Katz DL, O'Connell M, Yeh MC, Nawaz H, Njike V, Anderson LM, Cory S, Dietz W; Task Force on Community Preventive Services. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep 2005;54(RR-10):1–12.
Poor nutrition may be one of the easiest conditions to self-diagnose. Look at the food pyramid and the suggested servings. Look at your diet. Are you getting the recommended daily amounts of fruits and vegetables? Enough calcium? Read the labels and compare what you eat to what you need. You may discover that even if your weight is ideal, you are not getting enough nutrition.
Salt, caffeine and alcohol intake may interfere with the balance of calcium in the body by affecting the absorption of calcium and increasing the amount lost in the urine. Moderate alcohol intake (one to two standard drinks per day) and moderate tea, coffee and caffeine-containing drinks (no more than six cups per day) are recommended. Avoid adding salt at the table and in cooking
Equally challenging for women are the physiological and emotional changes associated with the cessation of menses (menopause or climacteric). While typically occurring gradually towards the end of the fifth decade in life marked by irregular bleeding the cessation of ovulation and menstruation is accompanied by marked changes in hormonal activity, both by the ovary itself (oestrogen and progesterone) and the pituitary gland (follicle stimulating hormone or FSH and luteinizing hormone or LH). These hormonal changes may be associated with both systemic sensations such as hot flashes and local changes to the reproductive tract such as reduced vaginal secretions and lubrication. While menopause may bring relief from symptoms of menstruation and fear of pregnancy it may also be accompanied by emotional and psychological changes associated with the symbolism of the loss of fertility and a reminder of aging and possible loss of desirability. While menopause generally occurs naturally as a physiological process it may occur earlier (premature menopause) as a result of disease or from medical or surgical intervention. When menopause occurs prematurely the adverse consequences may be more severe.
Of the few studies evaluating nutrition education interventions for women and adolescent girls who were overweight and obese, many were “facility-based” and involved delivery platforms such as health clinics (13, 22), worksites (30), and schools (26, 27, 29). Delivery platforms targeting women and adolescents who were undernourished similarly involved facility-based settings (13), but also included community outreach (16, 28), home visits, community kitchens (15, 28), and text messaging platforms (32). Such community-based platforms could provide additional opportunities for the delivery of nutrition education interventions addressing overweight, obesity, and associated noncommunicable disease in the future.
Frankly, looking around, it seems your choice is either a magazine that barely addresses fitness, or going straight to the hardcore muscle-building mags. I was hoping for something reasonably in-between with Women's Health, but failed to find it. If someone knows of such a magazine, I'd be interested to hear it (I tried Women's Fitness, which suffers from the same problems as Women's Health). The good news is that my subscription to Women's Health seemed to get me a good price on Men's Health, which I am switching over to because some reviewers recommended it for those disappointed with the content of WH. I'll see how that works out.
Income-generation interventions largely target adult women (women of reproductive age, women with young children, and older women). Many microfinance and loan programs are targeted to women because of their likelihood to pay back the loans, although women with lower education levels and smaller businesses do not benefit to the same degree as women who are educated or who have bigger businesses (165). There was limited evidence of such interventions targeting adolescent girls (169). In order to understand the potential impact of income-generating activities on adolescents, more information is needed about the pathways by which adolescents contribute to their own food security, the degree to which they rely on their caregivers to meet their nutritional needs, and how those dynamics change with the age of adolescents (169). Training, workshops, and extension activities were often delivered through community centers, community groups, and financial institutions (165). Other affiliated interventions, such as agricultural extension and nutrition education, were provided at the community level and at home visits (160, 173). These delivery platforms were effective at reaching women, including low-income women, particularly when they engaged with existing community groups (e.g., self-help, farmers’, and women's groups) (160, 161, 167, 169, 172, 173).
Sugar is a source of calories, not nutrients. Consuming too much sugar can lead to weight gain and tooth decay. Contrary to what many people think, there is no evidence linking high-sugar diets to hyperactivity or diabetes. However, high-fructose corn syrup, found in most processed foods, is linked with obesity, and obesity increases your risk for developing diabetes and other conditions.
Osteoporosis ranks sixth amongst chronic diseases of women in the United States, with an overall prevalence of 18%, and a much higher rate involving the femur, neck or lumbar spine amongst women (16%) than men (4%), over the age of 50 (Gronowski and Schindler, Table IV). Osteoporosis is a risk factor for bone fracture and about 20% of senior citizens who sustain a hip fracture die within a year.  The gender gap is largely the result of the reduction of estrogen levels in women following the menopause. Hormone Replacement Therapy (HRT) has been shown to reduce this risk by 25–30%, and was a common reason for prescribing it during the 1980s and 1990s. However the Women's Health Initiative (WHI) study that demonstrated that the risks of HRT outweighed the benefits has since led to a decline in HRT usage.
It sounds counterintuitive, but fatty fish are actually good for you because they deliver omega-3 polyunsaturated fatty acids (PUFAs), fats with cardiovascular and anti-inflammatory benefits. While fish oil capsules will help you meet your PUFA needs, studies have found that fish itself offers even more nutritional benefits, including vitamin D, selenium, and antioxidants. Among the best choices are salmon, albacore tuna, herring, and trout. Recommendations are for 1 gram of PUFAs daily for people with coronary heart disease and at least 250 to 500 mg daily for those who want to prevent it.
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.
Grains, vegetables and fruits are essential to getting the vitamins, minerals, complex carbohydrates (starch and dietary fiber) and other nutrients you need to sustain good health. Some of these nutrients may even reduce your risk of certain kinds of cancer. But experts say we rarely eat enough of these foods. To make matters worse, we also eat too much of unhealthy types of food, including fat (and cholesterol), sugar and salt.
Native to East Asia, soybeans have been a major source of protein for people in Asia for more than 5,000 years. Soybeans are high in protein (more than any other legume) and fiber, low in carbohydrates and are nutrient-dense. Soybeans contain substances called phytoestrogens, which can significantly lower your "bad" LDL cholesterol and raise your "good" HDL cholesterol.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
^ Jump up to: a b c Aldridge, Robert W.; Story, Alistair; Hwang, Stephen W.; Nordentoft, Merete; Luchenski, Serena A.; Hartwell, Greg; Tweed, Emily J.; Lewer, Dan; Vittal Katikireddi, Srinivasa (2017-11-10). "Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis". Lancet. 391 (10117): 241–250. doi:10.1016/S0140-6736(17)31869-X. ISSN 1474-547X. PMC 5803132. PMID 29137869. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42–13·30; I2=94·1%) in female individuals
The authors’ contributions were as follows—ELF and CD: were involved in the acquisition of the data; ELF, CD, SMD, and JF: were responsible for the interpretation of the data; ELF: wrote the paper and had primary responsibility for the content; CD, SMD, WS, and JF: were involved in providing detailed comments and revising the manuscript for important intellectual content; and all authors: were involved in the conception of this review and read and approved the final manuscript.
The trick to biking uphill is to look ahead and anticipate. “Try to plan for what's coming,” says Georgia Gould, a LUNA pro athlete and 2012 Olympic bronze medalist in women's mountain biking. “Start shifting down one gear at a time for a smooth, energy-saving transition. Ideally your cadence should stay the same as you transition from harder to easier gears.”
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.
WASH interventions, such as toilet facilities, access to improved and safe water supply, and hand washing are associated with improved nutrition and health of entire communities (13, 14, 125–128). For women and adolescent girls, WASH interventions were associated with improved menstrual hygiene (126), reduced diarrhea and intestinal worm infections (128–131), and reduced maternal mortality (132). Women and young girls are also more affected by the physical and time burdens of collecting water (126), and harassment and violence associated with inadequate and unsafe toilet facilities (133, 134). Closer water points and sanitation facilities eased these gendered burdens (126, 135). WASH interventions and perceived water availability were associated with less time spent on water-related chores, and improved school attendance, women's empowerment, and self-esteem (126, 135, 136).
In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
If motivation is your hang-up, change your exercise routine every 14 days. A University of Florida study discovered that people who modified their workouts twice a month were more likely than to stick to their plans compared to those who changed their regimens whenever they wanted to. Boredom didn’t appear to be a factor; it seems people simply enjoyed the variety more.
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Most experts recommend 1,300 mg of calcium a day for girls aged 9 through 19. Natural sources of calcium, such as low-fat dairy products, are the smartest choice, because they also contain vitamin D and protein, both required for calcium absorption. Milk, yogurt, and cheese contribute most of the calcium in our diets. Some vegetables are also good sources, including broccoli, kale, and Chinese cabbage. Many foods are supplemented with calcium, including some brands of orange juice and tofu. The daily intake for Vitamin D is 600 IU per day for most children and healthy adults.
Adult women, and particularly women with children, were the primary targets for empowerment interventions. Empowerment interventions were predominantly delivered through community-based programs, including home visits, community groups, and community centers (5, 161, 163). There was some evidence that empowerment interventions that included delivery platforms such as radio and television, as a complement to the community- and home-based delivery platforms (5), could have some impact on reaching a wider audience. Adolescent girls were largely not the target of empowerment interventions, except for those relating to reproductive health (158), and could potentially benefit from them.
The increasing focus on Women's Rights in the United States during the 1980s focused attention on the fact that many drugs being prescribed for women had never actually been tested in women of child-bearing potential, and that there was a relative paucity of basic research into women's health. In response to this the National Institutes of Health (NIH) created the Office of Research on Women's Health (ORWH) in 1990 to address these inequities. In 1993 the National Institutes of Health Revitalisation Act officially reversed US policy by requiring NIH funded phase III clinical trials to include women. This resulted in an increase in women recruited into research studies. The next phase was the specific funding of large scale epidemiology studies and clinical trials focussing on women's health such as the Women's Health Initiative (1991), the largest disease prevention study conducted in the US. Its role was to study the major causes of death, disability and frailty in older women. Despite this apparent progress, women remain underepresented. In 2006 women accounted for less than 25% of clinical trials published in 2004, A follow up study by the same authors five years later found little evidence of improvement. Another study found between 10–47% of women in heart disease clinical trials, despite the prevalence of heart disease in women. Lung cancer is the leading cause of cancer death amongst women, but while the number of women enrolled in lung cancer studies is increasing, they are still far less likely to be enrolled than men.
Nutrition education, including communication and counseling to raise awareness and promote nutrition-related knowledge and behaviors aligned with public health goals, was found to increase women's knowledge and improve women's dietary diversity and protein intake (15–21). It also reduced energy intake of overweight women over a 9-mo period (22). However, evidence for the effectiveness of nutrition education interventions showed mixed impact on biological and anthropometric markers of women's nutritional status (14–16, 18, 23–29). This could be due to lack of statistical power given the small sample sizes of the reviewed studies. For adolescent girls, nutrition education was found to reduce odds of overweight, and improve knowledge, dietary intake, physical activity, and sedentary behavior (27, 29, 30). This was particularly true for nutrition education that lasted longer than 12 mo (29). Nutrition education was also more strongly associated with changes in health outcomes in studies evaluating childhood obesity treatment, rather than childhood obesity prevention (29).
Fats contain both saturated and unsaturated (monounsaturated and polyunsaturated) fatty acids. Saturated fat raises blood cholesterol more than unsaturated fat, which may even help lower harmful cholesterol. Reducing saturated fat (most comes from meat, dairy and bakery products) to less than seven percent of total daily calories may help you reduce your cholesterol level. Whenever possible, replace saturated fat with monounsaturated and polyunsaturated fats.
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.
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 social view of health combined with the acknowledgement that gender is a social determinant of health inform women's health service delivery in countries around the world. Women's health services such as Leichhardt Women's Community Health Centre which was established in 1974 and was the first women's health centre established in Australia is an example of women's health approach to service delivery.
Johnson, Paula A.; Therese Fitzgerald, Therese; Salganicoff, Alina; Wood, Susan F.; Goldstein, Jill M. (3 March 2014). Sex-Specific Medical Research Why Women's Health Can't Wait: A Report of the Mary Horrigan Connors Center for Women's Health & Gender Biology at Brigham and Women's Hospital (PDF). Boston MA: Mary Horrigan Connors Center for Women's Health & Gender Biology.
The World Health Organization (WHO) estimates that 35% of women in the world have experienced physical or sexual violence over their lifetime and that the commonest situation is intimate partner violence. 30% of women in relationships report such experience, and 38% of murders of women are due to intimate partners. These figures may be as high as 70% in some regions. Risk factors include low educational achievement, a parental experience of violence, childhood abuse, gender inequality and cultural attitudes that allow violence to be considered more acceptable.
No matter how busy you are, eat lunch before 3 p.m., a Spanish study suggests. Researchers placed a group of women on a diet for 20 weeks; half ate lunch before 3 and half consumed their midday meal after 3. Although both groups’ daily caloric intake, time spent exercising and sleeping, and appetite hormone levels were the same, those who lunched late lost about 25 percent less weight than earlier eaters. Being European, lunch was the biggest meal of the day for these women, constituting 40 percent of their calories for the day, so consider slimming down dinner in addition to watching the clock.
You should eat a healthful, well-balanced diet during pregnancy. However, you should avoid certain foods, including raw or undercooked fish, poultry and meat; raw or partially cooked eggs or foods containing raw eggs; unpasteurized juices; raw sprouts; unpasteurized milk products; and some soft cheeses (cream cheese is OK). Avoid deli meats and frankfurters unless they have been reheated to steaming hot before eating. To prevent food-borne illnesses, take the following precautions:
Nutrition is particularly important during pregnancy to ensure your health and the health of the baby. It's normal to gain weight during pregnancy—not just because of the growing fetus, but because you'll need stored fat for breast-feeding. The Institute of Medicine (IOM) recommends a gain of 25 to 35 pounds in women of normal weight when they get pregnant; 28 to 40 pounds in underweight women; and at least 15 pounds in women who are overweight when they get pregnant. 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.
Both your nutritional needs (the food and water) and your metabolism (how fast your body converts food to energy) change at this age. Your metabolism gets slower. Women lose about half a pound of muscle per year starting around the age of 40. That makes losing weight even more difficult. Some of the changes women experience are due to decreased hormones, reduced activity level, and medical conditions.
Omega-3 fatty acids are essential for the neurological and early visual development of your baby and for making breast milk after birth. Aim for two weekly servings of cold water fish such as salmon, tuna, sardines, herring, or anchovies. Sardines are widely considered the safest and most sustainable fish to eat, while seaweed is a rich vegetarian source of Omega-3s.
Instinct may tell you to slow down when running in wintery conditions, but the secret to not slipping is actually to speed up and shorten your stride. Aim to have each foot strike the ground 90 times per minute, says Terry Chiplin, owner of Active at Altitude, a Colorado-based facility for endurance athletes. This high cadence helps ensure that each foot lands beneath the center of your weight rather than ahead of it, which can throw off your balance on slick terrain.
Abortion is the intentional termination of pregnancy, as compared to spontaneous termination (miscarriage). Abortion is closely allied to contraception in terms of women's control and regulation of their reproduction, and is often subject to similar cultural, religious, legislative and economic constraints. Where access to contraception is limited, women turn to abortion. Consequently, abortion rates may be used to estimate unmet needs for contraception. However the available procedures have carried great risk for women throughout most of history, and still do in the developing world, or where legal restrictions force women to seek clandestine facilities. Access to safe legal abortion places undue burdens on lower socioeconomic groups and in jurisdictions that create significant barriers. These issues have frequently been the subject of political and feminist campaigns where differing viewpoints pit health against moral values.
Getting enough water also is important. Many experts recommend at least eight 8-ounce glasses of water daily—more if you exercise frequently or are exposed to extremes of heat and cold. The 2010 Dietary Guidelines for Americans emphasize drinking more water and other calorie-free beverages, along with fat-free or low-fat milk and 100 percent fruit juices, instead of calorie-packed regular sodas.
You can get calcium from dairy products like milk, yogurt and cheese, canned fish with soft bones (sardines, anchovies and salmon; bones must be consumed to get the benefit of calcium), dark-green leafy vegetables (such as kale, mustard greens and turnip greens) and even tofu (if it's processed with calcium sulfate). Some foods are calcium-fortified; that is, they contain additional calcium. Examples include orange juice, certain cereals, soy milk and other breakfast foods. Talk to your health care professional about whether you should take calcium supplements if you don't think you're getting enough calcium from food sources.
There were also supplementation programs that targeted nonpregnant women. National supplementation programs that provided food baskets to low-income families increased maternal BMI and improved household food insecurity (92, 93). However, there were some unintended consequences. In Mexico, food transfer programs disproportionately increased weight gain in overweight women compared with underweight women (93), and 1 study in Bangladesh found that food transfers had larger impacts on men's intake than women's intake, except with less preferred foods (94). Adolescents who received protein-energy supplementation at school showed an increase in weight gain during supplementation, as well as improvements in school attendance and mathematics scores (46, 95). However, the impact of supplementation on micronutrient deficiencies and, specifically, hemoglobin concentration, was limited (46).
Foods that contain natural folic acid include orange juice, green leafy vegetables, peas, peanuts and beans. (One cup of cooked kidney beans contains 230 mcg of folic acid.) Fortified foods, such as ready-to-eat breakfast cereals, also contain a synthetic form of folic acid, which is more easily absorbed by your body than the natural form. Folic acid is now added to all enriched grain products (thiamin, riboflavin, niacin, and iron have been added to enriched grains for many years).
“Berries, and a lot of fruits, are an excellent source of antioxidants and water-soluble vitamins,” says Julia Hincman, MS, RD, LDN, a registered dietitian with Massachusetts General Hospital in Boston. “They are important for the prevention of cancer and to maintain your weight.” They may also lower your risk of coronary heart disease. One of the many studies done on the benefits of berries looked at blueberries, a known powerhouse. Researchers found that all their benefits remained even after cooking. The serving size is one-half cup of fresh berries (or one-quarter cup if they are dried).
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.
If you do decide to diet, you still need to maintain good nutrition. You want to cut back on calories, not nutrients. And while you want to reduce fat, don't eliminate it entirely. Some studies suggest that older women who maintain a higher body-fat percentage are less likely to suffer from osteoporosis and other conditions associated with menopause. Fat cells also retain estrogen, which helps maintain the calcium in your bones. Younger women should be careful, too: a low body fat percentage can lead to infertility; below 17 percent may lead to missed periods, also known as amenorrhea.
Social protection Health centers (“condition” and delivery platform) ↑ knowledge about health and nutrition, ↑ HH food consumption, ↑ food expenditures, ↑/NC food share, ↑ dietary diversity, ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets, ↑ participation in social networks, ↑ self-confidence, ↑ control HH resources ↑ knowledge about health and nutrition, ↑ HH food security, ↑ food expenditures, ↑/NC food share, ↑ HH food consumption, ↑ dietary diversity, ↑ HH intake of fruits, vegetables, and ASF, ↑/NC intake of fats and sweets, ↑ self-confidence, ↑ participation in social networks, ↑ control HH resources, ↑ ANC coverage
CCTs have been more thoroughly evaluated for nutrition outcomes, particularly in Latin American countries. They were associated with improvements in women's knowledge of health and nutrition, as well as their self-esteem, participation in social networks, control over resources, and decision-making power (5, 202). Although intrahousehold allocation for women is not clear, CCTs increased household food expenditure and were associated with improved household dietary diversity, including increased household consumption of animal protein, fruits, and vegetables, and reduced consumption of staples and grains (14, 192, 202). There was also some evidence that household expenditure on fats and sweets also increased significantly (202). However, these findings were not consistent and some evaluations showed no significant increase (14, 202, 203). Despite this, in Mexico, there was evidence that in-kind and cash transfer programs resulted in excess weight gain in women who were not underweight (5, 93). This warrants future research given the burden of overweight and obesity among women.
Folate is most important for women of childbearing age. If you plan to have children some day, think of folate now. Folate is a B vitamin needed both before and during pregnancy and can help reduce risk of certain serious common neural tube birth defects (which affect the brain and spinal chord). Women ages 15-45 should include folate in their diet to reduce the risk for birth defects if one becomes pregnant, even if one is not planning a pregnancy.
Violence against women may take many forms, including physical, sexual, emotional and psychological and may occur throughout the life-course. Structural violence may be embedded in legislation or policy, or be systematic misogyny by organisations against groups of women. Perpetrators of personal violence include state actors, strangers, acquaintances, relatives and intimate partners and manifests itself across a spectrum from discrimination, through harassment, sexual assault and rape, and physical harm to murder (femicide). It may also include cultural practices such as female genital cutting.
A related issue is the inclusion of pregnant women in clinical studies. Since other illnesses can exist concurrently with pregnancy, information is needed on the response to and efficacy of interventions during pregnancy, but ethical issues relative to the fetus, make this more complex. This gender bias is partly offset by the iniation of large scale epidemiology studies of women, such as the Nurses' Health Study (1976), Women's Health Initiative and Black Women's Health Study.