When layering for an outdoor activity this winter, consider a compression fabric for your base layers. “These fabrics are fantastic at wicking moisture from the body, which allows you to sweat and breath while keeping you warm,” says Chiplin, who notes they can also reduce fatigue and muscle soreness so you’re ready to head out again tomorrow. Consider throwing them in the dryer for a minute before dressing to further chase away the morning chill.
In 2013 about 289,000 women (800 per day) in the world died due to pregnancy-related causes, with large differences between developed and developing countries. Maternal mortality in western nations had been steadily falling, and forms the subject of annual reports and reviews. Yet, between 1987 and 2011, maternal mortality in the United States rose from 7.2 to 17.8 deaths per 100,000 live births, this is reflected in the Maternal Mortality Ratio (MMR). By contrast rates as high as 1,000 per birth are reported in the rest of the world, with the highest rates in Sub-Saharan Africa and South Asia, which account for 86% of such deaths. These deaths are rarely investigated, yet the World Health Organization considers that 99% of these deaths, the majority of which occur within 24 hours of childbirth, are preventable if the appropriate infrastructure, training, and facilities were in place. In these resource-poor countries, maternal health is further eroded by poverty and adverse economic factors which impact the roads, health care facilities, equipment and supplies in addition to limited skilled personnel. Other problems include cultural attitudes towards sexuality, contraception, child marriage, home birth and the ability to recognise medical emergencies. The direct causes of these maternal deaths are hemorrhage, eclampsia, obstructed labor, sepsis and unskilled abortion. In addition malaria and AIDS complicate pregnancy. In the period 2003–2009 hemorrhage was the leading cause of death, accounting for 27% of deaths in developing countries and 16% in developed countries.
Family planning and birth spacing can influence the nutrition of adolescent girls, women of reproductive age, and women with young children by reducing the number of adverse outcomes associated with pregnancy and abortion. For adolescent girls, in particular, pregnancy is associated with increased risk of birth complications, anemia, hindered linear growth, and loss of educational attainment (8, 107). Delaying early child marriages and providing access to family planning, particularly for young wives, allow girls to achieve their maximum growth potential (8, 142). However, for women with young children, there was scarce evidence from observational studies to suggest that greater birth spacing had any impact on anthropometric status (BMI, weight), micronutrient status (anemia, as well as serum zinc, copper, magnesium, and folate), and maternal mortality outcomes (13, 107, 143–147). Findings were mixed, which was attributed to sample size and other confounding factors such as maternal age, breastfeeding status, and supplementation status (146, 147). The strongest evidence of the impact of birth spacing on women's nutrition was related to increased risk of preterm delivery and maternal anemia in interpregnancy intervals <6 mo (14, 146, 147) and increased risk of pre-eclampsia in intervals >5 y (107).
Changes in the way research ethics was visualised in the wake of the Nuremberg Trials (1946), led to an atmosphere of protectionism of groups deemed to be vulnerable that was often legislated or regulated. This resulted in the relative underrepresentation of women in clinical trials. The position of women in research was further compromised in 1977, when in response to the tragedies resulting from thalidomide and diethylstilbestrol (DES), the United States Food and Drug Administration (FDA) prohibited women of child-bearing years from participation in early stage clinical trials. In practice this ban was often applied very widely to exclude all women. Women, at least those in the child-bearing years, were also deemed unsuitable research subjects due to their fluctuating hormonal levels during the menstrual cycle. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. These exclusions pose a threat to the application of evidence-based medicine to women, and compromise to care offered to both women and men.
Although there is evidence that interventions can address widespread malnutrition among women, there is a lack of operational research and programs to tackle the issue. There is an imperative for the nutrition community to look beyond maternal nutrition and to address women's nutrition across their lives (3). How we reach women matters, and different delivery platforms are more appropriate for some women than others. Delivery platforms for reaching young mothers are different from those for adolescents and postmenopausal women. There is a need to intentionally consider strategies that appropriately target and deliver interventions to all women. This means that nutrition researchers and practitioners need to further adapt existing strategies and modes of delivery to adequately engage women who might not be in clinic settings (78). This also requires that researchers and practitioners explore how to deliver nutrition interventions to women and at different stages of life in order to reduce inequities in the delivery of nutrition services and to reach women missed by programs focusing on maternal nutrition alone.
Income-generation activities Home visits ↑ health knowledge, ↑ health care utilization, ↓ poverty ↑ nutrition and knowledge, ↓ anemia, ↓/NC night blindness, ↑ intake of vitamin A–rich foods, ↑/NC intake of vegetables, ↑ intake of ASF, ↓ underweight, ↑ health care utilization, ↓ poverty ↑ health knowledge, ↑ health care utilization, ↓ poverty
In addition, more research is needed to evaluate the impact of targeting women alone compared with targeting women alongside other members of their families and communities (e.g., with groups of other women, men, husbands, children, parents, in-laws, other family members, other community members, etc.). Interventions that targeted women with their children during child health visits or alongside other members of their communities through community mobilization and mass media campaigns showed improvements in knowledge and some health and nutrition behaviors of women. The inclusion of boys and men, for instance, as well as the inclusion of other family and community members, could enhance the impact and delivery of nutrition interventions for women through support of certain practices, reminders, time-savings, and normalization of nutrition behaviors. However, more research is needed to identify effective targeting mechanisms (i.e., alone or alongside other members of households and communities) and we expect that these will likely need to be context- and content-specific.
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).
The total fat in your daily diet should average no more than 30 percent of your total calories consumed. And saturated fat should be no more than 10 percent of those 30 percent of calories. The amount of fat and saturated fat you eat depends on the foods you select and consume that have fat in them. Consider consulting with a nutrition professional to learn more about how to calculate your fat needs and to not exceed what are healthy amounts. There are many tools available to help you determine how much fat you should consume each day based on your current energy and nutrition needs. Reading food labels is one way to begin to identify where and how much fat is in particular food items.
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).
Internationally, many United Nations agencies such as the World Health Organization (WHO), United Nations Population Fund (UNFPA) and UNICEF maintain specific programs on women's health, or maternal, sexual and reproductive health. In addition the United Nations global goals address many issues related to women's health, both directly and indirectly. These include the 2000 Millennium Development Goals (MDG) and their successor, the Sustainable Development Goals adopted in September 2015, following the report on progress towards the MDGs (The Millennium Development Goals Report 2015). For instance the eight MDG goals, eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality rates, improving maternal health, combating HIV/AIDS malaria and other diseases, ensuring environmental sustainability, and developing a global partnership for development, all impact on women's health, as do all seventeen SDG goals, in addition to the specific SDG5: Achieve gender equality and empower all women and girls.
Many nutrition-sensitive approaches were delivered in broader community-based settings and more equitably reached women across the life course. Non-facilities-based settings more equitably delivered nutrition interventions to women who were not pregnant or lactating, and who were less engaged with health clinics and schools. For instance, food fortification, which was often delivered through markets, home visits, and community centers, seemed to be more effective at reaching women of reproductive age than health center–based delivery platforms. Community-level interventions are often reported as more equitable than platforms that require access to “fixed and well-equipped health facilities” (212). This aligns with our findings, where we found that community-based platforms such as home visits, community centers, homes of community leaders, work, mass media, mobile phones, and commercial settings were effective at reaching women across the life course (Table 1). Other delivery platforms such as marketplaces, water points, tailoring shops, and agricultural points for seeds or inputs were also effective. These locations need to be context-specific in order to capture where women spend their time. For instance, in countries where many adolescent girls do not attend school, school-based delivery platforms might be less effective. Delivery platforms also need to be sensitive to the sociodemographic differences that influence where women spend their time, such as differences for women in rural and urban areas, and of different socioeconomic statuses. Additional research needs to identify and report where women and adolescent girls are, and how best to reach them.
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
Despite these differences, the leading causes of death in the United States are remarkably similar for men and women, headed by heart disease, which accounts for a quarter of all deaths, followed by cancer, lung disease and stroke. While women have a lower incidence of death from unintentional injury (see below) and suicide, they have a higher incidence of dementia (Gronowski and Schindler, Table I).
In low- and middle-income countries, health care services often respond to acute health needs and many focus on maternal–child health (105, 106, 110, 112). The use of preventative care is limited, and there are concerns about the capacity of health systems to address noncommunicable diseases, such as diabetes, in low- and middle-income settings (108, 112). This has implications for the reach of integrated health care interventions across the life course. Maternal and reproductive health care is often sought by women when they are pregnant and in the early years of their children's lives (3, 113). Even so, many women visit health facilities late in their pregnancy or not at all (114–116). For adolescents and adult women, care is often not sought until they are sick (3, 117, 118). This is problematic for older women, in particular, as screening and treatment for age-related health issues, such as diabetes, cancer, and hypertension, require access to preventative health care services (3).
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.
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.
Consult your health care professional. Women of childbearing age may want to consider taking folic acid supplements to reduce the risk of having a pregnancy affected with neural tube defects. Many women and teenage girls don't get enough calcium or vitamin D, both of which are critical to healthy bones and avoiding osteoporosis. Some people with diabetes appear to benefit from chromium. Vegetarians, especially vegans, may want to consider supplements to obtain nutrients they aren't getting from animal products.