Women’s and girls’ health throughout the life course

30 May 2019

At every phase of life, women and girls have specific needs and opportunities to optimize their health and well-being. Health is also linked across life phases. A life course approach helps optimise people’s health and well-being at all ages. It is built on evidence-based strategies and the right to the highest attainable standard of health.

Promoting health through the life course is a priority focus in WHO’s work, including in the 13th General Programme of Work . Universal Health Coverage underpins WHO’s efforts to support countries strengthen delivery of, and access to, services to prevent and treat the most common health conditions. The Organization also works to address risk factors, including those related to gender inequality and other social determinants such as socio-economic status, race, ethnicity, etc.

WHO produces and regularly updates evidence-based guidelines on key health issues, and works alongside partners in countries (e.g. via the H6 partnership of UN organizations working on health) to strengthen services on the ground.

Pregnancy, childbirth and newborn

Approximately 303 000 women died from preventable causes related to pregnancy and childbirth in 2015. Worldwide, one woman out of five still has no access during childbirth to a skilled health professional, who could prevent or manage most complications.
Over 10% of women globally, and about 20% of women in developing countries, experience peripartum and postpartum depression. This severely affects women’s health and well-being and their children’s early development.
An estimated 2.6 million stillbirths occurred globally in 2015, 98% of them in low- and middle-income countries. Globally, one in ten live births is preterm.
In some settings, gender-based discrimination can lead to sex-selective abortion and female infanticide.
The risk of dying is highest in the first month of life with 2.5 million neonatal deaths in 2017. Prematurity, complications during labour and birth, and infections like sepsis, pneumonia, tetanus and diarrhoea are leading causes, all of which can be prevented.

Infancy and early childhood (1 month–4 years)

5.4 million children under the age of 5 died in 2017. Children in sub-Saharan Africa are more than 14 times more likely to die before the age of 5 than children in high income countries.
Leading causes of death for girls and boys include preterm birth complications, pneumonia, birth asphyxia, congenital anomalies, diarrhoea and malaria, with similar death rates for girls and boys. Most of these conditions can be prevented or treated by simple, affordable interventions.
In some settings, gender discrimination means girls are less likely to access to vaccines, health services and good nutrition than their male counterparts.
Children in the poorest households are nearly twice as likely to die before the age of five than those from the richest, with the majority dying in southern Asia and sub-Saharan Africa.
Educating girls and women improves health outcomes. Despite progress made over the last 20 years however, girls are still less likely than boys to attend school.

Later childhood and early adolescence (5–14 years)

Girls aged 5-9 have a relatively high risk of dying from preventable infectious diseases such as lower respiratory infections, diarrhoeal diseases, or malaria. Lower respiratory infections are also the leading cause of death for younger adolescent girls aged 10–14 years.
Despite small improvements over the past few years, HIV/AIDS remains the second leading cause for this group of girls.
During puberty, gender norms may place restrictions on girls’ physical mobility and access to information, which influences their self-esteem and health seeking behavior as they transition into adulthood. Globally, an estimated 18% of girls, in comparison to 8% of boys, experience sexual abuse at some point in their childhood. An estimated 120 million adolescent girls have experienced forced intercourse or other forced sexual acts.
Nutritional problems are a major issue. Overweight and obesity can lead to premature death and disability later on, while girls may experience anorexia nervosa and other eating disorders. Iron deficiency anemia affects a substantial number of adolescent girls.
Vaccination of young adolescent girls against HPV prevents cervical cancer in later life.

Later adolescence and youth (15–24 years)

The top causes of death for females aged 15–24 years are maternal conditions, self-harm, road injury, HIV/AIDS, diarrheal diseases and tuberculosis. Depressive disorders, linked to self-harm and suicide, are leading causes of ill health. Sub-Saharan Africa is the region which has the highest burden of HIV among adolescent girls and young women.
Young women and girls are subject to a range of harmful practices and violence, including early marriage; every year, 12 million girls get married before the age of 18 years. In addition, 12.8 million births occur among adolescent girls aged 15-19 years, and 3.9 million unsafe abortions occur among girls aged 15-19 years each year, contributing to maternal mortality and lasting health problems.
At least 200 million girls and women have undergone female genital mutilation (FGM), including about one in three girls aged 15–19 years in 30 countries in which the practice is concentrated. This practice contributes to a range of adverse health outcomes.
Gender-based violence becomes a major problem and will continue in later life.
Data show that lack of decision-making power has a profound impact on the health of girls and young women. For example, 52% of adolescent girls and young women from rural areas and 47% from urban areas in 28 countries from sub-Saharan Africa need approval from their husbands/family to make decisions about their own health care.

Early adulthood (25–49 years)

HIV/AIDS remains the leading cause of death among women within this age group globally. Noncommunicable diseases, specifically heart disease is the second leading cause. Tuberculosis is another major threat.
214 million women of reproductive age in developing regions who want to avoid pregnancy are not using a modern contraceptive method. 44% of pregnancies are unintended. and this results in approximately 56 million abortions every year, half of which are unsafe. During or following pregnancy, women may develop or be diagnosed with health conditions including depression, obstetric fistula, hypertension and diabetes, all of which may require longer-term care.
Worldwide, the top five most common types of cancer among women are breast, lung, colorectal, cervical and stomach.
Women are more at risk of depression and anxiety than men. Associated risk factors include women’s subordinate status, stressors and negative life experiences including violence and the disproportionate burden of care for others.
One in three women experience physical and/or sexual violence, mostly by an intimate partner at some point in their life.

Middle adulthood (50–64 years)

Women face a multiple health problems in their post-reproduction years. Women may face chronic conditions, such as obstetric fistula, pelvic pain and incontinence as a result of their pregnancies. These problems are more common in low- and middle-income countries, particularly in places where fertility is high and women do not have access to good quality health care for pregnancy and delivery.
Cervical cancer is one of the most common causes of death for women: globally, one woman dies of cervical cancer every two minutes. Nearly 90% of cervical cancer deaths are of women living in low- and middle- income countries. Women who are living with HIV are at a particularly high risk of cervical cancer as they are 4-5 times more likely to experience persistent HPV infection and subsequently cervical cancer.
Breast cancer is becoming more of a problem in low- and middle-income countries. Age at first pregnancy, the number of pregnancies and breastfeeding history can all influence a woman’s risk of developing breast cancer.
Heart disease and stroke are significant causes of death and disability in women in both developed and developing countries and especially among women who are poor. Women with heart disease tend to present with different symptoms than men and are less likely to seek or to be provided with medical help and to be properly diagnosed until late in the disease process.
While improvements have been made in women’s health, women are less likely to have access to appropriate investigations and treatment, and are more likely to be underrepresented in research.

Later adulthood (65 to 79 and 80 years and over)

Regardless of where they live, the biggest killers of women at this life stage are heart disease, stroke, and chronic lung disease. Many of these are associated with modifiable risk factors in adolescence and early adulthood, including smoking, unhealthy diets, and sedentary lifestyles.
Women over the age of 65 have much higher rates of injuries due to falling than men – possibly related to frailty, osteoporosis and other underlying chronic conditions. Consequent fractures, limit quality of life and functional ability.These are often ignored because they are incorrectly seen as an inevitable part of ageing or less serious than such conditions as heart disease or cancer.
Dementia is more common among women than men in this age group.
Women aged 60 years and over also experience greater loss of functional abilities than men, including poor vision and hearing loss and are less likely to receive treatment or supportive aids for these conditions.
When older women live alone, they may be subject to elder abuse, including because of their limited access to social and financial protections (e.g. pensions, employment benefits). This in turn affects their access to health care.

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