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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. 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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. 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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