In our review, we found that fortification interventions that provided fortified foods reached women of all life stages through home visits, community distribution centers, local markets, and retail stores. Delivery of fortified foods in school-based programs, at work, and in maternal–child health centers were also used to target school-age children, women of reproductive age, and pregnant and lactating women that were engaged with those facilities (37, 72–74, 84). There was mixed evidence that consumption of fortified foods reached all socioeconomic groups. Some studies showed differences in consumption between nonpoor and extremely poor, and between urban and rural stakeholders (33, 64, 85). Women who have restricted access to markets, depend largely on locally grown foods, are in areas with underdeveloped distribution channels, or have limited purchasing power, might have limited access to fortified foods (64). Additional research is needed to address implementation gaps and to determine the best platforms for reaching high-risk populations.
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).
A 45-year-old woman who gets less than 30 minutes of daily physical activity in addition to her normal routine should consume six ounce of grains; two and a half cups of vegetables; one and a half cups of fruit; three cups of milk; five ounces of meat and/or beans; five teaspoons of oil; and just 195 calories of additional fat and sugar. With a higher level of daily activity (30 to 60 minutes), this woman would be able to consume a little more in certain food groups: her fruit intake could rise to two cups; meat and beans to five and a half ounces; oils to six teaspoons; and extra fat and sugar to 265 calories.
Nutrition-sensitive approaches are difficult to link to women's nutritional status (5, 102). This is due to limited measurement of benefits to program beneficiaries, families, households, and communities, limited timeframes to evaluate long-term impact, logistical and political realities that make implementation difficult, and different priorities of different stakeholders in multisectoral programs (102). Many nutrition-sensitive approaches, as will be described, thus focus on more distal measures of impact (e.g., coverage, knowledge) and not more proximal measures of women's nutritional status (e.g., BMI, anemia status, etc.).
“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.
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. 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. Women have also mounted campaigns against potentially dangerous forms of contraception such as defective intrauterine devices (IUD)s, particularly the Dalkon Shield.
For some simple suggestions about eating a healthy, balanced diet, check out the "New American Plate Concept" from the American Institute for Cancer Research. This concept suggests you fill your plate with two-thirds or more of vegetables, fruits, whole grains or beans and only one-third or less of animal protein. This simple principle can guide you toward healthier eating. For more details, visit http://www.aicr.org/site/PageServer?pagename=reduce_diet_new_american_plate.
Food fortification is one of the most cost-effective strategies to improve micronutrient status through a variety of food vehicles, including staples, condiments, and processed foods (63, 64). Common fortifiable micronutrients include iron, folic acid, vitamin A, vitamin D, vitamin E, and iodine, although B vitamins and vitamin C are also used as fortificants (33, 64). Food fortification reduced anemia and iron deficiency anemia, and improved vitamin A, folate, niacin, thiamin, vitamin B-6, vitamin B-12, zinc, and iodine status of women of reproductive age and adolescents (13, 46, 61, 63–74). Vitamin D and calcium fortification were found to reduce the risk of osteoporosis among older women, especially for those exposed to inadequate sunlight (63, 64). Biofortification efforts, including those that involved breeding or genetic modification of plants to improve micronutrient content, have also shown improvements in the vitamin A and iron status of women (64, 75). Similar to micronutrient supplementation, women and girls with low micronutrient status were most likely to benefit.
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.
Social protection interventions are intended to support vulnerable households by providing them with in-kind (e.g., food) or cash transfers. The impact of social protection on women's nutrition was nuanced, as such interventions were associated with protecting against adverse nutrition outcomes, but were also associated with excess weight gain in some settings. In-kind transfers, including food baskets, fortified foods, and school lunches, improved women's and adolescent girls’ energy and micronutrient intakes, as described in the preceding sections. Both CCTs and unconditional cash transfers were common around the world and were associated with improvements in health care utilization and increased food expenditures (5, 14, 195, 196). CCTs were dependent on “conditions” such as school attendance and health care utilization. For children in Burkina Faso, CCTs were associated with greater numbers of preventative health visits compared with unconditional cash transfers (197), and this could be relevant to adult women's health care utilization as well. Unconditional cash transfers, such as old-age pensions, were also common, including in low- and middle-income countries (5, 198). Older women who received pensions had fewer missed meals (199), although evidence was mixed (200). In South Africa, granddaughters who cohabitated with women who received pensions had improved anthropometric measures and fewer missed meals, indicating spillover effects of pension transfers (199, 201).
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.