined foods, such as bran cereal and other whole-grain products, brown rice, beans and other legumes, and many fruits and vegetables. These carbohydrates are digested and absorbed slowly, so they raise the blood sugar gradually and don't trigger a large release of insulin. People who eat lots of these foods have higher HDL ("good") cholesterol levels and a lower risk of obesity, diabetes, and heart disease. A good amount of soluble fiber in the diet lowers LDL ("bad") cholesterol, and high-fiber diets reduce the risk of intestinal disorders ranging from constipation and diverticulosis to hemorrhoids. Some studies have shown that fiber may help reduce the risk of colon cancer. Men need more fiber than women: 38 vs. 25 grams a day before the age of 50 and 30 vs. 21 grams a day thereafter.
Nutrition is particularly important when you are pregnant. Weight gain during pregnancy is normal—and it's not just because of the growing fetus; your body is storing fat for lactation. The National Academy of Sciences/Institute of Medicine (NAS/IOM) has determined that a gain of 25 to 35 pounds is desirable. However, underweight women should gain about 28 to 40 pounds, and overweight women should gain at least 15 pounds. 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. Remember that pregnancy isn't the time to diet. Caloric restriction during pregnancy has been associated with reduced birth weight, which can be dangerous to the baby.
Although growing bodies need plenty of energy in the form of calories, many children and teenagers consume way too many, says Ruth Frechman, RD, a spokesperson for the American Dietetic Association. The latest findings from federal surveys show that 18% of adolescents and teenagers are fatter than they should be. Kids who are obese are 16 times more likely than healthy weight children to become obese as adults, other findings show.
Downloading that new weight-loss app may not be as beneficial as you think. A study published in American Journal of Preventive Medicine rated the top 30 weight-loss apps using criteria set by the Centers for Disease Control and Prevention’s Diabetes Prevention Plan, which consists of 20 behavior-based strategies, including willpower control, problem solving, stress reduction, motivation, and relapse prevention. Twenty-eight of the programs offered 25 percent or fewer of these essential tummy-trimming tactics. If you’re into tech, use your apps to log food and share your progress on social networks, but don't rely on either too heavily to make lasting lifestyle changes. 

Lipid-based nutrient supplement (LNS) programs are intended to enrich diets with micronutrients and essential fatty acids (97), and are often used in emergency settings to meet nutritional needs of pregnant and lactating women (98). Of the studies that report on women's health outcomes, LNSs provided to pregnant and lactating women increased body weight and midupper arm circumference, particularly of multiparous women and women >25 y of age (99). They were associated with increased plasma α-linoleic acid, although not plasma lipids and other fatty acids (100). LNSs did not affect women's immune responses, particularly pregnant women's anti-malarial antibody responses (101). There was limited evidence connecting LNS supplementation to unhealthy weight gain and retention, and this is being explored in ongoing studies in Ghana (97).


A well-balanced diet, comprised of a variety of foods, adequately meets women’s needs for vitamins, minerals and energy. For good health, women need to pay special attention to calcium, iron and folate (folic acid) intake. A healthy diet also should minimize the intake of fat and sugar. Diets high in saturated or trans fat can promote high levels of blood cholesterol and increase risk for heart disease. A diet that includes high sugar provides empty calories, or calories that do not provide any nutritional value and often times replace more nutritious food selections.
The effect of education programs on nutrition outcomes is difficult to assess because programs often have poor baseline data or nutrition outcomes are not evaluated (174, 182). Studies that used longitudinal analyses and “natural” experiments (e.g., before and after a national education policy) found that education was associated with reduced fertility (183, 184), and delayed early marriages and pregnancies (184–187). The impact was more significant for higher levels of education (185). However, 1 study in Malawi identified negative associations between education and timing of first birth, although these findings were largely not statistically significant (188). Secondary education for adolescents and women of reproductive age also showed no impact on women's empowerment (184), although it did show an impact on improved literacy and leadership (174). Educational interventions that provided conditional cash transfers (CCTs) and school feeding, as well as other forms of social protection to families of enrolled girls, were associated with greater school enrollment and attendance (189–191), improved test scores (189, 190), reduced gender gaps (192), and reduced hunger (190, 191).
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.
Women often received micronutrient supplements during antenatal and postnatal care (13, 35–42, 51, 60), and, as such, supplementation was often targeted to pregnant and lactating women. The delivery of micronutrient supplementation commonly occurred in health care settings for at-home consumption. Community-based antenatal care that involved home visits by community health workers was also a common delivery platform for supplementation delivery. There were some studies that reported micronutrient supplementation to adolescents, women of reproductive age, pregnant women, and women with young children outside of the antenatal care setting. These included primary health care clinics, home visits, community centers, pharmacies, and workplaces (32, 38–43, 45, 52, 53). Adolescent girls were also reached by community- and school-based programs (26, 41, 46). School-based programs were more efficacious in reducing rates of anemia among adolescent girls, compared with the community-based interventions (26, 46). However, many of the reported studies to date involved small samples of adolescents in controlled settings, and additional research is needed on the effectiveness of these programs (59, 62).
The new guidelines encourage eating more nutrient-dense food and beverages. Many of us consume too many calories from solid fats, added sugar and refined grains. The guidelines promote a diet that emphasizes vegetables, fruits, whole grains, fat-free or low-fat dairy products, seafood, lean meat and poultry, eggs, beans and peas, and nuts and seeds.
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