Ekta BelwalID No. 38305

Batch 2009

Ekta BelwalID No. 38305

Batch 2009

• According to national level surveys 40% of the population, majority is of women, in India consume <80% of the energy requirement

• NFHS shows 33% of the women in the age group 15--49 fall under the category of malnourished (BMI <18.5), showing a relatively high CED.

• Every 3rd woman in India is undernourished (35.6 per cent have low Body Mass Index) and every second woman is anaemic (55.3%) census 2011.

• 88% adolescent girls (3.3% has hemoglobin <7 gm./dl; severe anemia) and 85% pregnant women (9.9% having severe anemia. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia

• Recent research indicates that 60 percent of deaths of children under age 5 are associated with malnutrition — and children's malnutrition is strongly correlated with mothers' poor nutritional status.

Importance of Women Health• Better nutrition means stronger immune systems, fewer incidences of

illness and better health.• The nutritional status of women is important both for the quality of

their own lives and the survival and healthy development of their children.

• healthy women can fulfill their multiple roles — generating income, ensuring their families' nutrition, and having healthy children — more effectively and thereby help advance countries' socioeconomic development.

• Improving women's nutrition can also help nations achieve three of the Millennium Development Goals, which are commonly accepted as a framework for measuring development progress

Millennium Development GoalHow Improving Women and Adolescent Girls’ Nutrition Helps

Goal #1: Eradicate extreme poverty and hunger. Halve, between 1990 and 2015, the proportion of people who suffer from hunger.

Well-nourished women are better able to provide for themselves, their children, and their families.

Well-nourished mothers are more likely to have infants with healthy birth weights, and such children are less likely to ever suffer from malnutrition.

Goal #4: Reduce child mortality.Reduce, by two-thirds, between 1990 and 2015, the under-5 mortality rate.

Well-nourished mothers are less likely to bear low birth-weight babies, who are more likely to die in infancy.

Well-nourished mothers are more likely to have healthy babies who can survive childhood illnesses.

Goal #5: Improve maternal health.Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

Women with adequate stores of iron and other micronutrients are less likely to suffer fatal infections and are more likely to survive bleeding during and after childbirth.

Well-nourished adolescent mothers are less likely to experience obstructed labor than their undernourished peers.

Factors affecting Nutritional status of a woman

• Household income and its utilization• Quality of the environment• Number of siblings• Vulnerability to gender discrimination• Educational level• Her activity status & exposure to social

stimulation• Decision making power at the household, etc.

Poor Nutrition Throughout the Life Cycle

Improve Nutrition Throughout Women's Lives

Addressing the needs of girls and women throughout their lives — the "life cycle approach" — can improve women's nutritional status.

Many nutritional deficits experienced in infancy and childhood have irreversible consequences, so interventions to support adequate nutrition from infancy onward directly benefit women later in life.

ADOLESCENCE

Nutrient Requirements• Energy- 2330 Kcal(13-115 yrs.) &2440 Kcal(16-17yrs.)• Protein• Minerals – Ca (800 mg) ; Fe (27 mg/dL) 0.5 mg/day lose by way of

Menstruation therefore ensure adequate intake of Iron Zn (12mg/d) supplements are helpful in

treating pubertal delay.• Vitamins – B1 (1.2mg/d), B12 (0.2-1µg/d )

B2 (1.4mg/d),

Niacin(14mg/d), Pyridoxine(2mg/d) Vit D for structural growth, functional integrity of newly formed cells depends on Vit

A (600µg/d Retinol &4800µg/d ß-Carotene), Vit C & E.

Nutritional Problems

Every adolescent girl…• need access to information and services related to nutrition,

reproductive health, family planning, and general health. Programs can reach girls through a variety of avenues, including schools, workplaces and youth-oriented health programs.

• Needs education and literacy to improve nutrition.• should receive enough food, iron and folate supplements, and iron

and iodine-fortified foods.• Needs to use their knowledge of nutrition when preparing and

handling food can also improve their health and that of their families.• Needs Twice yearly deworming prophylaxis. • develops life skills to avoid early marriage & early pregnancy is also

vital.

Nutrient Requirements

• Energy: +350Kcal• Protein: 82.2g/d• Minerals –

Ca(1200mg/d) ; Fe(35mg/d) ; Iodine(+25µg) ; zinc(12mg/d)

Vitamins – increased need for Vit D, Vit A, Vit E & Vit KVit C (40mg/d);B1 (+0.2mg/d);B2 (+0.3mg/d);B6 (2mg/d);B12 (0.2-1µg/d); Niacin(14mg/d);Folic Acid(400µg/day)

Micronutrient Deficiencies Iron: Anemia is responsible for about 35% of preventable LBW.

Infants born to anemic mothers are at greater risk of low birth weight, premature birth, & impaired cognitive development.

Vitamin A: Low maternal stores of vitamin A compromise children's stores of vitamin A, putting those children at greater risk of illness and death.

Iodine : Iodine deficient mothers are more likely to miscarry or have a stillborn child. The physical growth & mental development of the children who do survive is often severely impaired, & children may suffer irreversible mental retardation.

Folate and Other B Vitamins: Folate deficiency at the time of conception can cause neural tube defects in infants, & maternal zinc deficiency is associated with preterm delivery, low birth weight, and increased infant mortality. Other B vitamins, including B6 & B12, are important for ensuring children's healthy neurological development.

Complications• Anaemia• Toxaemia or Pregnancy Induced HTN or

Eclampsia• Gestational Diabetes

Nutritional Interventions•Access to sufficient quality & quantity food including during pregnancy & lactation.•Regular Consumption of iron & folate supplements when pregnant & for at least 3 months after childbirth to reduce maternal anemia & improve pregnancy & lactation outcomes, and should receive other micronutrients as needed•Regular salt consumption with adequate levels of iodine to prevent foetal brain damage associated with iodine deficiency•In areas where many women suffer CED and with high incidence of LBW, pregnant and lactating women may need high-energy food supplements.•Educational programs and public information campaigns can also help address cultural norms that prevent women from eating enough.

Exclusive breast feeding•Exclusive breastfeeding during the first six months of an infant's life benefits both mother and child. •Breastfeeding protects infants and children from illness and helps ensure healthy growth and development, and starting breastfeeding soon after birth may help prevent excessive maternal bleeding.•Breastfeeding for up to two years can also help mothers keep their iron levels up by delaying the return of menstruation. •Estimates suggest that improving breastfeeding practices by encouraging women to breastfeed their infants immediately after birth and to avoid supplemental feeding for at least the first six months could save the lives of 1.5 million children each year.

Nutrient Requirements

Energy

Kcal/d

Protein

g/d

Ca

mg/d

Fe

mg/d

Vit B1

mg/d

Vit B2

mg/d

Niacin

mg/d

Vit B6mg/d

Vit C

mg/d

Vit B12

µg/d

Zn

mg/d

0-6 m +600 77.91200

25+0.3 +0.3 +4

2.5 80 1.5 12

6-12 m +520 70.2 +0.2 +0.2 +3

Old age

• Osteoporosis• Obesity• degenerative

diseases like CAD, cancer, diabetes mellitus, hypertension

Improve Women's Status "The quality of care and feeding offered to children … is critically dependent on women's education, social status, and workload."

—UN Sub-Committee on Nutrition

•Addressing gender inequalities can help ensure that women can get the nutrition they need, improving their own health and that of their families and, ultimately, contributing to their societies' development.•Women who have greater control over household resources tend to be healthier and better nourished — as do their families — because women tend to spend more on the nutrition, health, and well-being of their households

How Women's Nutrition Affects National Economies

• Malnutrition in women leads to economic losses for families, communities, and countries because malnutrition reduces women's ability to work and can create ripple effects that stretch through generations.

• malnutrition leads to reduced income from malnourished citizens, and face long-term problems related to LBW, including high rates of cardiac disease and diabetes in adults.

• Problems related to anemia, for example, including cognitive impairment in children and low productivity in adults, cost US$5 billion a year in South Asia alone.

• A recent report from Asia shows that malnutrition reduces human productivity by 10 percent to 15 percent and gross domestic product by 5 percent to 10 percent.

• By improving the nutrition of adolescent girls and women, nations can reduce health care costs, increase intellectual capacity, and improve adult productivity.21

Programs 1.Integrated Child Development Services Scheme (ICDS) 2 Oct,1975Beneficiaries: 1. Children below 6 years 2. Pregnant and lactating women 3. Women in the age group of 15-44 years 4. Adolescent girls in selected blocks Services:1. Supplementary nutrition, Vit-A, Iron and Folic Acid,2. Immunisation, 3. Health check-ups,4. Referral services, 5. Treatment of minor illnesses,6. Nutrition and health education to women,7. Pre-school education of children in the age group of 3-6 years, and8. Convergence of other supportive services like water supply, sanitation

2. Special Nutrition Programs (SNP) 1970-71.provides supplementary feeding of about 300 calories and 10 grams of protein to preschool children and about 500 calories and 25 grams of protein to expect at and nursing mothers for six days a week.

3.Applied Nutrition Programs (ANP); 1973The beneficiaries are children between 2-6 years and pregnant and lactating mothers. Nutrition worth of 25 paise per child per day and 50 paise per woman per day are provided for 52 days in a year. No definite nutrient content has been specified.4.Nutrition Programme for Adolescent Girls (NPAG) 2002-03Target Group: Adolescent girls (11-19 years) (weight < 35 Kg).Services: (i) 6 kg of free food-grains (wheat/rice/Maize based on habitual consumption pattern of the state) /per month per beneficiary.(ii) Nutrition and Health Education to the beneficiaries and their families.5.

5. National Nutritional Anemia Prophylaxis Program (NNAPP); 1970•the expected and nursing mothers as well as acceptors of family planning - one tablet of iron and folic acid containing 100 mg elementary iron & 0.5 mg of folic acid• children (1-5 yrs. )- one tablet of iron containing 20 mg elementary iron (60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a

period of 100 days.6. National Program for Prevention of Blindness due to Vitamin A Deficiency7. National Iodine Deficiency Disorders Control Program ,1992

It is not just about women and not just for women. Addressing women’s health is a necessary and effective approach to strengthening health systems overall – action that will benefit everyone.

Improving women’s health matters to women, to their families, communities and societies at large.

Improve women’s health – improve the world.

References

• Srilakshmi, B.2005.Dietetics.New Age International(P),Publishers, New Delhi

• Women and health : today's evidence tomorrow's agenda. (2009)World Health Organization.

• http://www.nihfw.org/NDC/DocumentationServices/NationalHealthProgramme/SNP.html

• http://www.sciencedaily.com/releases/2008/09/080908135942.htm