Hesperian Health Guides

Hesperian Health Guides

Chapter 4: Helping women stay healthy

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HealthWiki > A Book for Midwives > Chapter 4: Helping women stay healthy


A woman who eats well and takes good care of her body is much more likely to have a healthy pregnancy and healthy baby. In fact, the ways to stay healthy listed in this chapter can be used by women and their families to stay well throughout their whole lives.

Eating well

Eating well means eating enough food and eating a variety of healthy foods.

Eating well helps a woman and her baby stay healthy and strong.

Eating well:

  • helps a woman resist illness and stay healthy.
  • keeps a woman’s teeth and bones strong.
  • gives a woman strength to work.
  • helps the baby grow well in the mother’s womb.
  • helps prevent heavy bleeding after birth.
  • helps a mother recover her strength quickly after birth.

Contents

Problems from poor nutrition (not eating well)

Poor nutrition can cause tiredness, weakness, difficulty fighting infections, and other serious health problems.

Poor nutrition during pregnancy is especially dangerous. It can cause miscarriage or cause a baby to be born very small or with birth defects. It also increases the chances of a baby or a mother dying during or after birth.

Talking to women about food

Talk to women about the food they eat. The earlier women start eating healthier foods, the better chance they have to stay healthy, to have normal births, and to have healthy babies.

2 women speaking to each other.
I eat cassava every day, and I usually have some fish — or beans cooked with onions and tomatoes, and I drink soda pop.
That sounds good. Cassava gives energy. Beans and fish give strength. If you drink fruit juice instead of soda pop, and you also eat some green vegetables, you will get more vitamins.

To find out whether a woman is eating well, ask her what she usually eats, and how much. For example: “What did you eat yesterday?” Be sure to tell her what is healthy about what she eats. Then make a suggestion for how she could eat better.

Even if a woman knows the best foods for health, she may not eat them. Many families cannot afford to buy enough food or a wide variety of foods. Other women simply may not like the taste of some foods. To help a woman eat better, suggest healthy foods that she can and will choose to eat.

Eat more food

Pregnant women and women who are breastfeeding need to eat more than usual. The extra food gives them enough energy and strength, and helps their babies grow.

Some pregnant women feel nauseated and do not want to eat. But pregnant women need to eat enough — even when they do not feel well. Simple foods like chapatis, tortillas, or rice can be easier for these women to eat.

Eat a variety of foods

examples of the kinds of foods listed below, including flour, rice, milk, yogurt, fish, beans, oil, fruits, and vegetables.
For a healthier body, eat many kinds of foods.

It is important for pregnant women (like everyone else) to eat different kinds of food: main foods (carbohydrates), grow foods (proteins), glow foods (vitamins and minerals), and go foods (fats, oils, and sugar), along with plenty of fluids.

Main foods (carbohydrates)

In most parts of the world, people eat one main food at each meal. This main food may be rice, maize, wheat, millet, cassava, taro, plantain, breadfruit, or another low-cost starchy food. These foods give the body energy. But to grow and stay healthy, the body needs other types of food too.

Grow foods (proteins)

Grow foods contain protein, which is needed for the growth of muscles, bones, and strong blood. Everyone needs protein to be healthy and to grow.

Some grow foods high in proteins:

  • eggs
  • legumes (beans, peas, and lentils)
  • nuts and seeds
  • cheese, milk, and yogurt
  • meat, fish, and insects


Note: Meat, fish, and cheese are nutritious foods but they can carry parasites or disease when they are eaten raw. Pregnant women should only eat fish, meat, or cheese that is well cooked or pasteurized. Fish, especially fatty fish, can also contain mercury and other poisons because water is often contaminated. Pregnant women should avoid fatty fish, to be safe.
Glow foods (vitamins and minerals)

Glow foods contain vitamins and minerals, which help the body fight infection and keep the eyes, skin, and bones healthy and strong.

Fruits and vegetables are high in vitamins and minerals. It is important for women to eat as many different fruits and vegetables as they can.

Go foods (sugars and fats)

Go foods contain sugars and fats, which give the body energy. Everyone needs these foods to be healthy.

These days, many people eat more sugars and fats than they need. That is because more people drink sugary soda pop, or eat foods that come from packages instead of foods made at home. These packaged, sugary foods are expensive and not as healthy. They also damage the teeth. It is better to eat go foods that are natural, not packaged.

Some healthy go foods
high in sugars:

  • fruit
  • honey
  • molasses

Some go foods high
in fats:

  • nuts and seeds
  • avocados
  • vegetable oil,
    butter, ghee, and lard
  • fatty meat

Eat these 5 important vitamins and minerals every day

Pregnant and breastfeeding women need more of five vitamins and minerals — iron, folic acid, calcium, iodine, and vitamin A — than other people do. Pregnant women should try to get these vitamins and minerals every day because the baby needs them to grow and be healthy. Every pregnant woman needs enough for the baby and for herself.

Iron

Iron helps make blood healthy and prevents anemia (weak blood). A pregnant woman needs a lot of iron to have enough energy, to prevent too much bleeding at the birth, and to make sure that the growing baby can form healthy blood and store iron for the first few months after birth.

These foods contain a lot of iron:

  • meat (especially liver, kidney, and other organ meats)
  • poultry (birds)
  • grasshoppers, crickets, and termites
  • fish, clams, and oysters
  • eggs
  • beans, peas, and lentils
  • sunflower, pumpkin, and squash seeds
  • dark green leafy vegetables
  • breadfruit
  • yams
  • hard squash
  • blackstrap molasses


Other ways to get more iron:

  • Eat iron foods with citrus fruits or tomatoes. The vitamin C in these foods helps a woman absorb iron into her system.
a hand squeezing a lemon into a glass containing an iron nail.
  • Cook food in iron pots or add a clean piece of iron — like an iron nail — to the cooking pot. Only use a nail that you know is made of pure iron, not a mix of metals.
  • Put a clean piece of pure iron, like an iron nail, in a little lemon juice for a few hours. Drink the juice mixed with clean water.


It can be difficult for a pregnant woman to get enough iron, even if she eats iron-rich foods every day. If possible, she should also take iron pills or iron syrup. These medicines may be called ferrous sulfate, ferrous gluconate, ferrous fumerate, or other names.

In many places health centers will give iron pills to pregnant women. Sometimes iron pills are combined with folic acid. The iron pills may make it hard for the woman to pass stool (constipation), and her stool may turn black. These problems should get better in a few days.

Folic acid (folate)

Lack of folic acid can cause anemia in the mother and severe birth defects in the baby. To prevent these problems, it is most important for a woman to get enough folic acid before she gets pregnant and in the first few months of pregnancy.

These foods contain a lot of folic acid:

  • whole grains (brown rice, whole wheat)
  • dark green leafy vegetables
  • meat (especially liver, kidney, and other organ meats)
  • peas and beans
  • fish
  • sunflower, pumpkin, and squash seeds
  • eggs
  • mushrooms

Some women also take folic acid pills.


Folic acid pills
  • take 0.5 to 0.8 mg (500 to 800 mcg) folic acid
by mouth, 1 time each day

Calcium

A growing baby needs a lot of calcium to make new bones, especially in the last few months of pregnancy. Women need calcium for strong bones and teeth.

These foods contain a lot of calcium:

  • milk, curd, yogurt, and cheese
  • ground sesame (tahini)
  • almonds
  • green leafy vegetables
  • yellow vegetables (hard squash, yams)
  • shellfish
  • lime (carbon ash)
  • bone meal and eggshells
hands scraping lime into a cooking pot.


Women can also get more calcium in these ways:

  • Soak bones or eggshells in vinegar or lemon juice for a few hours. Then
    use the liquid to make soup or eat with other foods.
  • Add lemon juice, vinegar, or tomatoes when cooking bones.
  • Grind eggshells into a fine powder and mix into food.
  • Soak maize in lime (carbon ash) before cooking it.
Iodine

Iodine prevents goiter (swelling of the throat) and other problems in adults. Lack of iodine in a pregnant woman can cause her child to have hypothyroidism (cretinism), a disability that affects thinking and brain development.

The easiest way to get enough iodine is to use iodized salt instead of regular salt.

These foods contain a lot of iodine:

  • shellfish (like shrimp)
  • fish
  • seaweed
  • egg yolks
  • liver


If hypothyroidism or goiter are common in your area, find out if the local health ministry will give iodized oil by mouth or iodine by injection. If not, women can make iodine solution at home with polyvidone iodine.

To make an iodine solution to drink

Add 1 drop of Lugol's iodine to 1 glass of clean drinking water or milk.

In places where goiter or hypothyroidism are common, everyone except breastfeeding babies should drink 1 glass of this iodine solution every month of his or her life. This is especially important for children and pregnant women. Do not take more iodine than this. Too much is dangerous.

Store iodine at room temperature, and in dark containers to protect it from light.

Vitamin A

Vitamin A prevents night blindness and helps fight infections. Lack of vitamin A also causes blindness in children. A woman needs to eat plenty of vitamin A during pregnancy and while breastfeeding.

Dark yellow and green leafy vegetables and yellow fruits have vitamin A.

Ideas about food affect women's health

Some beliefs about foods are harmful — especially when people believe that women should not eat as much as men do, or should not eat a variety of foods.

It is not safe for girls to be fed less than boys

Girls need as much food as boys — to grow and learn and work. If a girl does not get enough food, her bones may not grow well. This can cause serious problems during labor when the girl becomes a woman and has babies of her own.

a man speaking to a woman as she serves food to him and a child.
Come and eat with us!
When a woman must feed her family first, she may not get enough to eat

A woman may be taught to feed her family before herself. She eats only what is left and often does not get as much as others in the family. This is never healthy. And when a woman is pregnant, or has just had a baby, it can be very dangerous.

If the family will not help the woman eat enough, she may need to hide food, eat while she is cooking, or eat while her husband is out of the house.

Packaged and processed foods are rarely as good as homemade

People are eating more and more packaged and processed foods. Some people like the taste, and some people think that packaged foods are healthier.

Packaged foods may be advertised as the healthiest choice, but this is rarely the truth! Advertisers will say anything just to sell products. Some packaged foods are fortified with vitamins and minerals, but our bodies cannot use these added-on vitamins as well as our bodies use the vitamins that we get from eating whole, fresh foods. Most packaged foods contain more sugar, salt, and fat than we need. Many are full of chemicals to keep the food looking and tasting fresh, and some of these chemicals have not been carefully tested to be sure of their safety.

Avoiding foods can be dangerous

In many places, pregnant women are told not to eat certain foods. In these communities, people believe that these foods will harm the baby. At the same time, a doctor or a midwife may tell a woman it is important to eat those same foods. This can be confusing for the woman.

Everyone needs to eat a wide variety of foods.

Avoiding foods can be dangerous. For a woman to be healthy during and after pregnancy, she must eat a wide variety of foods — main foods, grow foods, glow foods, and go foods. Eating only one kind of food is not enough.

If a woman does choose to avoid certain foods, make sure she is getting enough of each kind of food, and enough vitamins and minerals from her food.

Finding creative answers

Beliefs about food can be hard to change. But you may find ways to help women eat better without working against their beliefs. This example is based on a true story:

Maria is a midwife in Guatemala. She and her people believe that some foods are “hot” foods, and some foods are “cold” foods. They believe that pregnant women should not eat cold foods.

To Maria and her people, beans and eggs are cold foods (even when they are cooked). But Maria knows that beans and eggs are good, low-cost ways for pregnant women to get the protein and iron they need.

Maria wants pregnant women to eat well, but they will not eat cold foods. And Maria too thinks that cold foods may not be good for pregnant women to eat. Her solution is simple and smart. She tells pregnant women to eat beans and eggs with a little hot pepper or another hot food. This way, the foods will not be cold anymore.

Maria has found a creative answer to a problem. She has found a way for pregnant women to eat better and has shown respect for the beliefs of her community.

Eating well with little money

a thin woman holding a baby next to 2 men arguing and a richer man thinking.
I must eat first.
No, I eat first!
Fools. None
of you have as much as I do.
The problems of hunger and poor nutrition will not be solved until we all share with each other fairly.

The biggest cause of poor nutrition is poverty. Rich people in wealthy countries can buy any foods they want, while those in poor communities cannot. And within each community, some can afford to eat better than others. A few people own most of the land or businesses, and make money off of the work of others. Even within each family, a father may eat better than his wife or children.

To learn more about the root causes of poverty and ways to work for change, see the books Where There Is No Doctor and Helping Health Workers Learn.

Even a very poor family can eat better by spending money wisely. A father who buys alcohol and tobacco could instead buy nutritious food or he could buy a hen to lay eggs. A mother who buys her children sweets or soda pop could instead buy eggs, beans, or other low-cost healthful foods.

Here are some ideas that families can use to eat better with little money:

Breast milk

Breast milk costs nothing, and has all the nutrition a baby needs. Young children do not need fortified milks — especially if they are still breastfeeding and eating other foods.

Grow beans this year. Next year, maize.
Beans, peas, and lentils

Beans and other legumes have a lot of protein and vitamins, and they usually do not cost much. They have even more vitamins if they are sprouted before being eaten.

Planting legumes makes soil richer. Other crops will grow better in a field where legumes once grew.

Less expensive meats and animal products

Blood and organ meats like liver, heart, and kidney have a lot of iron and may cost less than other meats. Fish and chicken are as healthy as other meats, and usually cost less — especially for a family that fishes or raises their own chickens.

Eggs have a lot of protein, iron, and vitamin A. Eggs give more protein for less money than almost any other food.

Whole grains

Grains, like wheat, rice, and corn, are more nutritious when they have not been refined (processed to take out the color). Taking out the color takes out healthy things too. White bread and white rice have less vitamins, minerals, and proteins than brown bread or brown rice.

Use only a little water to cook vegetables.
Vegetables and fruits

When vegetables are boiled or steamed, some of the vitamins from the foods go into the cooking water. Use this water to make soups.

a cassava plant.

The outside leaves of plants are usually thrown away, but sometimes they can be eaten. The leaves of the cassava plant have more vitamins and protein than the root.

Many wild fruits and berries are rich in vitamins and natural sugars that give energy.

Avoid buying vitamins

Most of the time people can get enough vitamins and minerals by eating a variety of foods. Buying vitamins is usually a waste of money.

But pregnancy and breastfeeding are times that women may need to take extra vitamins — more than what they can get from food. Vitamin pills work as well as vitamin injections, and cost less.


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