DIETING

Dieting is the practice of eating food in a regulated and supervised fashion to decrease, maintain, or increase body weight. In other words, it is conscious control or restriction of the diet. A restricted diet is often used by those who are overweight or obese, sometimes in combination with physical exercise, to reduce body weight. Some people follow a diet to gain weight (usually in the form of muscle). Diets can also be used to maintain a stable body weight and improve health. In particular, diets can be designed to prevent or treat diabetes.Diets to promote weight loss can be categorized as: low-fat, low-carbohydrate, low-calorie, very low calorie and more recently flexible dieting.A meta-analysis of six randomized controlled trials found no difference between low-calorie, low-carbohydrate, and low-fat diets, with a 2–4 kilogram weight loss over 12–18 months in all studies.At two years, all calorie-reduced diet types cause equal weight loss irrespective of the macro nutrients emphasized.In general, the most effective diet is any which reduces calorie consumption.

History:

One of the first dietitians was the English doctor George Cheyne. He himself was tremendously overweight and would constantly eat large quantities of rich food and drink. He began a meatless diet, taking only milk and vegetables, and soon regained his health. He began publicly recommending his diet for everyone suffering from obesity. In 1724, he wrote An Essay of Health and Long Life, in which he advises exercise and fresh air and avoiding luxury foods.

The Scottish military surgeon, John Rollo, published Notes of a Diabetic Case in 1797. It described the benefits of a meat diet for those suffering from diabetes, basing this recommendation on Matthew Dobson's discovery of glycosuria in diabetes mellitus. By means of Dobson's testing procedure (for glucose in the urine) Rollo worked out a diet that had success for what is now called type 2 diabetes.

The first popular diet was "Banting", named after the English undertaker William Banting. In 1863, he wrote a booklet called Letter on Corpulence, Addressed to the Public, which contained the particular plan for the diet he had successfully followed. His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, sweet foods, starch, beer, milk and butter. Banting’s pamphlet was popular for years to come, and would be used as a model for modern diets. The pamphlet's popularity was such that the question "Do you bant?" referred to his method, and eventually to dieting in general. His booklet remains in print as of 2007.

The first weight-loss book to promote calorie counting, and the first weight-loss book to become a bestseller, was the 1918 Diet and Health: With Key to the Calories by American physician and columnist Lulu Hunt Peters.

Types:

Low-fat:

Low-fat diets involve the reduction of the percentage of fat in one's diet. Calorie consumption is reduced because less fat is consumed. Diets of this type include NCEP Step I and II. A meta-analysis of 16 trials of 2–12 months' duration found that low-fat diets (without intentional restriction of caloric intake) resulted in average weight loss of 3.2 kg (7.1 lb) over habitual eating.

Low-carbohydrate:

Low-carbohydrate diets such as Atkins and Protein Power are relatively high in protein and fats. Low-carbohydrate diets are sometimes ketogenic (i.e., they restrict carbohydrate intake sufficiently to cause ketosis).

Low-calorie:

Low-calorie diets usually produce an energy deficit of 500–1,000 calories per day, which can result in a 0.5 to 1 kilogram (1.1 to 2.2 pounds) weight loss per week. One of the most commonly used low-calorie diets is Weight Watchers. The National Institutes of Health reviewed 34 randomized controlled trials to determine the effectiveness of low-calorie diets. They found that these diets lowered total body mass by 8% in the short term, over 3–12 months.Women doing low-calorie diets should have at least 1,200 calories per day. Men should have at least 1,800 calories per day.

Very low-calorie:

Very low calorie diets provide 200–800 calories per day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average loss of 1.5–2.5 kg (3.3–5.5 lb) per week. "2-4-6-8", a popular diet of this variety, follows a four-day cycle in which only 200 calories are consumed the first day, 400 the second day, 600 the third day, 800 the fourth day, and then totally fasting, after which the cycle repeats. These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.

Detox:

Detox diets claim to eliminate "toxins" from the human body rather than claiming to cause weight loss. Many of these use herbs or celery and other juicy low-calorie vegetables.

Religious:

Religious prescription may be a factor in motivating people to adopt a specific restrictive diet.For example, the Biblical Book of Daniel (1:2-20, and 10:2-3) refers to a 10- or 21-day avoidance of foods (Daniel Fast) declared unclean by God in the laws of Moses. In modern versions of the Daniel Fast, food choices may be limited to whole grains, fruits, vegetables, pulses, nuts, seeds and oil. The Daniel Fast resembles the vegan diet in that it excludes foods of animal origin.The passages strongly suggest that the Daniel Fast will promote good health and mental performance.

Fasting is practiced in various religions. Examples include Lent in Christianity; Yom Kippur, Tisha B'av, Fast of Esther, Tzom Gedalia, the Seventeenth of Tamuz, and the Tenth of Tevet in Judaism. Muslims refrain from eating during the hours of daytime for one entire month, Ramadan, every year.

Details of fasting practices differ. Eastern Orthodox Christians fast during specified fasting seasons of the year, which include not only the better-known Great Lent, but also fasts on every Wednesday and Friday (except on special holidays), together with extended fasting periods before Christmas (the Nativity Fast), after Easter (the Apostles Fast) and in early August (the Dormition Fast). Members of The Church of Jesus Christ of Latter-day Saints (Mormons) generally fast for 24 hours on the first Sunday of each month. Like Muslims, they refrain from all drinking and eating unless they are children or are physically unable to fast. Fasting is also a feature of ascetic traditions in religions such as Hinduism and Buddhism. Mahayana traditions that follow the Brahma's Net Sutra may recommend that the laity fast "during the six days of fasting each month and the three months of fasting each year" [Brahma's Net Sutra, minor precept 30]. Members of the Baha'i Faith observe a Nineteen Day Fast from sunrise to sunset during March each year.

Nutrition:

Weight loss diets that manipulate the proportion of macronutrients (low-fat, low-carbohydrate, etc.) have been shown to be more effective than diets that maintain a typical mix of foods with smaller portions and perhaps some substitutions (e.g. low-fat milk, or less salad dressing).Extreme diets may, in some cases, lead to malnutrition.

Nutritionists also agree on the importance of avoiding fats, especially saturated fats, to reduce weight and to be healthier. They also agree on the importance of reducing salt intake because foods including snacks, biscuits, and bread already contain ocean-salt, contributing to an excess of salt daily intake.

MyPyramid Food Guidance System is the result of extensive research performed by the United States Department of Agriculture to revise the original Food Guide Pyramid. It offers a wide array of personalized options to help individuals make healthy food choices. It also provides advice on physical activity.

One of the most important things to take into consideration when either trying to lose or put on weight is output versus input. It is important to know the amount of energy your body is using every day, so that your intake fits the needs of one's personal weight goal. Someone wanting to lose weight would want a smaller energy intake than what they put out. There is increasing research-based evidence that low-fat vegetarian diets consistently lead to healthy weight loss and management, a decrease in diabetic symptoms as well as improved cardiac health.

How the body eliminates fat:

When the body is expending more energy than it is consuming (e.g. when exercising), the body's cells rely on internally stored energy sources, such as complex carbohydrates and fats, for energy. The first source to which the body turns is glycogen (by glycogenolysis). Glycogen is a complex carbohydrate, 65% of which is stored in skeletal muscles and the remainder in the liver (totaling about 2,000 kcal in the whole body). It is created from the excess of ingested macro nutrients, mainly carbohydrates. When glycogen is nearly depleted, the body begins lipolysis, the mobilization and catabolism of fat stores for energy. In this process, fats, obtained from adipose tissue, or fat cells, are broken down into glycerol and fatty acids, which can be used to generate energy.The primary by-products of metabolism are carbon dioxide and water; carbon dioxide is expelled through the respiratory system.

Weight loss groups:

Some weight loss groups aim to make money, others work as charities. The former include Weight Watchers and Peer trainer. The latter include Over eaters Anonymous and groups run by local organizations.

These organizations' customs and practices differ widely. Some groups are modelled on twelve-step programs, while others are quite informal. Some groups advocate certain prepared foods or special menus, while others train dieters to make healthy choices from restaurant menus and while grocery-shopping and cooking.

Food diary:

A 2008 study published in the American Journal of Preventive Medicine showed that dieters who kept a daily food diary (or diet journal), lost twice as much weight as those who did not keep a food log, suggesting that if you record your eating, you wouldn't eat as many calories.

Possible weight loss effects of drinking water prior to meals:

A 2009 review found that existing limited evidence suggested that encouraging water consumption and substituting energy-free beverages for energy-containing beverages (i.e., reducing caloric intake) may facilitate weight management. A 2009 article found that drinking 500 ml of water prior to meals for a 12-week period resulted in increased long-term weight reduction.

Fasting:

Lengthy fasting can be dangerous due to the risk of malnutrition and should be carried out only under medical supervision. During prolonged fasting or very low calorie diets the reduction of blood glucose, the preferred energy source of the brain, causes the body to deplete its glycogen stores. Once glycogen is depleted the body begins to fuel the brain using ketones, while also metabolizing body protein (including but not limited to skeletal muscle) to be used to synthesize sugars for use as energy by the rest of the body. Most experts believe that a prolonged fast can lead to muscle wasting, although some dispute this. The use of short-term fasting, or various forms of intermittent fasting have been used as a form of dieting to circumvent this issue.

Side effects:

While there are studies that show the health and medical benefits of weight loss, a study in 2005 of around 3000 Finns over an 18-year period showed that weight loss from dieting can result in increased mortality, while those who maintained their weight fared the best. Similar conclusion is drawn by other studies,and although other studies suggest that intentional weight loss has a small benefit for individuals classified as unhealthy, it is associated with slightly increased mortality for healthy individuals and the slightly overweight but not obese.This may reflect the loss of subcutaneous fat and beneficial mass from organs and muscle in addition to visceral fat when there is a sudden and dramatic weight loss.

Low carbohydrate versus low fat:

Many studies have focused on diets that reduce calories via a low-carbohydrate (Atkins diet, Scarsdale diet, Zone diet) diet versus a low-fat diet (LEARN diet, Ornish diet). The Nurses' Health Study, an observational cohort study, found that low carbohydrate diets based on vegetable sources of fat and protein are associated with less coronary heart disease.The same study also found no correlation (with multivariate adjustment) between animal fat intake and coronary heart disease (table 4). A long term study that monitored 43,396 Swedish women however suggests that a low carbohydrate-high protein diet, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, is associated with increased risk of cardiovascular disease.

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration in 2002 concluded that fat-restricted diets are no better than calorie-restricted diets in achieving long term weight loss in overweight or obese people. A more recent meta-analysis that included randomized controlled trials published after the Cochrane review found that low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. These results can be understood because weight loss is mainly governed by daily caloric deficit and not by the particular foods eaten.However, when low-carbohydrate diets to induce weight loss are considered, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values."

The Women's Health Initiative Randomized Controlled Dietary Modification Trial found that a diet of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily resulted in:

• no reduction in cardiovascular disease
• no statistically significant reduction in invasive breast cancer
• no reductions in colorectal cancer

Additional randomized controlled trials found that:

• A comparison of Atkins, Zone diet, Ornish diet, and LEARN diet in premenopausal women found the greatest benefit from the Atkins diet.
• The choice of diet for a specific person may be influenced by measuring the individual's insulin secretion:

In young adults "Reducing glycemic [carbohydrate] load may be especially important to achieve weight loss among individuals with high insulin secretion. This is consistent with prior studies of diabetic patients in which low carbohydrate diets were more beneficial.

The American Diabetes Association recommended a low carbohydrate diet to reduce weight for those with or at risk of Type 2 diabetes in its January 2008 Clinical Practice Recommendations.

Low glycemic index:

"The glycemic index (GI) factor is a ranking of foods based on their overall effect on blood sugar levels. The diet based around this research is called the Low GI diet. Low glycemic index foods, such as lentils, provide a slower, more consistent source of glucose to the bloodstream, thereby stimulating less insulin release than high glycemic index foods, such as white bread."

The glycemic load is "the mathematical product of the glycemic index and the carbohydrate amount".

In a randomized controlled trial that compared four diets that varied in carbohydrate amount and glycemic index found complicated results:

• Diet 1 and 2 were high carbohydrate (55% of total energy intake)
  • Diet 1 was high-glycemic index
  • Diet 2 was low-glycemic index
• Diet 3 and 4 were high protein (25% of total energy intake)
  • Diet 3 was high-glycemic index
  • Diet 4 was low-glycemic index

Diets 2 and 3 lost the most weight and fat mass; however, low density lipoprotein fell in Diet 2 and rose in Diet 3. Thus the authors concluded that the high-carbohydrate, low-glycemic index diet was the most favorable.

A meta-analysis by the Cochrane Collaboration concluded that low glycemic index or low glycemic load diets led to more weight loss and better lipid profiles. However, the Cochrane Collaboration grouped low glycemic index and low glycemic load diets together and did not try to separate the effects of the load versus the index.

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HOUSEWIFE

A housewife is a women whose occupation is running or managing her family's home - caring for her children,buying,cooking and storing food for the family; buying goods that the family needs in; and making clothes for the family - and who is not employed outside the home.A housewife may also be called a stay-at-home mother or SAHM, and a househusband may be called a "male homemaker" ,stay-at-home-father or SAHD.

Traditional societies:

In societies of hunters and gatherers like the traditional society of the Australian aboriginal people, the men hunt animals for meat, and the women gather other foods such as grain, fruit and vegetables. One of the reasons for this division of labor was that it is much easier to look after a baby while gathering fruit than while hunting a fast-moving animal. Even when homes were very simple and there were few possessions, men and women did different jobs.

In rural societies, where the main work is farming, women have also taken care of gardens and animals around the house, generally helping men with heavy work when a job needed to be done quickly, usually because of the season.

Examples of the heavy work that a traditional housewife (homemaker) in a rural society would do are:

• Picking fruit when it was ripe for market
• Planting rice in a paddy field
• Harvesting and stacking grain
• Cutting hay

In rural studies, the word housewife is occasionally used for a woman who does the majority of the chores within a farm's compound as opposed to field and livestock work.

Modern society:

Regarding work, being a housewife may be seen as the opposite of being a career woman. However, a career woman may also be contrasted to someone following the "mommy track", or a shared earning/shared parenting marriage.

Regarding family size, a study of three Mexican cities came to the result that there was no significant difference in the number of children in housewife families compared to those where women worked part or full-time.

It is becoming more commonplace for the husband and wife to be employed in paid work and for both to share in the "housework" and caring for the children.However, in other families, there is still a traditional idea that housework is only a woman's job; so when a couple gets home from work, the wife works in the house while the man takes a rest, or uses the time for recreational pursuits.

Housewives are usually financially dependent on members of the household who are employed; however, people working full-time (particularly under "at-will employment" arrangements) benefit from the unwaged work provided by the housewife; otherwise the performance of such work (child care, cooking, housecleaning, teaching, transporting, etc.) in her absence would cost money.Studies have shown the percentage of women staying home does not increase consistently "as husband's earnings go up." In fact, women with the "lowest earning husbands are more likely to stay home, followed by women with the highest earning husbands.

HOUSEWIFES IN INDIA:

In a traditional Hindu family, the head of the family is the Griha Swami (Lord of the House) and his wife is the Griha Swamini (Lady of the House). The Sanskrit words Grihast and Grihasta perhaps come closest to describing the entire gamut of activities and roles undertaken by the homemaker. Grih is the Sanskrit root for house or home; Grihasta and Grihast are derivatives of this root, as is Grihastya. The couple lives in the state called Grihastashram or family system and together they nurture the family and help its members (both young and old) through the travails of life. The woman who increments the family tree (bears children) and protects those children is described as the Grihalakshmi (the wealth of the house) and Grihashoba (the glory of the house). The elders of the family are known as Grihshreshta. The husband or wife may engage in countless other activities which may be social, religious, political or economic in nature for the ultimate welfare of the family and society. However, their unified status as joint householders is the nucleus from within which they operate in society. The traditional status of a woman as a homemaker anchors them in society and provides meaning to their activities within the social, religious, political and economic framework of their world. However, as India undergoes modernisation, many women are in employment, particularly in the larger cities such as Mumbai, Delhi, Kolkata, Chennai, Hyderabad, Bangalore where most women will work. The role of the male homemaker is not traditional in India, but it is socially accepted in urban areas. According to one sociologist's study in 2006, twelve percent of unmarried Indian men would consider being a homemaker according to a survey conducted by Business Today.One sociologist, Sushma Tulzhapurkar, called this a shift in Indian society, saying that a decade ago, "it was an unheard concept and not to mention socially unacceptable for men to give up their jobs and remain at home."However, only 22.7 percent of Indian women are part of the labor force, compared to 51.6 percent of men; thus, women are more likely to be caregivers because most do not work outside the home.

History:

Although men have generally been thought of as the primary breadwinners for families in recent history, the division of labor between men and women in traditional societies required both genders to take an active role in obtaining resources outside the domestic sphere. Prior to discovering agriculture and animal husbandry, predictable food sources were a scarce commodity. To achieve optimal nutrition during this time, it was imperative that both men and women focus their energies on hunting and gathering as many different edible foods as possible to sustain themselves on a daily basis. Lacking the technologies necessary to store and preserve food, it was critical for men and women to seek out and obtain fresh food sources almost continuously. These nomadic tribes used gender differences to their advantage, allowing men and women to use their complementary adaptations and survival strategies to find the most diverse and nutritionally complete foods available. For example, in the context of daily foraging, childcare itself was not a hindrance to women's productivity; rather, performing this task with her children both increased the overall efficiency of the activity (more people participating equals a greater yield of edible roots, berries, nuts and plants), and functioned as an important hands-on lesson in survival skills for each child. By sharing the burden of daily sustenance – and developing specialized gender niches – humans not only ensured their continued survival, but also paved the way for later technologies to evolve and grow through experience.

In the 1960s in western countries, it was becoming more accepted for a woman to work until she got married, when it was widely held that she should stop work and be a housewife. Many women believed that this was not treating men and women equally and that women should do whatever jobs they were able to do, whether they were married or not. The Feminine Mystique, a 1963 book by Betty Friedan which is widely credited with sparking the beginning of second-wave feminism in the United States, discussed among other things the lives of housewives from around the United States who were unhappy despite living in material comfort and being married with children.At this time, many women were becoming more educated. As a result of this increased education, some women were able to earn more than their husbands. In very rare cases, the husband would remain at home to raise their young children while the wife worked. In 1964 a US stamp was issued honoring homemakers for the 50th anniversary of the Smith-Lever Act.

About 50% of married US women in 1978 continued to work after giving birth, while in 1997, the number was 61%. The number of housewives increased in the 2000s. With the 2008 financial crisis, a decrease in average income made two incomes more attractive, and the percentage of married US women who kept working after they giving birth increased to 69% by 2009.As of 2014, according to the Pew Research Center, more than one in four mothers are stay at home in the United States.

In the late 20th century, in many countries it became harder for a family to live on a single wage. Subsequently, many women were required to return to work following the birth of their children. However, the number of male homemakers began gradually increasing in the late 20th century, especially in developed Western nations. In 2010, the number of male homemakers had reached its highest point of 2.2 million. Though the role is subject to many stereotypes, and men may have difficulties accessing parenting benefits, communities, and services targeted at mothers, it became more socially acceptable by the 2000s.The male homemaker was more regularly portrayed in the media by the 2000s, especially in the United States. However, in some regions of the world the male homemaker remains culturally unacceptable.

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Women's Health

Women's health refers to the health of women, which differs from that of men in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.

Although women in industrialised countries have narrowed the gender gap in life expectancy and now live longer than men, in many areas of health they experience earlier and more severe disease with poorer outcomes. Gender remains an important social determinant of health, since women's health is influenced not just by their biology but also by conditions such as poverty, employment, and family responsibilities. Women have long been disadvantaged in many respects such as social and economic power which restricts their access to the necessities of life including health care, and the greater the level of disadvantage, such as in developing countries, the greater adverse impact on health.

Women's reproductive and sexual health has a distinct difference compared to men's health. Even in developed countries pregnancyand childbirth are associated with substantial risks to women with maternal mortality accounting for more than a quarter of a million deaths per year, with large gaps between the developing and developed countries. Comorbidity from other non reproductive disease such as cardiovascular disease contribute to both the mortality and morbidity of pregnancy, including preeclampsia. Sexually transmitted infections have serious consequences for women and infants, with mother-to-child transmission leading to outcomes such as stillbirths and neonatal deaths, and pelvic inflammatory disease leading to infertility. In addition infertility from many other causes, birth control, unplanned pregnancy, unconsensual sexual activity and the struggle for access to abortion create other burdens for women.

Definitions and scope:

Women's experience of health and disease differ from those of men, due to unique biological, social and behavioural conditions. Biological differences vary all the way from phenotype to the cellular, and manifest unique risks for the development of ill health.The World Health Organization (WHO) defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".Women's health is an example of population health, the health of a specific defined population.

Women's health has been described as "a patchwork quilt with gaps".Although many of the issues around women's health relate to their reproductive health, including maternaland child health, genital health and breast health, and endocrine (hormonal) health, including menstruation, birth control and menopause, a broader understanding of women's health to include all aspects of the health of women has been urged, replacing "Women's Health" with "The Health of Women". The WHO considers that an undue emphasis on reproductive health has been a major barrier to ensuring access to good quality health care for all women. Conditions that affect both men and women, such as cardiovascular disease, osteoporosis, also manifest differently in women.Women's health issues also include medical situations in which women face problems not directly related to their biology, such as gender-differentiated access to medical treatment and other socioeconomic factors.Women's health is of particular concern due to widespread discrimination against women in the world, leaving them disadvantaged.

Global perspective:

Gender differences in susceptibility and symptoms of disease and response to treatment in many areas of health are particularly true when viewed from a global perspective.Much of the available information comes from developed countries, yet there are marked differences between developed and developing countries in terms of women's roles and health.The global viewpoint is defined as the "area for study, research and practice that places a priority on improving health and achieving health equity for all people worldwide". In 2015 the World Health Organisation identified the top ten issues in women's health as being cancer, reproductive health, maternal health, human immunodeficiency virus (HIV), sexually transmitted infections, violence, mental health, non communicable diseases, youth and aging.

Life expectancy:

Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the industrial revolution. Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.

Despite these differences, the leading causes of death in the United States are remarkably similar for men and women, headed by heart disease, which accounts for a quarter of all deaths, followed by cancer, lung disease and stroke. While women have a lower incidence of death from unintentional injury (see below) and suicide, they have a higher incidence of dementia (Gronowski and Schindler, Table I).

The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with obesity and diabetes amongst women in these countries and increasing the risks of cardiovascular disease and other NCDs.

Social and cultural factors:

Women's health is positioned within a wider body of knowledge cited by, amongst others, the World Health Organisation, which places importance on gender as a social determinant of health. Women's health is affected not just by their biology, but also by their social conditions, such as poverty, employment, and family responsibilities.

Women have traditionally been disadvantaged in terms of economic and social status and power, which in turn reduces their access to the necessities of life including health care. Despite recent improvements in western nations, women remain disadvantaged with respect to men.The gender gap in health is even more acute in developing countries where women are relatively more disadvantaged. In addition to gender inequity, there remain specific disease processes uniquely associated with being a woman which create specific challenges in both prevention and health care.

Even after succeeding in accessing health care, women have been discriminated against, a process that Iris Young has called "internal exclusion", as opposed to "external exclusion", the barriers to access. This invisibility effectively masks the grievances of groups already disadvantaged by power inequity, further entrenching injustice.

                                                   Women demonstrate for abortion rights, Dublin, 2012

Reproductive and sexual health:

Women experience many unique health issues related to reproduction and sexuality and these are responsible for a third of all health problems experienced by women during their reproductive years (aged 15–44), of which unsafe sex is a major risk factor, especially in developing countries.Reproductive health includes a wide range of issues including the health and function of structures and systems involved reproduction, pregnancy, childbirth and child rearing, including antenatal and perinatal care.Global women's health has a much larger focus on reproductive health than that of developed countries alone, but also infectious diseases such as malaria in pregnancy and non-communicable diseases (NCD). Many of the issues that face women and girls in resource poor regions are relatively unknown in developed countries, such as female genital cutting, and further lack access to the appropriate diagnostic and clinical resources.

Maternal health:

Pregnancy presents substantial health risks, even in developed countries, and despite advances in obstetrical science and practice.Maternal mortality remains a major problem in global health and is considered a sentinel event in judging the quality of health care systems.Adolescent pregnancy represents a particular problem,whether intended or unintended, and whether within marriage or a union or not. Pregnancy results in major changes in a girl's life, physically, emotionally, socially and economically and jeopardises

her transition into adulthood. Adolescent pregnancy, more often than not, stems from a girl's lack of choices. or abuse.Child marriage (see below) is a major contributor worldwide,

since 90% of births to girls aged 15–19 occur within marriage.

                                                                                                        Maternal death:

In 2013 about 289,000 women (800 per day) in the world died due to pregnancy-related causes, with large differences between developed and developing countries.Maternal mortality in western nations had been steadily falling, and forms the subject of annual reports and reviews.Yet, between 1987 and 2011, maternal mortality in the United States rose from 7.2 to 17.8 deaths per 100,000 live births, this is reflected in the Maternal Mortality Ratio (MMR).By contrast rates as high as 1,000 per birth are reported in the rest of the world,with the highest rates in Sub-Saharan Africa and South Asia, which account for 86% of such deaths.These deaths are rarely investigated, yet the World Health Organization considers that 99% of these deaths, the majority of which occur within 24 hours of childbirth, are preventable if the appropriate infrastructure, training, and facilities were in place. In these resource-poor countries, maternal health is further eroded by poverty and adverse economic factors which impact the roads, health care facilities, equipment and supplies in addition to limited skilled personnel. Other problems include cultural attitudes towards sexuality, contraception, child marriage, home birth and the ability to recognise medical emergencies. The direct causes of these maternal deaths are hemorrhage, eclampsia, obstructed labor, sepsis and unskilled abortion. In addition malaria and AIDS complicate pregnancy. In the period 2003–2009 hemorrhage was the leading cause of death, accounting for 27% of deaths in developing countries and 16% in developed countries.

Complications of pregnancy:

In addition to death occurring in pregnancy and childbirth, pregnancy can result in many non-fatal health problems including obstetrical fistulae, ectopic pregnancy, preterm labor, gestational diabetes, hyperemesis gravidarum, hypertensive states including preeclampsia, and anemia.Globally, complications of pregnancy vastly outway maternal deaths, with an estimated 9.5 million cases of pregnancy-related illness and 1.4 million near-misses (survival from severe life-threatening complications). Complications of pregnancy may be physical, mental, economic and social. It is estimated that 10–20 million women will develop physical or mental disability every year, resulting from complications of pregnancy or inadequate care.Consequently, international agencies have developed standards for obstetric care.

Female genital mutilation:

Female genital mutilation (also referred to as female genital cutting) is defined by the World health Organization (WHO) as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons". It has sometimes been referred to as female circumcision, although this term is misleading because it implies it is analogous to the circumcision of the foreskin from the male penis.Consequently, the term mutilation was adopted to emphasise the gravity of the act and its place as a violation of human rights. Subsequently, the term cutting was advanced to avoid offending cultural sensibility that would interfere with dialogue for change. To recognise these points of view some agencies use the composite female genital mutilation/cutting (FMG/C).

Child marriage:

Child marriage (including union or cohabitation)is defined as marriage under the age of eighteen and is an ancient custom. In 2010 it was estimated that 67 million women, then, in their twenties had been married before they turned eighteen, and that 150 million would be in the next decade, equivalent to 15 million per year. This number had increased to 70 million by 2012. In developing countries one third of girls are married under age, and 1:9 before 15. The practice is commonest in South Asia (48% of women), Africa (42%) and Latin America and the Caribbean (29%). The highest prevalence is in Western and Sub-Saharan Africa. The percentage of girls married before the age of eighteen is as high as 75% in countries such as Niger (Nour, Table I).Most child marriage involves girls. For instance in Mali the ratio of girls to boys is 72:1, while in countries such as the United States the ratio is 8:1. Marriage may occur as early as birth, with the girl being sent to her husbands home as early as age seven.

Other issues:
Other reproductive and sexual health issues include sex education, puberty, sexuality and sexual function. Women also experience a number of issues related to the health of their breasts and genital tract, which fall into the scope of gynaecology.

Women in health research:

Changes in the way research ethics was visualised in the wake of the Nuremberg Trials (1946), led to an atmosphere of protectionism of groups deemed to be vulnerable that was often legislated or regulated. This resulted in the relative underrepresentation of women in clinical trials. The position of women in research was further compromised in 1977, when in response to the tragedies resulting from thalidomide and diethylstilbestrol (DES), the United States Food and Drug Administration (FDA) prohibited women of child bearing years from participation in early stage clinical trials. In practice this ban was often applied very widely to exclude all women. Women, at least those in the child bearing years, were also deemed unsuitable research subjects due to their fluctuating hormonal levels during the menstrual cycle. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. These exclusions pose a threat to the application of evidence-based medicine to women, and compromise to care offered to both women and men.

Women's Health Initiative logo

Goals and challenges:

Research is a priority in terms of improving women's health.Research needs include diseases unique to women, more serious in women and those that differ in risk factors between women and men. The balance of gender in research studies needs to be balanced appropriately to allow analysis that will detect interactions between gender and other factors. Gronowski and Schindler suggest that scientific journals make documentation of gender a requirement when reporting the results of animal studies, and that funding agencies require justification from investigators for any gender inequity in their grant proposals, giving preference to those that are inclusive.They also suggest it is the role of health organisations to encourage women to enroll in clinical research. However, there has been progress in terms of large scale studies such as the WHI, and in 2006 the Society for Women's Health Research founded the Organization for the Study of Sex Differences (OSSD) and the journal Biology of Sex Differences to further the study of sex differences.

Research findings can take some time before becoming routinely implemented into clinical practice. Clinical medicine needs to incorporate the information already available from research studies as to the different ways in which diseases affect women and men. Many "normal" laboratory values have not been properly established for the female population separately, and similarly the "normal" criteria for growth and development. Drug dosing needs to take gender differences in drug metabolism into account.

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E-commerce in India.

India has an internet users base of about 450 million as of July 2017,40% of the population. Despite being the second-largest userbase in world, only behind China (650 million, 48% of population),the penetration of e-commerce is low compared to markets like the United States (266 million, 84%),or France (54 M, 81%), but is growing at an unprecedented rate, adding around 6 million new entrants every month. The industry consensus is that growth is at an inflection point. In India, cash on delivery is the most preferred payment method,accumulating 75% of the e-retail activities. Demand for international consumer products (including long-tail items) is growing much faster than in-country supply from authorised distributor and e-commerce offerings.In 2015, the largest e-commerce companies in India were Flipkart, Snapdeal, Amazon India, and Paytm.

Market size and growth:

India's e-commerce market was worth about $3.9 billion in 2009, it went up to $12.6 billion in 2013. In 2013, the e-retail segment was worth US$2.3 billion. About 70% of India's e-commerce market is travel related.According to Google India, there were 35 million online shoppers in India in 2014 Q1 and was expected to cross 100 million mark by end of year 2016. CAGR vis-à-vis a global growth rate of 8–10%. Electronics and Apparel are the biggest categories in terms of sales.

According to a study conducted by the Internet and Mobile Association of India, the e-commerce sector is estimated to reach Rs. 211,005 crore by December 2016. The study also stated that online travel accounts for 61% of the e-commerce market.

According to a study done by Indian Institute of eCommerce, by 2020 India is expected to generate $100 billion online retail revenue out of which $35 billion will be through fashion e-commerce. Online apparel sales are set to grow four times in coming years.

India's retail market is estimated at $470 billion in 2011 and is expected to grow to $675 Bn by 2016 and $850 billion by 2020, – estimated CAGR of 10%.. According to Forrester, the e-commerce market in India is set to grow the fastest within the Asia-Pacific Region at a CAGR of over 57% between 2012–16.

As per "India Goes Digital", a report by Avendus Capital, the Indian e-commerce market is estimated at Rs 28,500 Crore ($6.3 billion) for the year 2011. Online travel constitutes a sizable portion (87%) of this market today. Online travel market in India had a growth rate of 22% over the next 4 years and reach Rs 54,800 crore ($12.2 billion) in size by 2015. Indian e-tailing industry is estimated at Rs 3,600 crore (US$800 million) in 2011 and estimated to grow to Rs 53,000 crore ($11.8 billion) in 2015.

Closures:

Though the sector has witnessed tremendous growth and is expected to grow, many e-commerce ventures have faced tremendous pressure to ensure cash flows. But it has not worked out for all the e-commerce websites. Many of them like Dhingana, IndiaPlaza.in, Rock.in, Seventy MM amongst others had to close down  or change their business models to survive.

Infrastructure:

There are many hosting companies working in India but most of them are not suitable for eCommerce hosting purpose, because they are providing much less secure and threat protected shared hosting. eCommerce demand highly secure, stable and protected hosting.Trends are changing with some of eCommerce companies starting to offer SaaS for hosting web stores with minimal one time costs.

India has got its own version of Cyber Monday known as Great Online Shopping Festival which started in December 2012, when Google India partnered with e-commerce companies including Flipkart, HomeShop18, Snapdeal, Indiatimes shopping and Makemytrip. "Cyber Monday" is a term coined in the USA for the Monday coming after Black Friday, which is the Friday after Thanksgiving Day. Most recent GOSF Great Online Shopping Festival was held during Dec 10 to 12, 2014.

In early June 2013, Amazon.com launched their Amazon India marketplace without any marketing campaigns. In July 2014, Amazon had said it will invest $2 billion (Rs 12,000 crore) in India to expand business, after its largest Indian rival Flipkart announced $1 billion in funding. In June 2016, Amazon agreed to invest another $3 billion to further pressure rivals Flipkart & Snapdeal. Amazon has also entered grocery segment with its Kirana now in bangalore and is also planning to enter in various other cities like Delhi, Mumbai and Chennai and faces stiff competition with Indian startups.A large proportion of traffic towards e-commerce sites is driven by coupon sites.

Funding:

Examples of venture capital firms having invested in e-commerce companies in India are as follows: Flipkart.com raised about USD 2.3 billion.On 10 July 2013, Flipkart announced it had received $200.

 million from existing investors Tiger Global, Naspers, Accel Partners, and ICONIQ Capital, and an additional $160 million from Dragoneer Investment Group, Morgan Stanley Wealth Management, Sofina, Vulcan Inc. and more from Tiger Global.

In February 2014, online fashion retailer Myntra.com raised $50 million from a group of investors led by Premji Invest, the investment company floated by Azim Premji, Chairman of Wipro. May 2014 also witnessed an acquisition of Myntra by Flipkart reportedly for ₹2,000 crores.

In September 2015, PepperTap raised $36 million from Snapdeal and others.

Niche retailers:

The spread of e-commerce has led to the rise of several niche players who largely specialize their products around a specific theme. As many as 1,06,086 websites are registered daily and more than 25% are for niche businesses.

During 2014, Royal Enfield sold 200 bikes of special series Online.

Online apparel is one of the more popular verticals, which along with computers and consumer electronics make up 42% of the total retail e-commerce sales. Niche online merchandising brands like Headbanger's Merch, Redwolf and No Nasties partner with and even help sustain independent musicians. Some established brands like Arvind are now creating clothing lines just for the e-commerce markets. Some of the bigger online retailer like VoxPop Clothing have secured multiple rounds of funding, the last round raising $1 million from Blume Ventures in 2014.

As these niche businesses get popular, they are slowly getting acquired by the big players. BabyOye was acquired by Mahindra Retail, part of the $17 billion Mahindra Group. Ekstop was acquired by the Godrej Group to complement their offline chain of Nature's Basket stores.



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