IJE Advance Access originally published online on June 10, 2005
International Journal of Epidemiology 2005 34(5):1144-1148; doi:10.1093/ije/dyi121
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Beyond reproduction: Women's health in today's developing world
1 The Center for Global Health and Economic Development, The Earth Institute and Mailman School of Public Health, Columbia University, New York, NY, USA
2 The Center for Global Health and Economic Development, The Earth Institute and Mailman School of Public Health, Columbia University, New York, NY, USA
3 Department of Medicine, College of Physicians and Surgeons, St Luke's Roosevelt Hospital Center, New York, NY, USA
4 The Center for Global Health and Economic Development, The Earth Institute and Mailman School of Public Health, Columbia University, New York, NY, USA
5 Australian Health Policy Institute, University of Sydney, Australia
* Corresponding author. Australian Health Policy Institute, Victor Coppleson Building–D02, University of Sydney, NSW 2006, Australia. E-mail: steve{at}med.usyd.edu.au
Accepted 18 May 2005
Background The concept of women's health is tethered strongly to reproductive health. At present, international attention and resources are focused on obstetric events and, recently, HIV/AIDS because of the significance of these problems in the least developed nations. This limited concept of women's health, however, is decreasingly relevant to the global community, and needs to be revisited in the light of decreasing fertility and increasing life expectancy in many countries where it was previously applicable. It should be expanded to embrace the full spectrum of health experienced by women, and preventive and remedial approaches to the major conditions that afflict women. Allocation of health service resources should be aligned with the epidemiological realities of these threats to women's health.
Methods Cause of death data for women aged 15–34 years and 35–44 years were examined for nine less developed countries. Deaths associated with pregnancy and child birth, and HIV were compared with deaths due to three chronic disease categories (cancer, cardiovascular disease, and diabetes). The women's health research literature for developing countries appearing in the American Journal of Public Health and British Medical Journal was also examined.
Results In seven out of the nine countries, among women aged 15–34 years, chronic diseases caused over 20% of deaths, while reproductive causes and HIV together accounted for 
10% of deaths, in all countries except in India. Among women aged 35–44 years, in all but India, chronic diseases accounted for over four times the deaths attributable to reproductive causes and HIV. The causes of death were not related to the level of development in these countries as measured by GNI PPP. Papers pertaining to women's health published in public health and medical research journals focused principally on reproduction.
Conclusions Extending the definition of women's health to include a concern for chronic diseases is critical if the needs of women in less developed nations are to be met. In less developed countries, chronic disease is the most important cause of female death even during childbearing years and for women with young families. Development agencies and private philanthropy must begin to fund the studies that will further refine our understanding of the role of chronic diseases in women's health in the developing world.
Keywords Women's health, developing countries, resource allocation, chronic diseases, cardiovascular disease
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