Women’s nutritional health is vitally important in relation to women’s quality of life and their reproductive health and pregnancy outcomes.  Women’s nutrition is directly linked to three of the UN Millennium Development Goals: #1. end poverty and hunger; #4. reduce child mortality; and #5. improve maternal health. Links with other goals may be less direct, but are still salient including: #3. achieve gender equality and empower women (for access to food and related resources); #6. combat HIV/AIDS, malaria, and other diseases (which affect and are affected by nutritional status); and #7. ensure environmental and agricultural sustainability (which impacts women’s roles in food production and their access to food and environmental resources). In its first principle supporting long-term systematic changes in global health by implementing women- and girl-centered approaches, the Global Health Initiative (GHI) seeks to remove barriers and increase access to quality health services (GHI, 2010).  Increasing access to food resources and nutrition care, particularly in settings where women and girls often eat ‘last and least,’ is an essential component of programs addressing their health and is consistent with GHI strategies.

Nutrition deficiencies and related conditions, including underweight, height stunting, anemia, vitamin A deficiencies and night blindness, low birth weight, and micronutrient-related birth defects, such as neural tube defects resulting from folic acid deficiency, continue to be major concerns for women’s health and reproductive outcomes in developing countries.  Serious problems with women’s undernutrition (BMI < 18.5 kg/m²) are evident in many regions and markedly so among countries in sub-Saharan Africa and south-central and southeastern Asia (Black et al., 2008). In addition to the high prevalence of undernutrition among women and girls in many regions and countries, there are growing issues surrounding overweight and obesity. Current evidence has clearly demonstrated that overweight and obesity and related non-communicable diseases have been exploding in low- and middle- income countries (Global Burden of Disease Report, 2012).  The emerging challenges associated with the “Double Burden” of over and under nutrition occurring side by side across populations, low income groups and even within the same households may be associated with both quality and quantity of the diet as well as metabolic consequences of overweight/obesity. Survey evidence for over two decades from developing countries has been demonstrating steady and widespread increases in the prevalence of overweight and obesity among adults, as well as, children and adolescents. In response to the recommendations of WHO’s Expert Consultation on Obesity, an online WHO Global Database on Body Mass Index (BMI) was created to monitor country-level and regional over- and under-nutrition trends.

Weight gain during pregnancy is one of the most critical factors in determining both birth outcomes and maternal nutritional outcomes of pregnancy. Weight gain is particularly important for women who are underweight prior to pregnancy, however, given the rising numbers of overweight and obese women of reproductive age, recommended weight gains for normal to overweight women and concerns with excess weight gain need to be taken into consideration. Pre-pregnancy obesity and excess weight gain during pregnancy are risk factors for heavier babies (Li et al., 2013).  In addition, a study has shown that high pregnancy BMI substantially increases the risk of postpartum anemia (Bodnar et al, 2012). Thus, more emphasis should be put on this population as well. In 2009, the Institute of Medicine (IOM) set guidelines for recommended weight gain ranges based on four levels of women’s pre-pregnancy body mass index (BMI) (IOM, 2009).

Intervention programs for undernutrition target three main problems: (1) general nutritional deficiency (e.g., inadequate dietary intake), (2) specific micronutrient deficiencies, and/or (3) diseases directly affecting nutritional outcome (e.g., malaria, helminthes, and HIV/AIDS). Strategies addressing the first two problems include provision of supplements (food supplements, micronutrients), food production strategies, food-based strategies (genetic engineering, agricultural interventions), and dietary behavior change.  Interventions to combat malaria, parasitic diseases, and HIV/AIDS include preventive and therapeutic treatment.  UNICEF considers nutrition interventions for women and children among the most affordable and cost-effective development investments countries can make (UNICEF, 2009). For a review of the scope and effectiveness of a range of international interventions targeting maternal and child nutrition, see Bhutta, et al., 2008).

The increasing programmatic emphasis on women’s nutrition requires needs assessments and effective monitoring and evaluation, ideally with core indicators consistent with DHS and country surveillance sources (Cogill, 2003; CORE Group et al., 2010). The thirteen indicators selected for this database cover the recommended ranges for pregnancy weight gain, anthropometric measures of nutritional status including underweight, overweight and obesity, key micronutrient deficiencies (iron/folate, iodine and Vitamin A), and supplies of vitamin and mineral supplements.  For indicators on diseases affecting nutritional outcomes, such as malaria and helminths, see the database technical areas for Malaria in Pregnancy and Safe Motherhood, respectively.  Because the interactions of nutritional status with HIV/AIDS are of special significance to women’s health and their infants’ welfare, the database also includes Women’s Nutrition and HIV as a separate technical area.  Additional online sources for nutrition indicators and surveillance data are the WHO Nutrition Landscape Information System (NLIS) and the WHO Vitamin and Mineral Information System (VMNIS).

___________ 

References:

ACC/SCN and IFPRI, 2000, The 4^th World Nutrition Situation Report: Nutrition through the Life Cycle, Geneva, UN.

Bhutta, ZA, Ahmed T, Black, RE, Cousens S, Dewey K, Guigliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HPS, Shekar M, ‘What Works? Interventions for maternal and child undernutrition and survivial,’ Lancet 2008; 371:41-64.

Black, RE, Allen, LH, Bhutta, ZA, Caufield LE, de Onis, M, Ezzati, M, Mathers, C, Rivera, J,, ‘Maternal and child undernutrition: global and regional exposures and health consequences,’ Lancet 2008; 371: 243-260.

Cogill B, 2003, Anthropometric Indicators Measurement Guide,  FANTA-2, Washington, DC: USAID.

CORE Group, FANTA-2, Save the Children and USAID, 2010, Nutrition Program Design Assistant: A Tool for Program Planners (NPDA), Reference Guide, Washington DC.: USAID.

Institute of Medicine and National Research Council, 2009, Weight Gain during Pregnancy: Reexamining the Guidelines, Eds: Kathleen Rasmussen and Ann Yaktine, Washington, D.C.: The National Academy Press.

UNICEF, 2009, Tracking Progress on Child and Maternal Nutrition, New York. http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf

WHO, Global Database on Body Mass Index , http://apps.who.int/bmi/index.jsp

WHO, 2010, Nutrition Landscape Information System (NLIS), Country Profile Indicators Interpretation Guide, Geneva: WHO. http://whqlibdoc.who.int/publications/2010/9789241599955_eng.pdf

WHO, Vitamin and Mineral Information System (VMNIS), Department for Health and Development (NHD), Geneva, Switzerland. Online database at http://www.who.int.vmnis/en/

Li, S., Rosenberg, L., Palmer, J. R., Phillips, G. S., Heffner, L. J. and Wise, L. A. (2013), Central adiposity and other anthropometric factors in relation to risk of macrosomia in an african american population. Obesity, 21: 178–184. doi: 10.1002/oby.20238

Lisa M. Bodnar, Anna Maria Siega-Riz and Mary E. Cogswell (2012), High Prepregnancy BMI Increases the Risk of Postpartum Anemia. Obesity, 6: 941-948. DOI: 10.1038/oby.2004.115