in growth and suboptimal dietary intake. in the adult woman, pregnancy leads to further iron depletion. violence main articles: violence against women, domestic violence, and intimate partner violence women experience structural and personal violence differently than men. the united nations has defined violence against women as; " any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life." (united nations, declaration on the elimination of violence against women, 1993) violence against women may take many forms, including physical, sexual, emotional and psychological and may occur throughout the life-course. structural violence may be embedded in legislation or policy, or be systematic misogyny by organisations against groups of women. perpetrators of personal violence include state actors, strangers, acquaintances, relatives and intimate partners and manifests itself across a spectrum from discrimination, through harassment, sexual assault and rape, and physical harm to murder (femicide). it may also include cultural practices such as female genital cutting. non-fatal violence against women has severe implications for women's physical, mental and reproductive health, and is seen as not simply isolated events but rather a systematic pattern of behaviour that both violates their rights but also limits their role in society and requires a systematic approach. the world health organization (who) estimates that 35% of women in the world have experienced physical or sexual violence over their lifetime and that the commonest situation is intimate partner violence. 30% of women in relationships report such experience, and 38% of murders of women are due to intimate partners. these figures may be as high as 70% in some regions. risk factors include low educational achievement, a parental experience of violence, childhood abuse, gender inequality and cultural attitudes that allow violence to be considered more acceptable. violence was declared a global health priority by the who at its assembly in 1996, drawing on both the united nations declaration on the elimination of violence against women (1993) and the recommendations of both the international conference on population and development (cairo, 1994) and the fourth world conference on women (beijing, 1995) this was followed by its 2002 world report on violence and health, which focusses on intimate partner and sexual violence. meanwhile, the un embedded these in an action plan when its general assembly passed the millennium declaration in september 2000, which resolved inter alia "to combat all forms of violence against women and to implement the convention on the elimination of all forms of discrimination against women". one of the millennium goals (mdg 3) was the promotion of gender equality and the empowerment of women, which sought to eliminate all forms of violence against women as well as implementing cedaw. this recognised that eliminating violence, including discrimination was a prerequisite to achieving all other goals of improving women's health. however it was later criticised for not including violence as an explicit target, the "missing target". in the evaluation of mdg 3, violence remained a major barrier to achieving the goals. in the successor sustainable development goals, which also explicitly list the related issues of discrimination, child marriage and genital cutting, one target is listed as "eliminate all forms of violence against all women and girls in the public and private spheres" by 2030. un women believe that violence against women "is rooted in gender-based discrimination and social norms and gender stereotypes that perpetuate such violence", and advocate moving from supporting victims to prevention, through addressing root and structural causes. they recommend programmes that start early in life and are directed towards both genders to promote respect and equality, an area often overlooked in public policy. this strategy, which involves broad educational and cultural change, also involves implementing the recommendations of the 57th session of the un commission on the status of women (2013). to that end the 2014 un international day of the girl child was dedicated to ending the cycle of violence. in 2016, the world health assembly also adopted a plan of action to combat violence against women, globally. women in health research women's health initiative logo 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. the increasing focus on women's rights in the united states during the 1980s focused attention on the fact that many drugs being prescribed for women had never actually been tested in women of child-bearing potential, and that there was a relative paucity of basic research into women's health. in response to this the national institutes of health (nih) created the office of research on women's health (orwh) in 1990 to address these inequities. in 1993 the national institutes of health revitalisation act officially reversed us policy by requiring nih funded phase iii clinical trials to include women. this resulted in an increase in women recruited into research studies. the next phase was the specific funding of large scale epidemiology studies and clinical trials focussing on women's health such as the women's health initiative (1991), the largest disease prevention study conducted in the us. its role was to study the major causes of death, disability and frailty in older women. despite this apparent progress, women remain underrepresented. in 2006 women accounted for less than 25% of clinical trials published in 2004, a follow up study by the same authors five years later found little evidence of improvement. another study found between 10 and 47% of women in heart disease clinical trials, despite the prevalence of heart disease in women. lung cancer is the leading cause of cancer death amongst women, but while the number of women enrolled in lung cancer studies is increasing, they are still far less likely to be enrolled than men. one of the challenges in assessing progress in this area is the number of clinical studies that either do not report the gender of the subjects or lack the statistical power to detect gender differences. these were still issues in 2014, and further compounded by the fact that the majority of animal studies also exclude females or fail to account for differences in sex and gender. for instance despite the higher incidence of depression amongst women, less than half of the animal studies use female animals. consequently, a number of funding agencies and scientific journals are asking researchers to explicitly address issues of sex and gender in their research. a related issue is the inclusion of pregnant women in clinical studies. since other illnesses can exist concurrently with pregnancy, information is needed on the response to and efficacy of interventions during pregnancy, but ethical issues relative to the fetus, make this more complex. this gender bias is partly offset by the initiation of large scale epidemiology studies of women, such as the nurses' health study (1976), women's health initiative and black women's health study. women have also been the subject of neglect in health care research, such as the situation revealed in the cartwright inquiry in new zealand (1988), in which research by two feminist journalists revealed that women with cervical abnormalities were not receiving treatment, as part of an experiment. the women were not told of the abnormalities and several later died. the women's health care market is today a major pharmaceutical industry, projected to double in size within the five years from 2019 to 2024 and reach usd 17.8 billion. the by far most valued company worldwide whose leading products are in women's health is bayer (germany) with the focus area of contraception. national and international initiatives logo of un sustainable development goals in addition to addressing gender inequity in research, a number of countries have made women's health the subject of national initiatives. for instance in 1991 in the united states, the department of health and human services established an office on women's health (owh) with the goal of improving the health of women in america, through coordinating the women's health agenda throughout the department, and other agencies. in the twenty first century the office has focussed on underserviced women. also, in 1994 the centers for disease control and prevention (cdc) established its own office of women's health (owh), which was formally authorised by the 2010 affordable health care act (aca). internationally, many united nations agencies such as the world health organization (who), united nations population fund (unfpa) and unicef maintain specific programs on women's health, or maternal, sexual and reproductive health. in addition the united nations global goals address many issues related to women's health, both directly and indirectly. these include the 2000 millennium development goals (mdg) and their successor, the sustainable development goals adopted in september 2015, following the report on progress towards the mdgs (the millennium development goals report 2015). for instance the eight mdg goals, eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality rates, improving maternal health, combating hiv/aids malaria and other diseases, ensuring environmental sustainability, and developing a global partnership for development, all impact on women's health, as do all seventeen sdg goals, in addition to the specific sdg5: achieve gender equality and empower all women and girls. goals and challenges women in nepal learning oral health 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 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. women receiving health education in india globally, women's access to health care remains a challenge, both in developing and developed countries. in the united states, before the affordable health care act came into effect, 25% of women of child-bearing age lacked health insurance. in the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. the situation is aggravated by the fact that women living below the poverty line are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion. added to the financial burden in this group are poor educational