TOPIC 5. FOOD AND CARE FOR WOMEN

NUTRITION NOTES

Why women should eat well

Girls and women need to eat well throughout their lives but particularly when they are planning a baby, are pregnant or breastfeeding. If they eat healthy, balanced diets they are likely to:

• stay active and well;

• produce healthy babies and breastfeed successfully.

A woman is at risk of complications and a difficult labour if she is already undernourished when she becomes pregnant, or is undernourished during pregnancy, and her baby is likely to have a low birthweight (i.e. <2 500 g). Low birthweight babies are at greater risk than healthy newborns of:

• growing and developing slower;

• contracting an infection and of dying. The lower the birthweight the greater the risk of death;

• having low body stores of micronutrients that may result in disorders, such as anaemia, and vitamin A and zinc deficiencies;

• developing heart disease, high blood pressure, obesity and diabetes when adult.

Other causes of low birthweight are prematurity, malaria or other infections in the mother, or the mother’s smoking or abusing drugs during pregnancy.

Feeding women and girls of reproductive age

Look at Appendix 2, Table 4. It compares the daily energy and nutrient needs of average-sized women and men.Women of reproductive age who are not pregnant or breastfeeding have slightly lower energy and protein needs than men but they need double the amount of iron (because of menstruation). Compared to men’s diets, the diets of women should provide:

• slightly smaller amounts of staples, legumes and fats;

• at least the same amounts of vegetables and fruits;

• more iron-rich foods (meat, offal, poultry and fish).

Women's needs for energy and most nutrients increase during pregnancy and breastfeeding. Iron needs during pregnancy are so high that it is usually advisable to give iron supplements, such as iron/folic acid tablets (see Topic 11, page 91).

Make sure that women and their relatives know the following.

• All girls and women of reproductive age should:

  - eat a healthy, balanced diet (see Topic 3) that contains plenty of iron-rich foods;
  - have plenty of clean, safe drinks;
  - eat iodized salt.Women who lack iodine when they become pregnant are at greater risk of having a baby who is physically and mentally damaged (see Section C, page 9).

• Pregnant and breastfeeding women and girls need extra food (see Appendix 2, Table 4).

  - When pregnant they need about 280 extra kcal/day, more protein, zinc, vitamin A, vitamin C and folate, and much more iron (i.e. the equivalent of an extra nutritious snack each day; see Topic 3, page 35, for examples). It is particularly important for women to eat well and be well nourished throughout their pregnancy, including the first trimester, so that the babies’ bodies and brains develop properly. Women should gain about 1 kg a month in the second and third trimester of pregnancy.

  - When breastfeeding they need about 450 extra kcal/day and much more protein, zinc, vitamin A, vitamin C and folate (i.e. the equivalent of an extra small meal each day).You can suggest that women eat more at each meal or eat more frequently - perhaps having more snacks during the day.

  - Women should eat well between pregnancies so they rebuild their bodies’ stores of nutrients.

A woman who is overweight or obese when she becomes pregnant should eat healthy meals but not ‘diet’. Advise her how to lose weight if she is still overweight after breastfeeding (see Box 19 in Topic 11, page 94).

At certain times some women may need micronutrient supplements in addition to good meals. For example, most women need iron/folic acid tablets during pregnancy. A good diet should provide enough of the other micronutrients, including vitamin A. However, in situations where vitamin A is likely to be deficient, women should receive vitamin A supplements as soon after delivery as possible and not more than six weeks later. This provides a store for use during breastfeeding. Do not give high doses of vitamin A to any woman who could be pregnant as they can harm her unborn baby.

Figure 8. Women need extra food when they are pregnant or breastfeeding

In some places many women are HIV+. Make sure these women know:

• the risks of passing the virus to their unborn or breastfeeding babies and how to minimize these risks (see Topic 6, page 55);

• that good feeding will help them stay healthy longer (see Topic 10, page 85).

Another way to help women and their unborn babies

You can help to improve the health of women and prevent their babies from having low birthweights by encouraging family planning. Advise parents to:

• wait at least two to three years between pregnancies;

• not have a baby when the woman is too young (e.g. under 18 years) or too old;

• wait at least six months between ending breastfeeding and becoming pregnant again. This gives time for women to ‘fill up’ their body stores of fat, iron and other nutrients and become strong again.

Exclusive breastfeeding (see Topic 6) is one contraceptive method (although not a totally secure one). A woman is unlikely to become pregnant if:

• she has not restarted her menstrual periods and;

• the baby is less than six months old and;

• the baby breastfeeds exclusively (has nothing else to eat or drink or suck).

Dangers of adolescent pregnancy

Adolescent pregnancy is a nutritional as well as a social problem in many places. Adolescent mothers are likely to be undernourished and to have undernourished babies because:

• their bodies are still developing so their nutrient needs during pregnancy are especially high. They are more likely to die during pregnancy and childbirth than older women;

• some girls are frightened to admit that they are pregnant, so they delay getting antenatal care. Some girls are forced to leave school or home and to support themselves, often by prostitution.

Warn adolescent girls of the dangers of becoming pregnant, tell them about the different methods of contraception, and monitor and counsel them sympathetically if they do get pregnant.

SHARING THIS INFORMATION

Before sharing this information with families, you may need to:

1. Find out. What women eat. What pregnant women eat. What breastfeeding women eat. What the food customs and taboos for menstruating, pregnant and breastfeeding women are. What types of malnutrition there are among women, especially pregnant and breastfeeding women. Whether adolescent pregnancy is a problem. Whether adolescent pregnant girls are undernourished. How many babies have low birthweights. What the causes of low birthweight are. What people believe are the causes of low birthweight. What the blocks to women having better diets are. Whether anaemia and/or vitamin A deficiency disorders are problems in the area.

2. Prioritize. Decide which information is most important to share with women and their families.

3. Decide whom to reach. For example: women and adolescent girls; women’s partners and other relatives; relatives of adolescent girls.

4. Choose communication methods. For example: discussions, handouts, demonstrations of good foods for women, quizzes, plays/drama and songs.

Examples of questions to start a discussion
(choose only a few questions that deal with the information women and their partners need most)

Why do women and girls need good food all the time?

Do pregnant women need extra food? Why? Which foods are good for pregnant women? Do women need to improve their diets when they are pregnant? How can they do this?

Are there customs and taboos that prevent some women from eating nutrientrich foods (e.g. eggs or fish)?

Do breastfeeding women have special food needs? What are they? Do they need to improve their diets when they are breastfeeding? How can they do this?

Do some babies have low birthweights? Does this matter? What can we do to improve the birthweights of the babies?

Are adolescent pregnancies a problem in the area? Why are adolescent mothers at risk of having low birthweight babies? How can we help these girls?