- Poverty and everything it entails: deficient nutrition based on a monotonous diet; high risk of infection due to overcrowding, poor hygiene habits and poor environmental sanitation; deficient access to health services, and so on.
- Women’s employment in activities involving high energy expenditure due to arduous physical labor.
- Low educational level among women, which affects the efficiency of their role within the family and in the process of motherhood.
- Negative feelings about pregnancy due to poor paternal or maternal experiences in the woman’s own childhood, defective or nonexistent social support systems, family instability, and even the relative devaluation of young women in relation to young men.
- Malnutrition in other members of the family.
- Belonging to a social group characterized by high maternal and child mortality, and by mortality among children under five caused by malnutrition and related causes, such as diarrhea, vaccine-preventable diseases and respiratory infections.
- Residence in communities undergoing crisis or disaster, such as unemployment and severe economic deterioration, natural disasters, war, migration and similar situations.
- Inadequate breastfeeding practices, beginning with lack of early contact between mother and newborn. Although this factor poses greater risk for the child, perinatal and reproductive health from the maternal standpoint also benefits from breastfeeding when it occurs within a favorable environment.
The critical analysis of several of these risk factors, however, reveals unknowns and suggests specific interventions that may have a favorable influence on several risk factors. Three possible new approaches are analyzed below. Above all, their potential practical consequences are considered, as well as the precise definition of studies that can be carried out in the short term and yield results with immediate application.
The three approaches discussed are complementary and present overlapping areas. They are:
- The relationship between women’s social value and their reproductive health.
- The concept of preventive nutrition, which gives importance to puberty and applies to reproductive function.
- The relationship between pre- and perinatal health, energy balance and physical activity.
Just as these three specific topics have been selected because they may give rise to new approaches in relation to maternal health, specific topics could also be selected in relation to child health. It should be emphasized that women’s health in its reproductive function has often been approached in a utilitarian and unfair way toward women.
In general, very little attention has been paid to women’s nutritional needs in themselves, before, during and after reproductive life. Here, these aspects of women’s nutrition are treated as such.
Social Value and Reproductive Health
Women, especially in traditional cultures, are the primary element in actions for the promotion and protection of family health. Despite this, women are underestimated in their social role, as reflected in the male dominance of society and the family, which reaches the extreme of machismo.
Their lack of preparation to perform their social function results in failures, as clearly shown by correlation studies between infant mortality and maternal educational level as a variable independent of socioeconomic level and other variables.
The mechanisms through which this relationship is established are complex and have deep practical repercussions. Better knowledge of them may give rise to priority interventions aimed at increasing the social value of women. This, in turn, should facilitate and promote their educational level and preparation to assume greater responsibilities in the household economy, health and nutrition of the entire family nucleus.
The low social value assigned to women leads, in cases of relative food scarcity, to discrimination against the young girl in favor of the young boy, and against the adult woman in favor of the adult man. This behavior, in turn, establishes a family food-consumption pattern that is manifested in a higher frequency of malnutrition among girls and, through negative functional repercussions, in defects in physical growth, cognitive and emotional development, and future reproductive functions.
Another consequence of social devaluation is that the need for formal education for girls is underestimated, since they are used predominantly to meet household needs and to support the mother in caring for younger siblings. This unilateral reduction of their social function and limitation of their education makes them subject to the cultural tradition transmitted through the mother and, frequently, the grandmother, giving rise to the perpetuation of a social attitude that accepts female inferiority.
Within the same framework, the value of women’s economic contribution during puberty and adolescence is considered inferior to that of men. A frequent solution to this problem is to give the girl in marriage at a very young age and, in that way, bring a productive male into the girl’s family, or send the girl into the husband’s family. This early union also influences early pregnancies, before the age of 17, which are a risk for the future mother and for her child.
Among women, an important part of food-intake limitation during times of scarcity is a behavioral pattern that often does not rise to consciousness and is very difficult to overcome through nutritional education. This psychological condition also favors the development of unfair feeding habits, which persist and may even intensify during pregnancy and lactation.
Faced with this complex situation, which defines not only dietary patterns but also the general behavior of the socially underestimated woman, it would be too much to expect her behavior to change solely because of pregnancy and lactation, which physiologically do not favor the intake of larger amounts of food.
There are data that document the previous concepts. In most underdeveloped countries where no actions have been specifically directed toward reducing malnutrition and infant mortality, the proportion of girls who die with a diagnosis of malnutrition before the age of five is higher than that of boys who die with the same diagnosis in the same age group.
Moreover, this difference is due mainly to the contribution of the two-to-five-year-old group, a situation that reflects the progressive deterioration of the girl’s nutrition in relation to the boy’s when both compete for, and depend on, the availability of food at the family table.
By contrast, mortality from dehydration and acute diarrhea is similar for both sexes, both among children under one year of age and among those between two and five. This suggests that, when faced with a process requiring immediate care because of risk of death, both sexes receive it equally. But this is not the case with the intrafamily distribution of food, which is a continuous process, strongly determined by cultural patterns and less dramatic in terms of acute severity.
In the same groups of countries, illiteracy is higher among females than among males, given the lesser importance assigned to women’s education. Ethnographic studies of societies where the social devaluation of women is most evident show the predominance of agreements between families to arrange unions between pubescent girls and adolescent boys.
