Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.
Part of the reason why so many women fail to get the amount of iron they need is because one of the best sources of iron is red meat (especially liver) which also contains high levels of saturated fat. While leafy green vegetables and beans are also good sources of iron—and don’t contain high levels saturated fat—the iron from plant foods is different to the iron from animal sources, and not absorbed as well by the body. Other foods rich in iron include poultry, seafood, dried fruit such as raisins and apricots, and iron-fortified cereals, breads, and pastas.
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.
These challenges are included in the goals of the Office of Research on Women's Health, in the United States, as is the goal of facilitating women's access to careers in biomedicine. The ORWH believes that one of the best ways to advance research in women's health is to increase the proportion of women involved in healthcare and health research, as well as assuming leadership in government, centres of higher learning, and in the private sector.[155] This goal acknowledges the glass ceiling that women face in careers in science and in obtaining resources from grant funding to salaries and laboratory space.[178] The National Science Foundation in the United States states that women only gain half of the doctorates awarded in science and engineering, fill only 21% of full-time professor positions in science and 5% of those in engineering, while earning only 82% of the remuneration their male colleagues make. These figures are even lower in Europe.[178]
If you are over the age of 50 (heck - even 40 and possibly 30) then this is not the magazine for you. Show me real female athletes of all ages and include more serious articles on women's issues. The final straw was seeing a Kardashian on the cover. No thanks. I felt like this was Cosmopolitan magazine and Entertainment Tonight wrapped in spandex. Going back to Runner's World and Prevention.
Having the proper footwear is essential for any workout, and for winter runs, that means sneaks with EVA (ethylene vinyl acetate), says Polly de Mille, an exercise physiologist who oversees New York Road Runner's Learning Series for first-time New York City Marathon runners. “Polyurethane tends to get really stiff and cold in the winter, which could increase your risk of injury.” Another important feature is a waterproof and windproof upper: Look for shoes made with Gortex, or wrap your mesh uppers in duct tape to keep feet dry and warm.
The recommended daily intake for vitamin E is 15 mg. Don't take more than 1,000 mg of alpha-tocopherol per day. This amount is equivalent to approximately 1,500 IU of "d-alpha-tocopherol," sometimes labeled as "natural source" vitamin E, or 1,100 IU of "dl-alpha-tocopherol," a synthetic form of vitamin E. Consuming more than this could increase your risk of bleeding because vitamin E can act as an anticoagulant (blood thinner).
There remain significant barriers to accessing contraception for many women in both developing and developed regions. These include legislative, administrative, cultural, religious and economic barriers in addition to those dealing with access to and quality of health services. Much of the attention has been focussd on preventing adolescent pregnancy. The Overseas Development Institute (ODI) has identified a number of key barriers, on both the supply and demand side, including internalising socio-cultural values, pressure from family members, and cognitive barriers (lack of knowledge), which need addressing.[67][68] Even in developed regions many women, particularly those who are disadvantaged, may face substantial difficulties in access that may be financial and geographic but may also face religious and political discrimination.[69] Women have also mounted campaigns against potentially dangerous forms of contraception such as defective intrauterine devices (IUD)s, particularly the Dalkon Shield.[70]
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 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).
Focus on the long term. Diets fail when people fall back into poor eating habits; maintaining weight loss over the long term is exceedingly difficult. Most people regain the weight they've lost. In fact, some studies indicate that 90 to 95 percent of all dieters regain some or all of the weight originally lost within five years. Your program should include plans for ongoing weight maintenance, involving diet, exercise and a behavioral component. While there are some physical reasons for obesity, there are also behavioral reasons for excessive eating. For example, many women use food as a source of comfort (perhaps to deal with stress). For these women, a weight loss program with a behavioral component will offer alternatives to replace food in this role.
After 40, your hormone levels (estrogen) drop. This causes your insulin (hormone that helps your body use sugar) rise. Your thyroid levels go down. This combination makes you hungrier. You end up eating more and burning fewer calories. Much of the weight gain occurs around your belly. Eat more foods with fiber (berries, whole grains, nuts) to fill you up and help you eat less. Aim for 25 grams of fiber each day after the age of 40. Other ways to increase your metabolism include:
Amongst non-governmental organizations (NGOs) working to end child marriage are Girls not Brides,[106] Young Women's Christian Association (YWCA), the International Center for Research on Women (ICRW)[107] and Human Rights Watch (HRW).[108] Although not explicitly included in the original Millennium Development Goals, considerable pressure was applied to include ending child marriage in the successor Sustainable Development Goals adopted in September 2015,[105] where ending this practice by 2030 is a target of SDG 5 Gender Equality (see above).[109] While some progress is being made in reducing child marriage, particularly for girls under fifteen, the prospects are daunting.[110] The indicator for this will be the percentage of women aged 20–24 who were married or in a union before the age of eighteen. Efforts to end child marriage include legislation and ensuring enforcement together with empowering women and girls.[92][93][95][94] To raise awareness, the inaugural UN International Day of the Girl Child[a] in 2012 was dedicated to ending child marriage.[112]
Mom, wife, daughter, nana, sister, aunt – women play many important roles throughout the years. From screening for common conditions that affect women to advanced medical and surgical care, the healthcare providers at Baylor Scott & White provide the comprehensive services you need as a woman. At Baylor Scott & White Health, you've got a women's health partner for life.​​
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]
Just like trying to find a guy who meets certain exact standards, trying to reach an exact weight is a lofty—and often unattainable—goal. Having a range, such as losing five to 10 pounds, may lead to a more successful outcome than if you aim to lose precisely 8 pounds in four weeks, according to a study published in the Journal of Consumer Research. Flexible goals seem more feasible, which in turn boosts your sense of accomplishment, encouraging you to stay driven, the study authors say.
Beans are another nutrient powerhouse, providing you with a reliable protein alternative to meat as well as the fiber needed for good digestion and prevention of chronic diseases. Beans — including navy, kidney, black, white, lima, and pinto — are part of the legume family that also includes split peas, lentils, chickpeas, and soybeans. Many are good sources of calcium, important to prevent osteoporosis, especially after menopause. If you’re new to beans, add them gradually to minimize gas. Count each one-quarter cup of cooked beans as one ounce of protein.
Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the industrial revolution. [6] Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.[18]

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.

Oaks BM, Young RR, Adu-Afarwuah S, Ashorn U, Jackson KH, Lartey A, Maleta K, Okronipa H, Sadalaki J, Baldiviez LM et al. Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: results of two randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids  2017;117:28–35.


The best training tool you're not using: a jump rope. “It may seem a little juvenile until you think of all the hot-bodied boxing pros who jump rope every single day,” says Landon LaRue, a CrossFit level-one trainer at Reebok CrossFit LAB in L.A. Not only is it inexpensive, portable, and easy to use almost anywhere, you’ll burn about 200 calories in 20 minutes and boost your cardiovascular health while toning, he adds.

Many women and teenage girls don't get enough calcium. Calcium-rich foods are critical to healthy bones and can help you avoid osteoporosis, a bone-weakening disease. Additionally, recent studies suggest that consuming calcium-rich foods as part of a healthy diet may aid weight loss in obese women while minimizing bone turnover. The National Institute of Medicine recommends the following calcium intake, for different ages:
Wood, Susan F.; Dor, Avi; Gee, Rebekah E.; Harms, Alison; Mauery, D. Richard; Rosenbaum, Sara J.; Tan, Ellen (15 June 2009). Women's health and health care reform: the economic burden of disease in women'. D. Richard. Washington DC: George Washington University, School of Public Health and Health Services, Jacobs Institute of Women's Health. Retrieved 17 July 2016.
Amongst non-governmental organizations (NGOs) working to end child marriage are Girls not Brides,[106] Young Women's Christian Association (YWCA), the International Center for Research on Women (ICRW)[107] and Human Rights Watch (HRW).[108] Although not explicitly included in the original Millennium Development Goals, considerable pressure was applied to include ending child marriage in the successor Sustainable Development Goals adopted in September 2015,[105] where ending this practice by 2030 is a target of SDG 5 Gender Equality (see above).[109] While some progress is being made in reducing child marriage, particularly for girls under fifteen, the prospects are daunting.[110] The indicator for this will be the percentage of women aged 20–24 who were married or in a union before the age of eighteen. Efforts to end child marriage include legislation and ensuring enforcement together with empowering women and girls.[92][93][95][94] To raise awareness, the inaugural UN International Day of the Girl Child[a] in 2012 was dedicated to ending child marriage.[112]
Packing your two-piece away for winter means you won't think about how you'll look in it until about April. Avoid any potential “how did my butt get this big?!” panics come spring by keeping your swimsuit handy and putting it on every so often to make sure you like what you see, says Tanya Becker, co-founder of the Physique 57 barre program. You can also toss it on when you're tempted to overindulge, she adds. “There’s no better way to keep yourself from having that after-dinner cookie or slice of cake."
The recommended daily intake for vitamin E is 15 mg. Don't take more than 1,000 mg of alpha-tocopherol per day. This amount is equivalent to approximately 1,500 IU of "d-alpha-tocopherol," sometimes labeled as "natural source" vitamin E, or 1,100 IU of "dl-alpha-tocopherol," a synthetic form of vitamin E. Consuming more than this could increase your risk of bleeding because vitamin E can act as an anticoagulant (blood thinner).
If you count calories, count fat calories, too. Food labels indicate how many calories come from fat, both in actual grams and in percentages. This helps you assess the percentage of fat in your diet. If the total number of fat calories is 30 percent or more of the total calories you consume in a day, you probably need to cut back. But don't be misled by terms like "lower fat." Ask yourself "lower than what?" and look at the overall percentage of fat calories in the food.
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.
A BMI of 25 to 29.9 is considered overweight and one 30 or above is considered obese. For an idea of what this means, a 5-foot 5-inch woman who weighs 150 pounds is overweight with a BMI of 25. At 180 pounds, she would be considered obese, with a BMI of 30. Keep in mind that the tables aren't always accurate, especially if you have a high muscle mass; are pregnant, nursing, frail or elderly; or if you are a teenager (i.e., still growing).
Nutrition education interventions were often implemented in conjunction with other programs, and it was difficult to identify the effects of nutrition education alone. In addition, many studies reported on one-on-one counseling and group education, and it was not possible to differentiate the impact. The effects of nutrition education were often greater when combined with other resource-based interventions, such as micronutrient supplementation (31, 32), home gardening (28), food supplementation (33), and water provision (22). For nutrition education programs targeting mothers, those who were more educated or of higher socioeconomic status more often translated the intervention to nutritional outcomes (33). This suggests that the effectiveness of nutrition education might relate to individuals’ ability to access resources and implement information received.
A 55-year-old woman who gets less than 30 minutes of daily physical activity should eat five ounces of grains; two cups of vegetables; one and a half cups of fruit; three cups of milk; five ounces of meat and beans; five teaspoons of oils, and no more than 130 calories of additional fat and sugar. If she got 30 to 60 minutes of daily exercise, she could increase her intake to six ounces of grains; two and a half cups of vegetables; and up to 265 additional calories of fat and sugar.
Also limit the amount of cholesterol you consume. Cholesterol is a fat-like substance found in every cell of the body. It helps digest some fats, strengthen cell membranes and make hormones. But too much cholesterol can be dangerous: When blood cholesterol reaches high levels, it can build up on artery walls, increasing the risk of blood clots, heart attack and stroke. Although dietary cholesterol can contribute to heart disease, the greater risk comes from a diet high in saturated and trans fats.
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.
The recommended daily intake for vitamin E is 15 mg. Don't take more than 1,000 mg of alpha-tocopherol per day. This amount is equivalent to approximately 1,500 IU of "d-alpha-tocopherol," sometimes labeled as "natural source" vitamin E, or 1,100 IU of "dl-alpha-tocopherol," a synthetic form of vitamin E. Consuming more than this could increase your risk of bleeding because vitamin E can act as an anticoagulant (blood thinner).
SOURCES: Elaine Turner, PhD, RD, associate professor, department of Food Science and Human Nutrition, University of Florida, Gainesville. Sharon B. Spalding, MEd, CSCS, professor, physical education and health; and associate director, Virginia Women's Institute for Leadership, Mary Baldwin College Staunton, Va. American Dietetic Association web site. Institute of Medicine at the National Academies web site.
Don't take dramatic steps alone. You need to work closely with an experienced health care professional to lose weight, particularly if you have other medical problems, plan to lose more than 15 to 20 pounds or take medication on a regular basis. An initial checkup can identify conditions that might be affected by dieting and weight loss. Make sure you find out how much experience your health care professional has dealing with nutrition. It's not always well covered in medical schools. You may want to talk to a registered dietitian before embarking on a diet.
B12: Like folic acid, B12 is essential for healthy nervous system development and function. Pregnant women who are vegans or vegetarians may fall short on B12, since it is present in animal protein and to a lesser extent in dairy. Teenage and adult women need 2.4 mcg. Recommended levels rise to 2.6 mcg for pregnant women and 2.8 mcg for lactating women.
Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked health insurance.[176] In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the poverty line are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (e.g. midwives, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits.[177] A lack of healthcare providers, facilities, and resources such as formularies all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted diseases and cervical cancer.[6]
Adopting a plant-based diet could help tip the scales in your favor. A five-year study of 71,751 adults published in the Journal of the Academy of Nutrition and Dietetics found that vegetarians tend to be slimmer than meat-eaters even though both groups eat about the same number of calories daily. Researchers say it may be because carnivores consume more fatty acids and fewer weight-loss promoting nutrients, like fiber, than herbivores do. Go green to find out if it works for you.
Iron is one of the keys to good health and energy levels in women prior to menopause. Foods that provide iron include red meat, chicken, turkey, pork, fish, kale, spinach, beans, lentils and some fortified ready-to-eat cereals. Plant-based sources of iron are more easily absorbed by your body when eaten with vitamin C-rich foods. So eat fortified cereal with strawberries on top, spinach salad with mandarin orange slices or add tomatoes to lentil soup.
Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
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.”
Mom, wife, daughter, nana, sister, aunt – women play many important roles throughout the years. From screening for common conditions that affect women to advanced medical and surgical care, the healthcare providers at Baylor Scott & White provide the comprehensive services you need as a woman. At Baylor Scott & White Health, you've got a women's health partner for life.​​
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).

The impact of income-generation interventions on women's nutrition has not been sufficiently evaluated. Income-generating interventions were associated with increases in women's income, empowerment, and household decision-making (161, 164–166). However, these gains were often at the expense of more work for women (5). Income-generation interventions have been associated with increased food-related expenditures, improved household food security, and greater household dietary diversity (160, 161, 165–168). Income-generating interventions targeting adolescents improved their social status; however, these showed no impact on their access to food, nor on individual and household food security (169). There was also limited evidence of impacts of income-generating interventions on women's anthropometric and biochemical nutrition outcomes (5, 169, 170). Increased income was associated with reductions in maternal underweight and anemia, but the reductions were modest (171). Studies suggested that the limited impact was related to continued poor access to health services (167), poor measurement, and the need for longer evaluation periods (164, 165, 167, 169).
We live in a modern world with amazing advancements in technology, yet our soil lacks minerals that it once contained causing whatever grows out of it (i.e. fruits, vegetables, and whole foods) to be significantly lower in minerals than it once was. Not only is our soil different, but our food takes a long time to get to us! Unless we’re growing our own whole food in our gardens, picking it out with our bare hands, and washing it off before eating, most likely our produce has been picked weeks before it reaches your grocery store and is purchased by you. This entire process can take weeks and cause nutrients to be depleted from the whole food (2).
You should consume only 25 percent to 35 percent of your total calories per day from fat, with a significant portion from good fats like omega-3 and omega-6 fatty acids. According to the American Heart Association, women should get at least five to 10 percent of their total daily calories from omega-6 fatty acids (equal to 12 to 20 grams), and anywhere from 0.5 to 3 grams of omega-3 fatty acids, depending on individual risk for heart disease.
Women's health refers to the health of women, which differs from that of men in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.
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