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IN HER LIFETIME: Female Morbidity and Mortality in Sub-Saharan Africa
TABLE 4-1 Obstetric Health Problems in Sub-Saharan Africa: Gender-Related Burden
Exclusive to Females
Greater for Females
Burden for Females and Males Comparable, but of Particular Significance for Females
Genital mutilation, sequelae
Sexually transmitted diseases
NOTE: Males obviously do not have obstetric and gynecologic problems. There is, however, a gender difference. While all the health problems listed occur in both males and females, they may be exacerbated by the processes of pregnancy and parturition. This aspect of gender differences needs to be taken into account, both in clinical research and in application.
they are listed in Table 4-1 as preexisting or concurrent conditions that, with the exception of genital mutilation, also affect males, but are exclusively female in the way they either exacerbate risk during pregnancy and childbirth, or are exacerbated by those events.
The length of this list is impressive. It includes six highly prevalent and burdensome tropical infectious diseases (dracunculiasis, or Guinea worm disease; leprosy; malaria; onchocerciasis; schistosomiasis; and trypanosomiasis); five chronic diseases, one of which is clearly genetic (cardiomyopathies, diabetes, hypertension, rheumatic heart disease, and sickle-cell disease); three nutrition-related conditions (anemia, iodine deficiency, and protein-energy malnutrition); and three conditions related to female sexual identity (HIV/AIDS, the sequelae of female genital mutilation, and the entire group of sexually transmitted diseases).
In addition to their sometimes deleterious interactions with the gravid state and the act of parturition, a number of the health problems on this list have vigorous relationships with one another, a dynamic that reappears throughout this chapter and is summarized in the chapter's final table, Table 4-15.
THE LIFE SPAN: AN APPROACH TO MATERNAL MORBIDITY AND MORTALITY
The basic premise of the life span approach is that the morbidity and mortality associated with reproduction are not haphazard phenomena, but a culmination of events that begin much earlier, even before a woman's own birth. These may include her mother's poor nutritional and health status, intrauterine events, and perhaps lack of adequate prenatal care; her own diet; insult from infectious diseases; injuries and accidents; poor access to health, education, and other resources as she grew up; her work burden; gender discrimination; and the general conditions of poverty. From the time she is conceived to the time she herself conceives, the course of a woman's pregnancy and its outcome will both be affected by a variety of clinical, economic, social, and cultural factors and affect her health and well-being for the rest of her life.