Are we doing enough on women's nutrition?

8 Mar 2017

NO, is the indisputable answer to the question.

Poor nutrition, ill-health, reduced potential, and poverty trap women in a vicious cycle which threatens their survival and blocks the progress they are capable of achieving for themselves, and for society.

Women constitute over 40% of the agricultural labour force in developing countries, but less than 20% of the world’s landholders are women (in some parts of Africa, less than 5%)[1]. They also disproportionately bear the burden of undernutrition- around 60% of the world’s chronically hungry people are women and girls. With the same resource access as men, women could raise yields on their farms by at least 20-30%, and also lift 100-150 million out of hunger, including themselves[2].

Inadequate quantity and quality nutrition during adolescence makes girls weak, hinders chances of catch-up growth, and adversely affects concentration and progress in school. Although data on adolescent nutrition itself is hugely lacking, in around half of the countries with data on adolescent anaemia 1 in 3 girls 15-19 years of age is anaemic[3]. Along with poor menstrual and reproductive health and hygiene, undernutrition contributes fewer years of schooling and increased school drop-out rates. 61 million girls are still out of school, and gender disparity increases into secondary schooling[4].

Around 830  women still die every single day, from pregnancy and childbirth related causes[5]. Ensuring good maternal nutrition can significantly bring these numbers down. Otherwise, in a nutritionally-deprived environment the foetus continues to receive nutrition albeit at the expense of maternal reserves. This weakens her own health, and almost always restricts the baby’s growth as well. Inadequate calorie intake as well as deficiencies of vitamins and minerals in the mother drive poor birth outcomes. For example, anaemia is known to underlie at least 20% of maternal mortality. That said, strengthening a woman’s decision making power regarding when she should have her first child and the number of children she chooses to have, alongside a strong health system will accelerate the positive impact of good nutrition in sharply reducing maternal deaths.

Girls eat lunch at a primary school in Tsihombe in southern Madagascar. Photo: Tom Maguire/RESULTS UK

Nutrition also affects the health and wellbeing of women, and can reduce individual earning potential by at least 10%[6]. The adverse impact of undernutrition on the survival of women during childbirth; on the growth and health of the child; thereafter on the health and educational attainment of the girl, and the potential of adult woman. As a result, a significant chunk of the global workforce is physically, mentally, and economically disadvantaged.

The gender inequality in nutrition continues even after childbirth. Proper breastfeeding practices can help save the lives of over 800,000 infants[7], and among the key factors in promoting proper infant feeding practices is mother’s nutrition– to help synthesis of adequate quantities of breastmilk whilst sparing the mother’s own nutrient reserves. Also important is an enabling work-place environment: sufficient and paid maternity leave so she is not compelled to resume work at the cost of breastfeeding her child, space for and social acceptance of breastfeeding in public, job security and flexible work hours. The good news is that a number of countries have at least some maternity policy in place, but still around 830 million women have no maternity protection, mostly in Asia and Africa (although the US is also an outlier on paid maternity leave), and more so in the informal sector[8]. Finally, a strong regulatory environment is necessary to implement the International code on marketing of breastmilk substitutes. Currently only 37 out of the 199 countries reporting to the WHO have passed laws which reflect all the recommendations of the code[9].

The complex interplay of poor resource-access throughout life, insufficient or inadequate quality education, work and labour demands, coupled with an absolute lack of nutritious diets but higher than usual nutritional demands during menstruation, pregnancy, and lactation, in a poor health system environment severely compromises women’s growth, health, and functioning. Add to this mix their role of child-bearing and –rearing, household duties, and an absolute lack of decision making power. No doubt poverty, which stems from all of these factors, is also sexist. It may affect men and women equally, but women are less equipped with the coping mechanisms to cushion the impact of impoverishment.

There are also positive examples on countries taking steps towards improving nutrition amongst women and girls. RESULTS UK’s case studies based on Malawi, India, and Pakistan highlight some of the best practices in these countries in improving nutrition across the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) continuum for a multiplier effect on nutrition and health outcomes across the life-cycle and through generations. Scaling up evidence based interventions such as Iron and Folic Acid supplementation and promotion of breastfeeding, and engaging communities in behaviour change promotion alongside establishing enabling political and regulatory environments are instrumental in improving women’s nutrition and health.

This International Women’s Day, we must remember just how important nutrition is to ensuring women survive and thrive. Improving nutrition will accelerate progress on at least 12 of the 17 Global goals, and everyone has a role to play in ensuring nutrition is high on the agenda – not in words, but in action.

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RESULTS UK is a charity registered as RESULTS Education in England and Wales (1015286), a company limited by guarantee (2761858), and a charity registered in Scotland (SC041481).