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      Economic Benefits of Investing in Women’s Health: A Systematic Review

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          Abstract

          Background

          Globally, the status of women’s health falls short of its potential. In addition to the deleterious ethical and human rights implications of this deficit, the negative economic impact may also be consequential, but these mechanisms are poorly understood. Building on the literature that highlights health as a driver of economic growth and poverty alleviation, we aim to systematically investigate the broader economic benefits of investing in women’s health.

          Methods

          Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed health, gender, and economic literature to identify studies that investigate the impact of women’s health on micro- and macroeconomic outcomes. We developed an extensive search algorithm and conducted searches using 10 unique databases spanning the timeframe 01/01/1970 to 01/04/2013. Articles were included if they reported on economic impacts stemming from changes in women’s health (table of outcome measures included in full review, Table 1). In total, the two lead investigators independently screened 20,832 abstracts and extracted 438 records for full text review. The final review reflects the inclusion of 124 articles.

          Results

          The existing literature indicates that healthier women and their children contribute to more productive and better-educated societies. This study documents an extensive literature confirming that women’s health is tied to long-term productivity: the development and economic performance of nations depends, in part, upon how each country protects and promotes the health of women. Providing opportunities for deliberate family planning; healthy mothers before, during, and after childbirth, and the health and productivity of subsequent generations can catalyze a cycle of positive societal development.

          Conclusions

          This review highlights the untapped potential of initiatives that aim to address women’s health. Societies that prioritize women’s health will likely have better population health overall, and will remain more productive for generations to come.

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          Most cited references80

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          Fetal origins of coronary heart disease.

          D. J. Barker (1995)
          The fetal origins hypothesis states that fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease. Animal studies have shown that undernutrition before birth programmes persisting changes in a range of metabolic, physiological, and structural parameters. Studies in humans have shown that men and women whose birth weights were at the lower end of the normal range, who were thin or short at birth, or who were small in relation to placental size have increased rates of coronary heart disease. We are beginning to understand something of the mechanisms underlying these associations. The programming of blood pressure, insulin responses to glucose, cholesterol metabolism, blood coagulation, and hormonal settings are all areas of active research.
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            Impact of maternal depression on infant nutritional status and illness: a cohort study.

            Atif Rahman, Zafar Iqbal, James Bunn … (2004)
            The risk for emotional and behavioral problems is known to be high among children of depressed mothers, but little is known about the impact of prenatal and postnatal depression on the physical health of infants. To determine whether maternal depression is a risk factor for malnutrition and illness in infants living in a low-income country. Prospective cohort study. Rural community in Rawalpindi, Pakistan. Six hundred thirty-two physically healthy women were assessed in their third trimester of pregnancy to obtain at birth a cohort of 160 infants of depressed mothers and 160 infants of psychologically well mothers. All infants were weighed and measured at birth and at 2, 6, and 12 months of age, and they were monitored for episodes of diarrhea and acute respiratory infections. The mothers' mental states were reassessed at 2, 6, and 12 months. Data were collected on potential confounders of infant outcomes, such as birth weight and socioeconomic status. Infants of prenatally depressed mothers showed significantly more growth retardation than controls at all time points. The relative risks for being underweight (weight-for-age z score of less than -2) were 4.0 (95% confidence interval [CI], 2.1 to 7.7) at 6 months of age and 2.6 (95% CI, 1.7 to 4.1) at 12 months of age, and the relative risks for stunting (length-for-age z score of less than -2) were 4.4 (95% CI, 1.7 to 11.4) at 6 months of age and 2.5 (95% CI, 1.6 to 4.0) at 12 months of age. The relative risk for 5 or more diarrheal episodes per year was 2.4 (95% CI, 1.7 to 3.3). Chronic depression carried a greater risk for poor outcome than episodic depression. The associations remained significant after adjustment for confounders by multivariate analyses. Maternal depression in the prenatal and postnatal periods predicts poorer growth and higher risk of diarrhea in a community sample of infants. As depression can be identified relatively easily, it could be an important marker for a high-risk infant group. Early treatment of prenatal and postnatal depression could benefit not only the mother's mental health but also the infant's physical health and development.
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              Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries.

              Emre Özaltin (2010)
              Although maternal stature has been associated with offspring mortality and health, the extent to which this association is universal across developing countries is unclear. To examine the association between maternal stature and offspring mortality, underweight, stunting, and wasting in infancy and early childhood in 54 low- to middle-income countries. Analysis of 109 Demographic and Health Surveys in 54 countries conducted between 1991 and 2008. Study population consisted of a nationally representative cross-sectional sample of children aged 0 to 59 months born to mothers aged 15 to 49 years. Sample sizes were 2,661,519 (mortality), 587,096 (underweight), 558,347 (stunting), and 568,609 (wasting) children. Likelihood of mortality, underweight, stunting, or wasting in children younger than 5 years. The mean response rate across surveys in the mortality data set was 92.8%. In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (absolute risk difference [ARD], 0.0014; relative risk [RR], 0.988; 95% confidence interval [CI], 0.987-0.988), underweight (ARD, 0.0068; RR, 0.968; 95% CI, 0.968-0.969), stunting (ARD, 0.0126; RR, 0.968; 95% CI, 0.967-0.968), and wasting (ARD, 0.0005; RR, 0.994; 95% CI, 0.993-0.995). Absolute risk of dying among children born to the tallest mothers (> or = 160 cm) was 0.073 (95% CI, 0.072-0.074) and to those born to the shortest mothers (< 145 cm) was 0.128 (95% CI, 0.126-0.130). Country-specific decrease in the risk for child mortality associated with a 1-cm increase in maternal height varied between 0.978 and 1.011, with the decreased risk being statistically significant in 46 of 54 countries (85%) (alpha = .05). Among 54 low- to middle-income countries, maternal stature was inversely associated with offspring mortality, underweight, and stunting in infancy and childhood.
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                Author and article information

                Contributors
                Jodi Pawluski: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 30 March 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 3
                Electronic Location Identifier: e0150120
                Affiliations
                [1 ]Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
                [2 ]Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
                University of Rennes-1, FRANCE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KHO JHI DEB. Performed the experiments: KHO JHI. Analyzed the data: KHO JHI. Wrote the paper: KHO JHI DEB.

                Article
                Publisher ID: PONE-D-15-37969
                DOI: 10.1371/journal.pone.0150120
                PMC ID: 4814064
                PubMed ID: 27028199
                SO-VID: acf4d4e3-1d7e-4287-bcf1-dcb15203748c
                Copyright © © 2016 Onarheim et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 30 September 2015
                Date accepted : 9 February 2016
                Page count
                Figures: 2, Tables: 2, Pages: 23
                Funding
                Preparation of this paper was supported by a grant from the Norwegian Agency for Development Cooperation (QZA-0408 QZA-12/0628). The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Mothers
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Socioeconomic Aspects of Health
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Socioeconomic Aspects of Health
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: Child Health
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Child Health
                Subject: Social Sciences
                Subject: Economics
                Subject: Research and Analysis Methods
                Subject: Database and Informatics Methods
                Subject: Database Searching
                Subject: Biology and Life Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Birth Weight
                Subject: Medicine and Health Sciences
                Subject: Physiology
                Subject: Physiological Parameters
                Subject: Body Weight
                Subject: Birth Weight
                Custom metadata
                Data Availability The data material used in this systematic review, which consists of academic and other articles, was made available from the Library of Harvard University and the University of Bergen. All relevant data for the manuscript are provided in the paper and its Supporting Information files. Information about the included articles in the full review, can be found in S2 Appendix, and all included articles are cited in the references of the manuscript.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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