Many of the leading causes of death and disability of women in developing countries can be prevented or treated through highly cost-effective interventions
Because many of the interventions that address women's health problems are highly cost-effective, any national health investment strategy based on achieving the greatest health gains at the least cost will give considerable emphasis to interventions directed at women. Special attention is warranted to reaching women during adolescence, when reproductive and other lifestyle behaviors set the stage for later life.
The arguments for accelerating investment in women's health and nutrition are compelling. Such investments promote equity. They confer widespread benefits for this generation and the next. And they are good for economic efficiency. Those are the conclusions of a recent World Bank Discussion Paper.[1]
A life cycle approach to women's health takes into account both the specific and the cumulative effects of poor health and nutrition. Many of the health problems affecting women of reproductive age, their newborns, and older women begin in childhood and adolescence. For example, inadequate diet in youth and adolescence can lead to anemia or stunting, which contribute to complications in childbirth and to underweight babies, and insufficient calcium can lead to osteoporosis later in life.
The following examples sketch a picture of some of the health and nutrition problems women face in developing countries:
Any national package of interventions designed on the basis of cost-effectiveness and the disease burden would include the following essential services for women:
Even in the poorest countries, governments can help to establish these essential services and ensure access to them by financing health interventions for the poor in the national package and interventions to change behavior for the entire population. Services beyond the national package should be financed from private sources.
Where resources permit a more comprehensive national package of interventions against a larger number of diseases and conditions, the essential services could be expanded and upgraded to include:
Governments have considerable power to improve the health outlook for their female citizens if they are willing to enact and promote gender-sensitive policies and to strengthen women's health services. Effective policy reform must include not only changes in the health delivery system but also efforts to redress social, educational, and economic inequities.
Existing services can be improved, extended, and tailored to fit local conditions. For example, where cultural norms discourage women from receiving care from men, governments could recruit and train more female health providers. In the design and implementation of health programs, attention can be paid to factors that have particular relevance to women because of biological and social influences: access, quality (including provider competence, counseling, continuity of care, and privacy), number of female health providers, and responsibilities of nonphysicians, such as midwives.
By working closely with the private sector to deliver information and services to improve women's health and nutrition, governments can help derive the greatest benefits from national health resources. Nongovernmental organizations that are well respected in the community can be helpful in reaching and representing disadvantaged women. Private for-profit providers can supplement government programs by offering a broader range of services to those who can afford to pay for them.
National education programs can be used to promote positive health behaviors and to change attitudes and conduct that are harmful to women. Such programs have been effective in changing a wide range of health behaviors related to family planning, nutrition, AIDS prevention, and tobacco consumption.