The relative lack of information on determinants of disease, disability, and death at major stages of a woman's lifespan and the excess morbidity and premature mortality that this engenders has important adverse social and economic ramifications, not only for Sub-Saharan Africa, but also for other regions of the world as well. Women bear much of the weight of world production in both traditional and modern industries. In Sub-Saharan Africa, for example, women contribute approximately 60 to 80 percent of agricultural labor. Worldwide, it is estimated that women are the sole supporters in 18 to 30 percent of all families, and that their financial contribution in the remainder of families is substantial and often crucial.

This book provides a solid documentary base that can be used to develop an agenda to guide research and health policy formulation on female health--both for Sub-Saharan Africa and for other regions of the developing world. This book could also help facilitate ongoing, collaboration between African researchers on women's health and their U.S. colleagues. Chapters cover such topics as demographics, nutritional status, obstetric morbidity and mortality, mental health problems, and sexually transmitted diseases, including HIV.

Contents

• COMMITTEE TO STUDY FEMALE MORBIDITY AND MORTALITY IN SUB-SAHARAN AFRICA
• Dedication
• Acknowledgments
• NOTE
• 1. Summary
  • Preamble
  • The "Life Span" Approach
  • The Study Process
  • Conclusions and Research Needs
• 2. The Context of Mortality and Morbidity
  • The Importance of Context
  • The issue of Heterogeneity
  • The Socioeconomics of Life and Death
  • Power, Control, Equity, and Status
  • Social Disruption and Health Status
  • Conclusions
• 3. Nutritional Status
  • Women's Roles and Female Nutritional Status in Sub-Saharan Africa
  • Extent of Malnutrition among Females in Sub-Saharan Africa
  • Functional Consequences of Female Nutritional Status: Taking a Life Span Perspective
  • Conclusions
  • Research Needs
• 4. Obstetric Morbidity and Mortality
  • Gender Burden
  • The Life Span: An Approach to Maternal Morbidity and Mortality
  • The Magnitude of Pregnancy-Related Mortality and Morbidity
  • The Nature of Maternal Mortality as a Public Health Problem
  • The Multiple Causality of Maternal Death
  • Maternal Health and Family Planning
  • Menopause
  • Conclusions
  • Research Needs
• 5. Nervous System Disorders
  • Life Span Perspective
  • Toxic and Nutritional Disorders of the Nervous System
  • Headache Syndromes
  • Cerebrovascular Diseases and Use of Oral Contraceptives
  • Other Neurological Disorders
  • Conclusions
  • Research Needs
• 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
  • Psychological Disorders in General Medical Settings
  • Psychological Disorders in Pregnancy and the Puerperium
  • Conclusions
  • Research Needs
• 7. Cardiovascular Diseases, Cancers, and Chronic Obstructive Pulmonary Diseases
  • Cardiovascular Diseases
  • Cancers
  • Chronic Obstructive Pulmonary Diseases
  • Conclusions
  • Research Needs
• 8. Injury
  • Definitions
  • Injuries Worldwide
  • Injuries in the Developing World
  • Injury Patterns in Developing Countries
  • Life Span Approach
  • Violence Against Females—A Growing Public Health Problem
  • Conclusions
  • Research Needs
• 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
  • Life Span Approach
  • Nature of the Evidence
  • Conclusions
  • Research Needs
• 10. Tropical Infectious Diseases
  • Malaria
  • Schistosomiasis (Bilharziasis)
  • African Trypanosomiasis
  • Trachoma
  • Dracunculiasis (Guinea Worm)
  • Onchocerciasis and Lymphatic Filariasis
  • Leishmaniasis and Leprosy
  • Conclusions
  • Research Needs
• 11. Sexually Transmitted Diseases and HIV Infection
  • Overview
  • Magnitude of the Problem
  • Societal Determinants of STDs and HIV Infection
  • Conclusions
  • Research Needs
• Appendix A Demographic Overview and State of the Data

The project was supported by funds from the Carnegie Corporation (contract nos. B-5269 and D-93065). Additional project support was provided by the Special Programme of Research, Development, and Research Training in Human Reproduction, World Health Organization (contract no. HQ/93/043301); the Kellogg Endowment Fund; and the National Research Council's NAS/NAE independent funds and IOM independent funds.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is President of the Institute of Medicine.