The relative lack of information on determinants of disease, disability, and death at major stages of a woman's lifespan and the excess morbidity and premature mortality that this engenders has important adverse social and economic ramifications, not only for Sub-Saharan Africa, but also for other regions of the world as well. Women bear much of the weight of world production in both traditional and modern industries. In Sub-Saharan Africa, for example, women contribute approximately 60 to 80 percent of agricultural labor. Worldwide, it is estimated that women are the sole supporters in 18 to 30 percent of all families, and that their financial contribution in the remainder of families is substantial and often crucial.
This book provides a solid documentary base that can be used to develop an agenda to guide research and health policy formulation on female health—both for Sub-Saharan Africa and for other regions of the developing world. This book could also help facilitate ongoing, collaboration between African researchers on women's health and their U.S. colleagues. Chapters cover such topics as demographics, nutritional status, obstetric morbidity and mortality, mental health problems, and sexually transmitted diseases, including HIV.
- In Her Lifetime
- Copyright
- Dedication
- Acknowledgments
- Contents
- 1 Summary
- PREAMBLE
- THE "LIFE SPAN" APPROACH
- THE STUDY PROCESS
- Background
- The Committee and Its Process
- Study Objectives
- Dilemmas and Strategies
- Definitions
- Sub-Saharan Africa
- Sex and Gender
- Report Organization
- CONCLUSIONS AND RESEARCH NEEDS
- Conclusions
- Gender-Related Burden
- Health Problems Across the Female Life Span: A Synthesis
- Research Needs
- Notes
- 2 The Context of Mortality and Morbidity
- THE IMPORTANCE OF CONTEXT
- THE ISSUE OF HETEROGENEITY
- THE SOCIOECONOMICS OF LIFE AND DEATH
- The Variables
- Gender Disparities
- Morbidity and Mortality
- Health Services Access and Utilization and Health-Seeking Behavior
- Access Bias
- The Dynamics of Female Education
- Access to Assets, Employment, and Income
- Widowhood and Its Sequelae
- POWER, CONTROL, EQUITY, AND STATUS
- Fostering
- Kinship and Residence
- HIV and AIDS
- SOCIAL DISRUPTION AND HEALTH STATUS
- War and Civil Strife
- Refugee Status
- Gender Violence
- Early Marriage
- Traditional Medicine
- Traditional Practices
- Food Prescriptions and Proscriptions
- Pregnancy, Labor, and Delivery
- Female Genital Mutilation
- CONCLUSIONS
- 3 Nutritional Status
- WOMEN'S ROLES AND FEMALE NUTRITIONAL STATUS IN SUB-SAHARAN AFRICA
- Effects of Household Food Production and Acquisition Strategies on the Nutritional Status of Women and Children
- Effects of Commercial Agriculture
- Seasonality
- Dietary Intake and Energy Expenditure of Pregnant and Lactating Women
- EXTENT OF MALNUTRITION AMONG FEMALES IN SUB-SAHARAN AFRICA
- Micronutrient Disorders
- Protein-Energy Malnutrition
- Obesity
- Micronutrient Deficiencies
- FUNCTIONAL CONSEQUENCES OF FEMALE NUTRITIONAL STATUS: TAKING A LIFE SPAN PERSPECTIVE
- Mortality and Morbidity
- Mortality
- Morbidity
- Cognitive Development and School Performance
- Reproductive Function
- Physical Work Capacity
- CONCLUSIONS
- RESEARCH NEEDS
- 4 Obstetric Morbidity and Mortality
- GENDER BURDEN
- THE LIFE SPAN: AN APPROACH TO MATERNAL MORBIDITY AND MORTALITY
- Childhood
- Adolescence
- Menopause and Postmenopause
- THE MAGNITUDE OF PREGNANCY-RELATED MORTALITY AND MORBIDITY
- Quantification of Maternal Mortality
- Vital Statistics
- Health Services Statistics
- Population-Based Data
- Alternative Approaches
- The Burden of Maternal Mortality and Morbidity
- Percent of Pregnancy-Related Deaths and Lifetime Risk of Dying
- Estimates of Maternal Morbidity
- Trends
- THE NATURE OF MATERNAL MORTALITY AS A PUBLIC HEALTH PROBLEM
- Prediction, Prevention, and Cure
- Prediction: Risk Factors and the Utility of Risk Scores
- Maternal Characteristics
- Community Characteristics
- Calculations of Risk
- Prevention
- Cure
- THE MULTIPLE CAUSALITY OF MATERNAL DEATH
- Clinical Causes
- Anemia
- Complications of Pregnancy and Delivery
- Sociocultural Factors: Traditional Medical Practices
- The Traditional Birth Attendant
- Gishiri Cuts
- Female Genital Mutilation (FGM)
- Health Services
- Access to Antenatal and Intrapartum Care
- MATERNAL HEALTH AND FAMILY PLANNING
- Provision of Family Planning Services
- Abortion
- Lactation
- MENOPAUSE
- CONCLUSIONS
- RESEARCH NEEDS
- 5 Nervous System Disorders
- LIFE SPAN PERSPECTIVE
- TOXIC AND NUTRITIONAL DISORDERS OF THE NERVOUS SYSTEM
- HEADACHE SYNDROMES
- CEREBROVASCULAR DISEASES AND USE OF ORAL CONTRACEPTIVES
- OTHER NEUROLOGICAL DISORDERS
- Epilepsies
- Demyelinating Diseases
- Neurologic Complications of Collagen Diseases
- Dementia
- CONCLUSIONS
- RESEARCH NEEDS
- 6 Mental Health Problems
- MENTAL HEALTH AND MENTAL ILLNESS IN AFRICA: GENERAL ISSUES
- GENDER DIFFERENCES IN THE RATE, COURSE, AND OUTCOMES OF MENTAL DISORDERS: GLOBAL ISSUES
- THE EPIDEMIOLOGIC EVIDENCE IN AFRICA
- GENDER DIFFERENCES IN AFRICA FOR ALL PSYCHOLOGICAL DISORDERS
- AFFECTIVE AND NEUROTIC DISORDERS
- SCHIZOPHRENIA
- Incidence
- Prevalence
- Course and Outcome
- PSYCHOLOGICAL DISORDERS IN GENERAL MEDICAL SETTINGS
- PSYCHOLOGICAL DISORDERS IN PREGNANCY AND THE PUERPERIUM
- CONCLUSIONS
- RESEARCH NEEDS
- 7 Cardiovascular Diseases, Cancers, and Chronic Obstructive Pulmonary Diseases
- CARDIOVASCULAR DISEASES
- Emerging Problems
- Coronary Artery Disease
- Stroke
- Factors Influencing Coronary Artery Disease and Stroke Risk
- Smoking
- Hypertension
- Dyslipidemias
- Obesity
- Diabetes Mellitus
- Oral Contraceptive Use
- Continuing Problems
- Rheumatic Heart Disease
- Cardiomyopathies
- CANCERS
- Emerging Problems
- Cancer of the Breast
- Cancers of the Uterus and Ovary and Choriocarcinoma
- Colorectal and Lung Cancers
- Continuing Problems
- Cancer of the Cervix
- Leukemias and Lymphomas
- Skin Cancers
- Liver Cancer
- Bladder Cancer
- CHRONIC OBSTRUCTIVE PULMONARY DISEASES
- Cigarette Smoking
- Indoor Air Pollution
- CONCLUSIONS
- RESEARCH NEEDS
- 8 Injury
- DEFINITIONS
- INJURIES WORLDWIDE
- Injuries as a Public Health Issue
- INJURIES IN THE DEVELOPING WORLD
- INJURY PATTERNS IN DEVELOPING COUNTRIES
- LIFE SPAN APPROACH
- Motor Vehicle Injuries
- Other Unintentional Injuries: Burns, Drowning, Falls, and Unintentional Poisonings
- Burns
- Drowning
- Falls
- Unintentional Poisonings
- VIOLENCE AGAINST FEMALES—A GROWING PUBLIC HEALTH PROBLEM
- Fatal Violent Injuries in Females
- Nonfatal Violent Injuries in Females
- Domestic Abuse (Battering)
- Rape and Sexual Assault
- Implications of Intentional Injury Directed Specifically Toward Females
- CONCLUSIONS
- RESEARCH NEEDS
- Improved Data Sources
- Prevention Strategies
- References
- 9 Occupational and Environmental Health
- WOMEN'S WORK IN SUB-SAHARAN AFRICA
- WOMEN AND WORK IN HISTORICAL CONTEXT
- PROBLEMS OF DEFINITION
- THE NATURE OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH PROBLEMS
- Occupational Injuries
- Occupational Diseases
- Chemical Hazards
- Toxic Emissions
- LIFE SPAN APPROACH
- NATURE OF THE EVIDENCE
- An Occupational and Environmental Health Hazard Profile for Women
- Physical Factors
- Chemical Factors
- Biological Factors
- Work Organizational Factors
- Psychosocial Organization of Work
- Job Load
- Job Control
- The Physical Organization of Work
- Additional Considerations Unique to Women in Sub-Saharan Africa
- Adverse Health Outcomes of Occupational and Environmental Hazards
- Indirect (Group) Health Effects
- Direct (Individual) Health Effects
- CONCLUSIONS
- Nature of Women's Work and Problems of Definition
- Morbidity and Mortality
- RESEARCH NEEDS
- 10 Tropical Infectious Diseases
- MALARIA
- Malaria in Children
- Malaria in Adolescent and Adult Females
- SCHISTOSOMIASIS (BILHARZIASIS)
- Schistosomiasis in Children
- Schistosomiasis and the Adolescent Female
- Schistosomiasis in Adult Females
- AFRICAN TRYPANOSOMIASIS
- African Trypanosomiasis in Children
- African Trypanosomiasis in Adolescent and Adult Females
- African Trypanosomiasis and Pregnancy
- TRACHOMA
- Trachoma in Children
- Trachoma in Adolescent and Adult Females
- DRACUNCULIASIS (GUINEA WORM)
- Dracunculiasis in Children and Adolescents
- Dracunculiasis in Adult Females
- ONCHOCERCIASIS AND LYMPHATIC FILARIASIS
- Onchocerciasis in Children
- Onchocerciasis in Adolescents
- Onchocerciasis in Adult Females
- LEISHMANIASIS AND LEPROSY
- CONCLUSIONS
- RESEARCH NEEDS
- 11 Sexually Transmitted Diseases and HIV Infection
- OVERVIEW
- STDs, Including HIV Infection, and their Complications
- Gender Differentials in STDs and HIV Infection
- Control Over the Circumstances of Sexual Intercourse
- Acquisition of STDs and HIV Infection and Development of Complications
- Health-Seeking Behavior
- Detection and Treatment of STDs
- The Social Implications of STDs and HIV Infection
- STDs and HIV Infection Throughout the Female Life Span
- Infancy, Childhood, and Adolescence
- MAGNITUDE OF THE PROBLEM
- Morbidity
- Mortality
- Economic Impact
- SOCIETAL DETERMINANTS OF STDS AND HIV INFECTION
- Population-Age Composition
- Urbanization, Sex Ratio, and Population Mobility
- War and Social Unrest
- Sexual Norms, Women's Social Status, and Patterns of Sexual Behavior
- Availability and Utilization of Health Services
- CONCLUSIONS
- RESEARCH NEEDS
- Operational Research
- Technology Development
- Behavioral Research
- Clinical Research and Epidemiology
- Notes
- References
- APPENDIX
- Appendix A Demographic Overview and State of the Data
- DATA ON FEMALE MORTALITY AND MORBIDITY ACROSS THE LIFE SPAN
- Data on Mortality
- Sources and Measures
- Gender Differences in Mortality
- Levels of Mortality
- Trends in Mortality over Time
- Cause-Specific Mortality Across the Life Span
- Data on Morbidity
- Sources and Quality
- Estimates of Morbidity
- Disability-Adjusted Life Years
- Understanding Mortality and Morbidity Across the Life Span
- CONCLUSIONS
- RESEARCH NEEDS
- Index
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