Women's health : Life span: conception to adolescence

doi:10.1136/bmj.315.7117.1227

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Naomi Craft, freelance medical journalista

^a Gower Place Practice, London WC1E 6BN

Introduction

The life span approach to women's health recognises that the health status of a woman in one phase of her life affects not only the subsequent phases but also the lives of her existing and future children. International health programmes and policies aim to enhance women's physical, mental, and social wellbeing throughout their lifespan. Most of the issues described in this article affect women living in the developing world.

Surviving the first years

The missing millions

Though 5% more boys are born in the world, given similar care, women survive better at all ages, including before birth.1 This means that in many developed countries there are more women than men. For example, in the United Kingdom, France, and the United States the ratio of women to men is more than 1.05. Girls are known to be intrinsically more resistant to infection and malnutrition, perhaps because of sex differences in chromosomal structures and a slower maturing of boys' lungs due to the effects of testosterone.2

Whatever their biological advantage, evidence is mounting that in many parts of the world, girls are at a social disadvantage which has a profound impact on their chance of survival. This social disadvantage depends on the practices in an individual society.

“Why did you come, oh girl, when we wished for a boy? Take the jar and fill it from the sea. May you fall into the water and drown.” (Pakistani folksong)

The preference for boys has complex historical roots. In many traditional societies, it stems from the reliance on men as primary breadwinners and providers of security in the parents' old age, while women are accorded secondary support roles. In India, for example, a daughter is considered to be a financial asset to her husband's family and a drain to her own because she will need a dowry—a practice still …