DEVELOPMENT BRIEFi Number 48 The World Bank January 1995 Better health and nutrition ~~~~~nutrition problems women face in Better health and nutrition developing countries: * In a clinic in Asia, 7,999 of 8,000 for w om en abortions performed after parents learned the sex of the fetus averted Many of the leading causes of death and disability of the birth of girls. * In Africa each year, an esti- women in developing countries can be prevented or mated 2 million young girls, most treated through highly cost-effective interventions between four and eight years of age, are subject to genital mutilation (re- ecause many of the interven- example, inadequate diet in youth moval of part or all of the external tions that address women's and adolescence can lead to anemia genitals). health problems are highly or stunting, which contribute to * The pregnancy rate among un- cost-effective, any national health complications in childbirth and to married adolescents is at an all-time investment strategy based on underweight babies, and insuffi- high in many countries. achieving the greatest health gains cient calcium can lead to osteo- * Each year, 50 million women at the least cost will give consider- porosis later in life. experience serious pregnancy com- able emphasis to interventions di- The following examples sketch a plications and half a million die as a rected at women. Special attention picture of some of the health and result. is warranted to reaching women during adolescence, when repro- Health and nutrition problems affecting women exclusively ductive and other lifestyle behav- or predominantly during specific stages of the life cycle iors set the stage for later life. The arguments for accelerating investment in women's health and Infancy and chi nutrition are compelling. Such in- vestments promote equity. They Sex confer widespread benefits for this generation and the next. And they are good for economic efficiency. Those are the conclusions of a re- cent World Bank Discussion Paper.* Xdolesceare Women's health throughout ~~~~~~~~~Lifetime health probles (10-19 years) thmenlif cycleh thoghu Gender violence * Early chidbearing the life cycle diess-o -: Certain occupational I * Wrafe abortion A life cycle approach to women's * Gynecological and environmental 4STDs and AIDS health takes into account both the * Osteoporosis healhhzrdssioniuiiin n specific and the cumulative effects * Osteoarthritis of poor health and nutrition. Many * Diabetes of the health problems affecting women of reproductive age, their newborns, and older women begin pregnancy in childhood and adolescence. For _n _ 'For more details, see Anne Tinker, Patricia Daly. Cynthia a tionespecially Green. Helen Saxenian, Rama Lakshminarayanan, and Kirrin Gill, Women's Health and Nutrition: Makinga Difference, World Aron deficiency Bank Discussion Paper 256, Washington, DC, 1994. * Anemia is prevalent throughout women to adopt healthful behaviors look for their female citizens if they the developing world and appears to and seek medical help when needed. are willing to enact and promote be worsening in Sub-Saharan * Prevention of practices harmful to gender-sensitive policies and to Africa and South Asia, where it af- health, such as less food and health care strengthen women's health ser- fects 40-60% of women age 15-49. for girls than boys and violence against vices. Effective policy reform must * Recent evidence reveals that women. By raising awareness among include not only changes in the domestic violence, rape, and sexual policymakers, health providers, and health delivery system but also ef- abuse are a significant cause of dis- the public of the harmful health forts to redress social, educational, ability among women. Between 20% consequences of these practices, and economic inequities. and 60% of women surveyed in vari- governments can be a positive force Existing services can be im- ous countries report that they have for change. proved, extended, and tailored to fit been beaten by their partners. Even in the poorest countries, local conditions. For example, governments can help to establish where cultural norms discourage Essential services for women these essential services and ensure women from receiving care from Any national package of interven- access to them by financing health men, governments could recruit tions designed on the basis of cost- interventions for the poor in the na- and train more female health pro- effectiveness and the disease tional package and interventions to viders. In the design and imple- burden would include the follow- change behavior for the entire mentation of health programs, ing essential services for women: population. Services beyond the na- attention can be paid to factors that * Prevention and management of tional package should be financed have particular relevance to women unwanted pregnancies. Family from private sources. because of biological and social in- planning services, safe abortion Where resources permit a more fluences: access, quality (including services, and treatment for compli- comprehensive national package of provider competence, counseling, cations of unsafe abortion can interventions against a larger num- continuity of care, and privacy), greatly reduce death and illness ber of diseases and conditions, the number of female health providers, among women. essential services could be ex- and responsibilities of non- * Safe pregnancy and delivery ser- panded and upgraded to include: physicians, such as midwives. vices. Prenatal care, safe delivery, * A wider choice of short- and By working closely with the pri- and postpartum care can have a long-term contraceptive methods. vate sector to deliver information and significant impact on the health of * Enhanced maternity care. services to improve women's health women and their newborns. Ser- * Expanded screening for and and nutrition, governments can help vices should include counseling, treatment of sexually transmitted derive the greatest benefits from na- micronutrient supplementation, diseases. tional health resources. Nongovem- tetanus toxoid immunization, and * Nutrition assistance for vulner- mental organizations that are well the detection, prompt referral, able groups. respected in the community can be and treatment of obstetric compli- * Cervical and breast cancer helpful in reaching and representing cations. screening and treatment. disadvantaged women. Private for- * Prevention and management of * Increased attention to early profit providers can supplement gov- sexually transmitted diseases. Promot- prevention. ernment programs by offering a ing condom use can help prevent * Increased policy dialogue and broader range of services to those the spread of sexually transmitted strategic efforts to reduce gender who can afford to pay for them. diseases, and timely management discrimination and violence. National education programs can of such diseases can avert both * Greater attention to the health be used to promote positive health acute and long-term complications. problems of women beyond repro- behaviors and to change attitudes * Promotion of positive health prac- ductive age. and conduct that are harmful to tices, including delayed childbearing, safe women. Such programs have been sex, and adequate nutrition. Public edu- What national health effective in changing a wide range cation programs and counseling by programs can do of health behaviors related to fam- health workers can help to change Governments have considerable ily planning, nutrition, AIDS pre- social norms and encourage girls and power to improve the health out- vention, and tobacco consumption. Development Briefs are issued by the World Bank to inform the media, business, academic, and government policy communities about development policy analyses and results from the Bank's research activities. They are drawn from the work of individual Bank researchers and do not necessarily represent the views of the World Bank and its member countries-and should not therefore be attributed to the World Bank or its affiliates. Briefs are issued periodically by the Research Advisory Staff, Development Economics Vice Presidency, The World Bank, 1818 H Street, NW, Washington, DC 20433. Tel: (202)473-3984, Fax: (202)477-0955. 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