By Judith S. McGuire

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Extra resources for Helping Women Improve Nutrition in the Developing World: Beating the Zero Sum Game (World Bank Technical Paper) (No 114)

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Women are the crucial link between the family and the traditional and modern health systems. One study of health-seeking behavior in 16 countries found women most often make the initial decisions about health care use (including self-care) except in crisis situations involving substantial sums of money. In the latter case, the male head of household becomes involved [43]. Women are expected to implement the child survival revolution by · bringing children to be immunized four times during the first year of life · procuring or producing oral rehydration solutions and administering them to the sick child many times over the course of each day of every bout of diarrhea · breast-feeding their babies on demand until the child is six months to two years old and processing and feeding proper weaning foods in frequent meals to small children · bringing children under age five to a weight surveillance program monthly.

Research has usually found time costs an important determinant of health service demand (reviewed in Akin et al. [45] and Leslie [44]). Women's time constraints have also limited breast-feeding [47, 48] and participation in a village-based vitamin A delivery system [49, 50]. Time costs of prenatal care in the Philippines are its chief deterrent to use [51]. Women's time costs and constraints appear to be either undervalued or ignored in the design of most primary health care systems. Clinic hours, long waits, and the need to go to a clinic (rather than a community worker) for certain services are factors to be considered.

Repeated miscarriages, stillbirths, and fetal losses combine with the LBW-related infant deaths to potentiate the effects of mothers' cultural roles on her nutritional status--issues discussed above. Second is the conflict between women's economic roles and their own nutritional needs. This issue is affected by changes in energy expenditures and intrahousehold food allocation associated with an enhanced economic role for women. Increased economic participation may increase energy expenditures--for instance, for women engaged in agricultural labor.

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Helping Women Improve Nutrition in the Developing World: Beating the Zero Sum Game (World Bank Technical Paper) (No 114) by Judith S. McGuire


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