In cultures where the preceding conditions exist, research aimed at identifying areas and mechanisms of intervention to increase the social value of women could be considered a priority. The evaluation process would move through intermediate stages leading to positive results in terms of the health and well-being of mothers, children and families.
Within this line of priority research, it will be important to seek and document the impact of processes that preferentially promote basic education and productive work among girls. The assumption is that better-prepared women will seek later unions.
Education within primary healthcare systems could also give importance to family education and to promoting greater social valuation of girls and women. Research is needed to define, on the basis of the cultural patterns specific to each group, the educational processes, contents and techniques that are acceptable and most effective.
The results of such studies should support actions capable of producing the following effects: reduction of early pregnancies; reduction of chronic protein-energy malnutrition in girls; reduction of malnutrition and overall infant mortality; and increased family well-being through a better household economy and through intrafamily stimulation that incorporates concepts of more equitable treatment of children.
Preventive Nutrition
In developing countries, it is not uncommon for women to reach reproductive age with the effects of chronic malnutrition, reflected in low height and weight, low weight for height, lean body mass and inadequate adiposity. They also frequently have profound deficiencies of specific nutrients, especially iron, which cause severe anemia.
In addition, these women show delayed sexual maturation, such as late menarche, and pregnancy and childbirth processes that are often complicated. The sum of these conditions results not only in a suboptimal gestational outcome, but also, for mothers and children, in high mortality rates during the perinatal period and a maternal health condition below the ideal.
Various studies have shown that food supplementation during pregnancy is capable of increasing the mother’s weight during that period, as well as the weight and maturation conditions of full-term newborns among groups of poor mothers who were undernourished before the beginning of pregnancy.
However, the relative impact of food supplementation is low when compared with the influence of the mother’s pre-pregnancy height and weight on the weight of the full-term newborn.
Moreover, nutritional interventions directed at pregnant women that include the provision of food for home consumption, when distributed within the family, result in the pregnant and lactating woman receiving a much smaller proportion than desired. In the Colombian study, for example, this proportion was 15%.
The process of food supplementation during pregnancy appears to be less efficient in very poor families and in those where the woman’s weight before pregnancy is lower. This may be due to two factors: a) a higher level of food distribution among other family members and food “leakage”; and b) thin women appear to have lower efficiency in using calories for weight gain during pregnancy and possibly during the preceding period.
The efficiency of caloric use may vary up to fivefold, and this variation makes weight gain more difficult in thin women. This is aggravated if the pregnant woman is an adolescent and still actively growing.
On the other hand, it is conceivable that the greater the food restriction, the greater the organism’s efficiency in using nutrients. Estimates of efficiency yield a figure of 2% in terms of conversion of supplemental energy intake into newborn weight.
Various studies also show that, under natural conditions without intervention, food intake during the last 10 weeks of pregnancy increases, on average, by slightly less than 5% when food is abundant. According to estimates, intake among pregnant women under conditions of relative scarcity does not differ from that of non-pregnant women and is subject to the same variations when food availability changes.
For all these reasons, it can be stated that pregnancy is far from being the most useful period for carrying out a nutritional intervention. However, in the presence of an undernourished pregnant woman, or groups of women who can only be reached because of pregnancy, an intervention during this critical and short period is necessary.
Consequently, when different nutritional and health interventions are necessary or desirable in order to improve women’s reproductive condition, they should be carried out before pregnancy, when there is more time and possibly greater receptiveness to changes in eating habits: during school age, puberty, adolescence and between pregnancies.
Added to this is the fact that many of the disorders observed during labor and childbirth in societies characterized by women’s undernutrition can be prevented by promoting better growth and pubertal development.
