For women to be healthy during pregnancy and childbirth they need:

• good nutrition, especially during childhood
• several years of education
  (beyond primary level)
• respect and consideration in their home and their society.

Nutrition
By the time a woman becomes pregnant, many things will have happened in her life which affect her health. For example, the food she ate as a child – the type and the amount – will make a big difference. Poor nutrition in early childhood results in slow growth and stunting. In many families, girl children are fed last and receive least food. This often leads to malnutrition and anaemia. They are also more likely to become seriously ill. They grow up into weaker adults. So poor nutrition for girls is directly linked to long, obstructed labour and a greater risk of death from bleeding or infection during childbirth.

Health workers and communities need to know that:

• l during infancy and childhood, girls need the same quantity and type of food as boys
• l once they get their monthly periods, girls may need additional iron in their diet to prevent anaemia
• l good nutrition during a girl’s infancy, childhood and adolescence contributes to healthier mothers and babies.

Education
Education gives people skills and con-fidence, and makes them aware of the choices they can make in their lives.
Educated women are more likely to marry later, have their first preg-nancy later and have fewer children. In addition, they are more likely to know about contraception, start to use it earlier and rely on modern rather than traditional methods. Educated women are more likely to attend for antenatal care during pregnancy.
Fewer girls go to primary school than boys. This is because girls are frequently kept at home to help with domestic chores such as collecting water and firewood, cooking, cleaning and caring for younger children. For the same reasons, girls who begin school often leave sooner than boys.
It is true that these seem to be good reasons for a family to stop their girls going to school. But there are even better reasons to keep girls at school – their own health and the health of their children depend on it.

Respect and consideration
Women’s health suffers in societies where women have a low status. where they are not respected, their needs are not taken into consideration and they are not able to take part in making decisions. It is more difficult for women to be healthy, or to help their children to be healthy if they have no money, or if they are exhausted from working too hard. It is even worse if their husband or partner is violent. The effect of the social and economic side of her life on a woman’s health is far more important than the medical services she uses (although these are important too!)
Women who are not allowed to make decisions cannot make use of health education messages. For exam-ple, a midwife may tell a pregnant woman who is anaemic that she should eat foods rich in iron. But if her husband controls all the money, deci-des what food is to be eaten, and eats first at family meals, then the woman is not able to act on this good advice.
In societies where women are more respected, they are more likely
to have some control over decisions which affect their own and their children’s health.
Although health workers cannot change society, they can make sure that the way they work is based on an understanding of the lives of women having babies. When they understand the problems and realities of women’s lives, they will better be able to give care which reaches those most at risk.

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