In Her Lifetime -- Copyright -- Dedication -- Acknowledgments -- Contents -- 1 Summary -- PREAMBLE -- THE "LIFE SPAN" APPROACH -- THE STUDY PROCESS -- Background -- The Committee and Its Process -- Study Objectives -- Dilemmas and Strategies -- Definitions -- Sub-Saharan Africa -- Sex and Gender -- Report Organization -- CONCLUSIONS AND RESEARCH NEEDS -- Conclusions -- Gender-Related Burden -- Health Problems Across the Female Life Span: A Synthesis -- Research Needs -- Notes -- 2 The Context of Mortality and Morbidity -- THE IMPORTANCE OF CONTEXT -- THE ISSUE OF HETEROGENEITY -- THE SOCIOECONOMICS OF LIFE AND DEATH -- The Variables -- Gender Disparities -- Morbidity and Mortality -- Health Services Access and Utilization and Health-Seeking Behavior -- Access Bias -- Health-Seeking Behavior -- The Dynamics of Female Education -- Access Bias -- Access to Assets, Employment, and Income -- Widowhood and Its Sequelae -- POWER, CONTROL, EQUITY, AND STATUS -- Fostering -- Kinship and Residence -- HIV and AIDS -- SOCIAL DISRUPTION AND HEALTH STATUS -- War and Civil Strife -- Refugee Status -- Gender Violence -- Early Marriage -- Traditional Medicine -- Traditional Practices -- Food Prescriptions and Proscriptions -- Pregnancy, Labor, and Delivery -- Female Genital Mutilation -- CONCLUSIONS -- References -- 3 Nutritional Status -- WOMEN'S ROLES AND FEMALE NUTRITIONAL STATUS IN SUB-SAHARAN AFRICA -- Effects of Household Food Production and Acquisition Strategies on the Nutritional Status of Women and Children -- Effects of Commercial Agriculture -- Seasonality -- Dietary Intake and Energy Expenditure of Pregnant and Lactating Women -- EXTENT OF MALNUTRITION AMONG FEMALES IN SUB-SAHARAN AFRICA -- Micronutrient Disorders -- Protein-Energy Malnutrition -- Obesity -- Micronutrient Deficiencies.

FUNCTIONAL CONSEQUENCES OF FEMALE NUTRITIONAL STATUS: TAKING A LIFE SPAN PERSPECTIVE -- Mortality and Morbidity -- Mortality -- Morbidity -- Cognitive Development and School Performance -- Reproductive Function -- Physical Work Capacity -- CONCLUSIONS -- RESEARCH NEEDS -- Notes -- References -- 4 Obstetric Morbidity and Mortality -- GENDER BURDEN -- THE LIFE SPAN: AN APPROACH TO MATERNAL MORBIDITY AND MORTALITY -- Childhood -- Adolescence -- Menopause and Postmenopause -- THE MAGNITUDE OF PREGNANCY-RELATED MORTALITY AND MORBIDITY -- Quantification of Maternal Mortality -- Vital Statistics -- Health Services Statistics -- Population-Based Data -- Alternative Approaches -- The Burden of Maternal Mortality and Morbidity -- Percent of Pregnancy-Related Deaths and Lifetime Risk of Dying -- Estimates of Maternal Morbidity -- Trends -- THE NATURE OF MATERNAL MORTALITY AS A PUBLIC HEALTH PROBLEM -- Prediction, Prevention, and Cure -- Prediction: Risk Factors and the Utility of Risk Scores -- Maternal Characteristics -- Community Characteristics -- Calculations of Risk -- Prevention -- Cure -- THE MULTIPLE CAUSALITY OF MATERNAL DEATH -- Clinical Causes -- Anemia -- Complications of Pregnancy and Delivery -- Sociocultural Factors: Traditional Medical Practices -- The Traditional Birth Attendant -- Gishiri Cuts -- Female Genital Mutilation (FGM) -- Health Services -- Access to Antenatal and Intrapartum Care -- MATERNAL HEALTH AND FAMILY PLANNING -- Provision of Family Planning Services -- Abortion -- Lactation -- MENOPAUSE -- CONCLUSIONS -- RESEARCH NEEDS -- References -- 5 Nervous System Disorders -- LIFE SPAN PERSPECTIVE -- TOXIC AND NUTRITIONAL DISORDERS OF THE NERVOUS SYSTEM -- HEADACHE SYNDROMES -- Migraine -- Tension Headache -- CEREBROVASCULAR DISEASES AND USE OF ORAL CONTRACEPTIVES -- OTHER NEUROLOGICAL DISORDERS -- Epilepsies -- Demyelinating Diseases.

Neurologic Complications of Collagen Diseases -- Dementia -- CONCLUSIONS -- RESEARCH NEEDS -- References -- 6 Mental Health Problems -- MENTAL HEALTH AND MENTAL ILLNESS IN AFRICA: GENERAL ISSUES -- GENDER DIFFERENCES IN THE RATE, COURSE, AND OUTCOMES OF MENTAL DISORDERS: GLOBAL ISSUES -- THE EPIDEMIOLOGIC EVIDENCE IN AFRICA -- GENDER DIFFERENCES IN AFRICA FOR ALL PSYCHOLOGICAL DISORDERS -- AFFECTIVE AND NEUROTIC DISORDERS -- SCHIZOPHRENIA -- Incidence -- Prevalence -- Course and Outcome -- PSYCHOLOGICAL DISORDERS IN GENERAL MEDICAL SETTINGS -- PSYCHOLOGICAL DISORDERS IN PREGNANCY AND THE PUERPERIUM -- CONCLUSIONS -- RESEARCH NEEDS -- Note -- References -- 7 Cardiovascular Diseases, Cancers, and Chronic Obstructive Pulmonary Diseases -- CARDIOVASCULAR DISEASES -- Emerging Problems -- Coronary Artery Disease -- Stroke -- Factors Influencing Coronary Artery Disease and Stroke Risk -- Smoking -- Hypertension -- Dyslipidemias -- Obesity -- Diabetes Mellitus -- Oral Contraceptive Use -- Continuing Problems -- Rheumatic Heart Disease -- Cardiomyopathies -- CANCERS -- Emerging Problems -- Cancer of the Breast -- Cancers of the Uterus and Ovary and Choriocarcinoma -- Colorectal and Lung Cancers -- Continuing Problems -- Cancer of the Cervix -- Leukemias and Lymphomas -- Skin Cancers -- Liver Cancer -- Bladder Cancer -- CHRONIC OBSTRUCTIVE PULMONARY DISEASES -- Cigarette Smoking -- Indoor Air Pollution -- CONCLUSIONS -- RESEARCH NEEDS -- References -- 8 Injury -- DEFINITIONS -- INJURIES WORLDWIDE -- Injuries as a Public Health Issue -- INJURIES IN THE DEVELOPING WORLD -- Epidemiologic Transition -- INJURY PATTERNS IN DEVELOPING COUNTRIES -- Evidence in Females -- LIFE SPAN APPROACH -- Motor Vehicle Injuries -- Implications for Females -- Other Unintentional Injuries: Burns, Drowning, Falls, and Unintentional Poisonings -- Burns -- Drowning -- Falls.

Unintentional Poisonings -- VIOLENCE AGAINST FEMALES-A GROWING PUBLIC HEALTH PROBLEM -- Fatal Violent Injuries in Females -- Homicide -- Suicide -- Nonfatal Violent Injuries in Females -- Domestic Abuse (Battering) -- Rape and Sexual Assault -- Implications of Intentional Injury Directed Specifically Toward Females -- CONCLUSIONS -- RESEARCH NEEDS -- Improved Data Sources -- Prevention Strategies -- References -- 9 Occupational and Environmental Health -- WOMEN'S WORK IN SUB-SAHARAN AFRICA -- WOMEN AND WORK IN HISTORICAL CONTEXT -- PROBLEMS OF DEFINITION -- THE NATURE OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH PROBLEMS -- Occupational Injuries -- Occupational Diseases -- Chemical Hazards -- Toxic Emissions -- LIFE SPAN APPROACH -- NATURE OF THE EVIDENCE -- An Occupational and Environmental Health Hazard Profile for Women -- Physical Factors -- Chemical Factors -- Biological Factors -- Work Organizational Factors -- Psychosocial Organization of Work -- Job Load -- Job Control -- The Physical Organization of Work -- Additional Considerations Unique to Women in Sub-Saharan Africa -- Adverse Health Outcomes of Occupational and Environmental Hazards -- Indirect (Group) Health Effects -- Direct (Individual) Health Effects -- CONCLUSIONS -- Nature of Women's Work and Problems of Definition -- Morbidity and Mortality -- RESEARCH NEEDS -- References -- 10 Tropical Infectious Diseases -- MALARIA -- Malaria in Children -- Malaria in Adolescent and Adult Females -- SCHISTOSOMIASIS (BILHARZIASIS) -- Schistosomiasis in Children -- Schistosomiasis and the Adolescent Female -- Schistosomiasis in Adult Females -- AFRICAN TRYPANOSOMIASIS -- African Trypanosomiasis in Children -- African Trypanosomiasis in Adolescent and Adult Females -- African Trypanosomiasis and Pregnancy -- TRACHOMA -- Trachoma in Children -- Trachoma in Adolescent and Adult Females.

DRACUNCULIASIS (GUINEA WORM) -- Dracunculiasis in Children and Adolescents -- Dracunculiasis in Adult Females -- ONCHOCERCIASIS AND LYMPHATIC FILARIASIS -- Onchocerciasis in Children -- Onchocerciasis in Adolescents -- Onchocerciasis in Adult Females -- LEISHMANIASIS AND LEPROSY -- CONCLUSIONS -- RESEARCH NEEDS -- References -- 11 Sexually Transmitted Diseases and HIV Infection -- OVERVIEW -- STDs, Including HIV Infection, and their Complications -- Complications of STDs -- Gender Differentials in STDs and HIV Infection -- Control Over the Circumstances of Sexual Intercourse -- Acquisition of STDs and HIV Infection and Development of Complications -- Health-Seeking Behavior -- Detection and Treatment of STDs -- The Social Implications of STDs and HIV Infection -- STDs and HIV Infection Throughout the Female Life Span -- Infancy, Childhood, and Adolescence -- MAGNITUDE OF THE PROBLEM -- Morbidity -- Prevalence -- Mortality -- Economic Impact -- SOCIETAL DETERMINANTS OF STDS AND HIV INFECTION -- Population-Age Composition -- Urbanization, Sex Ratio, and Population Mobility -- War and Social Unrest -- Sexual Norms, Women's Social Status, and Patterns of Sexual Behavior -- Availability and Utilization of Health Services -- CONCLUSIONS -- RESEARCH NEEDS -- Operational Research -- Technology Development -- Behavioral Research -- Clinical Research and Epidemiology -- Notes -- References -- APPENDIX -- Appendix A Demographic Overview and State of the Data -- DATA ON FEMALE MORTALITY AND MORBIDITY ACROSS THE LIFE SPAN -- Data on Mortality -- Sources and Measures -- Gender Differences in Mortality -- Levels of Mortality -- Trends in Mortality over Time -- Cause-Specific Mortality Across the Life Span -- Data on Morbidity -- Sources and Quality -- Estimates of Morbidity -- Disability-Adjusted Life Years.

Understanding Mortality and Morbidity Across the Life Span.