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Multi0page.Pdf Wf3RP'25 7151y )2q4 Public Disclosure Authorized 256 121WorldK Bank Discussion Papers Public Disclosure Authorized WVomen'sHealth and Nutrition Making a Difference Public Disclosure Authorized Anne Tinker Patricia Daly Cynthia Green Helen Saxenian Rama Lakshminarayanan Kirrin Gill Public Disclosure Authorized Recent World Bank Discussion Papers No. 199 BorrowerOwnership oJfAdjustmenit Programs and the PoliticalEconomy of Reform.John H. Johnson and Sulaiman S. Wasty No. 200 SocialInfrastructuire Constrjction in the Sahel: OptionsforImproving Ctrrent Practices.Bernard AbeiUlland Jean-Marie Lantran No. 201 Urbanization,Agricultuiral Development, and Land Allocation.Dipasis Bhadra and Antonio Salazar P. Bran&io No. 202 MakirngMotherhood Safe. Anne Tinker and Marjorie A. Koblinsky No. 203 PovertyReductioni itn East Asia: The SilentRevolution. FridaJohanscn No. 204 Alanagingthe Civil Service:The Lessonsof Refonn itnIndustrial Countries. Barbara Nunberg No. 205 Designintga Systemnof LaborMarket Statisticsand Information.Robert S. Goldfarb and Arvil V. Adams No. 206 InformationTechnology in WorldBank Leending:Increasing the DevelopmentalItnpact. Nagy Hanna and Sandc,rBoyson No. 207 Proceedingsof a Conferenceon CurrencySubstitution and CurrencyBoards. Edited by Nissan Liviatan No. 208 DevelopingEffective Employment Services. David Fretwell and Susan Goldberg No. 209 EvolvingLegal Fratneworksfor Private Sector Development in Centraland EasternEurope. Cheryl W. Gray an.I Associates No. 210 MarineBiotechnology and DevelopingCountries. Raymond A. Zilinskas and Carl GustafLundin No. 211 RevitalizingAgricultural Research in the Sahel:A ProposedFrameworkfor Action. Jan Weijenberg,Josue Dione1, Michael Fuchs-Carsch, Adolphe Kere, and Jacques Lefort No. 212 InstitutionalOptionsfor the Provisionof Itofrastnrature.Christine Kessides No. 213 The Contributionsof Infrastrgctureto EconotnicDevelopment: A Revieuwof Experienceand PoliticalImplications. Christine Kessides No. 214 From MacroeconomicCorrectiotn to PublicSector Reform: The CriticalRole of Evaluation.Eduardo Wiesner D. No. 215 China: Reformand Developmentin 1992-93. Peter Harrold and Rajiv Lall No. 216 The Reformnof PublicExpendituresforAgriculture. Bonni van Blarcom, Odin Knudsen, andJohn Nash No. 217 ManagingFishery Resources: Proceedings of a SymposiuimCo-Sponsored by the WorldBank and PeruvianMinisnry of Fisheriesheld in Lima, Peru,June 1992. Eduardo A. Loayza No. 218 Cooperativesand the Breakupof LargeMechanized Farms: Theoretical Perspectives and EmpiricalEvidence. Klau, W. Deininger No. 219 Developmentof Rural FinancialMarkets in Sub-SaharanAfrica. Sabapathy Thillairajah No. 220 The MaritimeTransport Crisis. Hans J. Peters No. 221 Policy-BasedFinance: The Experienceof PostwarJapan.The Japanese Development Bank and The Japan E, onomic Research Institute No. 222 MacroeconomicAManagement in China: Proceedingsof a Conferencein Dalian,June 1993. Edited by Peter Har-old, E. C. Hwa, and Lou Jiwei No. 223 Th1eDevelopmetnt of the PrivateSector itn a Small Economyin Transition:The Case of Mongolia.Hongjoo Hal .m No. 224 Towardan EnvirontmentalStrategyfor Asia. Carter Brandon and Ramesh Ramankutty No. 225 "FortressEurope " and Other Myths abouitTrade: Policies toward Merchandise Imports in the EC and Other Ma4or ItindustrialEconomies (and IVhatThey Meanfor DevelopingCouintries). Jean Baneth No. 226 Mfongolia:Financing Education duiring Economic Transitiotn. Kin Bing Wu No. 227 Citieswithout Land Markets:Lessons of the FailedSocialist Experiment. Alain Bertaud and Bertrand Renauc (Continued on the inside back cover.) 2 56 1z1E World Bank Discussion Papers Women's Health and Nutrition Making a Difference Anne Tinker Patricia Daly Cynthia Green Helen Saxenian Rama Lakshminarayanan Kirrin Gill The World Bank Washington, D.C. Copyright C 1994 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the Urited States of America First printingJuly 1994 Discussion Papers present results of country analysis or research that are circulated to encourage discussion and comment within the development community. To present these results with the least possible delay, the typescript of this paper has not been prepared in accordance with the procedures appropriate to formal printed texts, and the World Bank accepts no responsibility for errors. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee th, accuracy of the data included in this publication and accepts no responsibility whatsoever for any consequence of their use. Any maps that accompany the text have been prepared solely for the conveniencc of readers; the designations and presentation of material in them do not imply the expression of any opinion whatsoever on the part of the World Bank, its affiliates, or its Board or member countries concerning the legal status of any country, territory, city, or area or of the authorities thereof or concerning the delimitatio n of its boundaries or its national affiliation. The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to the Office of the Publisher at the address shown in the copyright notice above. The World Bank encourages dissemination of its work and will normally give permission promptly and, when the reproduction is for noncommercial purposes, without asking a fee. Permission to copy portions for classroom use is granted through the Copyright Clearance Center, Inc., Suite 910, 222 Rosewood Drive, Danvers, Massachusetts 01923, U.S.A. The complete backlist of publications from the World Bank is shown in the annual Index of Publications, which contains an alphabetical tide list (with full ordering information) and indexes of subjects, authors, and countries and regions. The latest edition is available free of charge from the Distribution Unit, Office of ths Publisher, The World Bank, 1818 H Street, N.W., Washington, D.C. 20433, U.S.A., or from Publication, The World Bank, 66, avenue d'Iena, 75116 Paris, France. ISSN: 0259-210X Anne Tinker is senior health specialist and Helen Saxenian is senior economist in the World Bank's Population, Health, and Nutrition Department. Patricia Daly, Cynthia Green, and Kirrin Gill were consultants to the Department. Rama Lakshminarayanan is in the World Bank's Young Professionals Program. Library of Congress Cataloging-in-Publication Data Women's health and nutrition: making a difference / Anne Tinker ... [et al.]. p. cm. - (World Bank discussion papers ; 256) Includes bibliographical references (p. ). ISBN 0-8213-2991-X 1. Women's health services-Developing countries. 2. Women- Health and hygiene-Developing countries. 3. Women-Developing countries-Nutrition. 4. Women-Developing countries-Social conditions. I. Tinker, Anne G. II. Series. RA564.85.W6667 1994 362.1'98'091724-dc2O 94-28769 CIP Contents Foreword vii Acknowledgments viii List of Abbreviations x Abstract xi Executive Summary 1 1. Why Invest in Women's Health and Nutrition? 4 Differentials in Health 4 Biological determinants of women's health 5 Socioeconomic influences on women's health 5 Widespread Impact of Women's Health 6 Child survival 6 Productivity, family welfare, and poverty reduction 7 The Cost-Effectivenessof Women's Health Interventions 8 2. An Overview of Women's Health and Nutrition 11 Global Trends 11 Women's Burden of Disease 11 Women's Health and Nutrition throughout Life 12 Infancy and childhood 12 Adolescence 13 Reproductive years 14 Post-reproductive years 15 Additional Health Problems 16 3. Health and Nutrition Interventions for Women 18 Essential Health Interventions 18 Prevention and management of unwanted pregnancies 18 Family planning services 20 Management of complications from unsafe abortion and safe services for pregnancy termination 21 Pregnancy services 22 Prenatal care 22 Safe delivery 23 Postpartum care 23 Prevention and management of sexually transmitted diseases 23 Condom promotion and distribution 24 Prenatal screening and treatment for syphilis 24 Symptomatic case management 25 Targeted screening and treatment of commercial sex workers 25 iii iv Women'sHealth and Nutrition:Making a Difference Essential Behavior Change Interventions 25 Promotion of positive health practices 25 Delayed childbearing among adolescents 26 Safe sex 26 Adequate nutrition 27 Increased male support 27 Eliminating harmful practices 28 Gender discrimination 28 Genital mutilation 29 Domestic violence and rape 29 Expanded Health Interventions 30 Expansion of Essential Services 30 Increased choice of contraceptive methods 30 Enhanced maternity care 31 Expanded screening and treatment of sexually transmitted diseases 32 Nutrition assistance for vulnerable groups 32 Screening, treatment, and referral for victims of violence 33 Cancer screening and treatment 34 Cervical cancer 34 Breast cancer 34 Expanded Behavior Change Interventions 34 Health education for early prevention 35 Increased efforts to reduce gender discrimination and violence 35 Women beyond reproductive age 36 4. Issues for National Program Planning 37 Broadening Policy Support 37 Improving the Equity and Efficiency of
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