Gender Inequality and Child Nutritional Status
Gender Inequality and Child Nutritional Status: A Cross Country Analysis
Anish Kumar Mukhopadhyay
Abstract
Food security has specific importance for the women in developing countries. They are more likely to experience malnutrition and health related hazards than their male counterparts. This actually originates from the existence of biased allocation of intra household resources. From the available literature it has been gathered that the empowerment of women has a direct impact on reduction of hunger and the provision of basic needs in education, health, income etc. Female empowerment is also important for the lives of the most vulnerable segment of the population-children. Children could be deemed the most food insecure part of the population because food shortage, poverty and deprivation are likely to have the harshest effects on them given their vulnerability.
This paper basically deals with the following issues and tries to make a comparative study between two different time periods. In particular the study has been done to get an idea as to how nutritional status of children fares between in a cross-national perspective with an improvement in gender specific achievement indicators. It has also been tried to get an idea about the degree of association between food security, gender inequality and development in this connection. Attempt has been made to find out the most significant variable that is responsible for having any possible trend between gender inequality and child nutritional status over time in an econometric framework. Findings are an important cross-national extension of existing research, utilizing new measures that capture the development dynamic.
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Indian Council of Social Science Research , Centre For Studies In Social Sciences, Calcutta
Introduction
Gender inequality is a well-known and still widespread reality in the developing countries. One of its most noted manifestations is the unnaturally low Juvenile Female Male Ratio (JFMR) in these areas. Among its proximate determinants are sex differences in domains such as abortion, infanticide, child health care and child nutrition. Child weight and height performance can be viewed as the output of a health production function whose inputs include elements such as nutritional intakes, exposure to infections and health care. In this sense, height and weight are affected by virtually all of the pathways through which gender bias operates. Anthropometric indicators are also extremely important because there is a well-documented relationship between child malnutrition and poor adult outcomes. When evaluating gender differences, another advantage of nutritional status versus, nutrient intakes, morbidity or health care is that the former is easily measured and therefore much less prone to measurement error or reporting bias.
According to the FAO mostly women and children experience hunger as a defining characteristic of their lives. Nearly 96% of those suffering from hunger live in the developing countries with Sub-Saharan Africa (SSA) and South Asia (SA) the hardest hit (FAO, WFP, 2000). There are numerous ways to describe food security. The FAO provides one of them as “when people must live with hunger and fear starvation”(FAO, 1999,P.1). Reutilinger defines food insecurity as lacking “access by all people at all times to enough food for an active healthy life.”(Reutlinger, 1986,p.1). Food insecurity thus denotes prevalence of hunger in a society, emphasizing the structural factors affecting an individual, household, group, or country without guaranteed access to food. Tweeten (1997) notes that food security is comprised of three components-food availability, access and utilization. For food security to exist there must be a reliable supply of food that can be obtained that is nutritionally adequate for a healthy life. Uvin (1994) mentions that food security concerns food shortage, poverty, and deprivation. Food shortage refers to supply of food available to a population (Uvin, 1994,p.1), but like availability is inadequate on its own. Thus, one must also consider food poverty, which exists when persons cannot “obtain sufficient food to meet the nutritional needs of their members due to inadequate income, poor access to productive resources, inability to benefit from private or public food transfers, or lack of other entitlements to food (Uvin, 1994,p.10) and deprivation that concerns the nutritional adequacy of food. Taken together, these concepts form a well-rounded perspective on food security that provides an important context for understanding child hunger specifically that is the focus of this paper. Given their dependence on others, children could be deemed the most food insecure part of the population because food shortage, poverty and deprivation are likely to have the harshest effects on them given their vulnerability. In the next section we have provided a brief survey of literature where a link has been traced out between food security and gender inequality. After that we have described in detail about the variables that we have taken, the sources of data from where we have gathered them and the methodology that we have followed to carry out statistical exercises. Then, we have given the results and tried to interpret those so that we can establish the possible association between different measures of child nutritional status and gender inequality. Finally, we have concluded mentioning the determinants which are chiefly responsible for having any possible trend.
Survey of Literature
It is now widely accepted that ‘gender inequality dwells not only outside the household but centrally within it’ [(Agarwal, 2002)]. Gender is found to be an important signifier of differences in interests and preferences, incomes are not necessarily pooled and self interest resides as much within the home as in the market place, with bargaining power affecting the allocation of who gets what and who does what. Not only do intra-household power equations serve to keep women underpowered and subservient but also directly impact on their individual food and nutrition security and indirectly on that of other family members, particularly children. Within the context of household dynamics, food security is related to decisions regarding the responsibility for food production, earning cash income for food purchases, purchasing and preparing food and finally, actual access to food in terms of consumption.
It is often difficult to assess the gender disparity in access to food within the household, as differences in calorie consumption may be attributed to the lower energy needs of women. However, indirect evidence in terms of gender specific malnutrition levels point to existing disparities. A study of eleven villages in Punjab Bose (2003), [Dasgupta (1987)] found that boys and girls had roughly similar calorie intake, girls were given more cereals, while boys are given more milk and fats with their cereal.
No wonder that the incidence of severe malnutrition is greater among girls. Though women devote countless hours doing laborious work related to household food security but at the end of the day that often go unrecognized. Key links have been established between female empowerment in the family, household food security and family welfare. The empowerment of women has a direct impact on the improvement of hunger and the provision of basic needs in education, health, and income and numerous case studies elaborate on these issues. Extending from this, female empowerment is especially important for the lives of the most vulnerable segment of the population – children (UNDP, 2003). Child mortality has been an important focus in the women and development literature. One of the more important areas of interests with regard to child mortality is that of gender bias and the potential preference for male children. Suar (1994) for example notes that gender discrimination begins before birth and spans the entire life of women – the classic “womb to womb” scenario. Such action is gender inequality in its most extreme form and is certainly not the case everywhere in the world (Klasen & Wink, 2003). But, it is a relevant example of the potential consequences of gender inequality for infant and child mortality as well as for access to education and food security that are essential to their quality of life. There are a number of determinants for having malnutrition in the developing countries. Infact we have found some of them in Scanlan’s (2004), Ramachandran’s (2005) and Mehrotra’s (2006) papers. Let us discuss them in a bit detail.Percentage of low birthweight infant is essentially an indicator of the nutritional status of mothers. Small mothers give birth to small babies. Besides, if the weight that mothers are supposed to put on during pregnancy is lower than what is required for the healthy growth of the child then the probability of a new born to be of low birthweight infant becomes high. Baby’s nutritional status is a direct outcome of the mother’s nutritional status.
2. Height of an adult is a direct outcome of several factors including nutrition during childhood and adolescence. Women who are below 140-150 cm might be nutritionally at risk in terms of height-l.b.w.The percentage of women below 145cms is highest for illiterate women and tends to decline with increasing education.
3.The BMI is used to evaluate thinness and obesity. Chronic energy deficiency is indicated by a BMI, which is less than 18.5.While Body Mass Index (BMI) and shortness are indicators of protein-energy malnutrition there is also a micro-nutrient deficiency. Thus, prevalence of iron-deficiency anemia is one indicator of the nutritional status of women. Anaemia may become an underlying cause of maternal mortality rate (MMR) and perinatal mortality. It results in an increased risk of premature delivery and l.b.w. [i) Height<145 cm, ii) BMI 18.5 are likely to suffer more from anemia]. This is more of a rural scenario than a typical urban one, which declines with an increase in education.
4. South Asia has the worst educational indicators relative to men compared to all other regions and it has been observed that half of world’s malnourished children live in India, Pakistan and Bangladesh. (Mehrotra, 2006). In this connection the role of female literacy becomes quite pertinent and especially that too for mother’s. It should matter since the mother is the principal care-giver and also for the sake of the well-being and capabilities of the woman herself (Nussabaum, 2000). An educated girl would like to marry later than a girl who remains without any education. Then the possibility of that educated girl to be engaged economically out side her home will enhance. Being educated she is expected to have fewer children, will seek medical attention sooner for herself and her children. Naturally, she is likely to provide better care and nutrition for children. So the percentage of L.B.W. reduces with an increase in education of the females. We have to keep it in mind that both adult literacy and gross enrollment rate are important for this reason.
5. The nutritional status of the child is outcome of a process that goes on over the whole life cycle, and without the right interventions, leads to an inter-generational transfer of ill being from women to children, irrespective of the latter’s gender. By far the most important evidence of systematic gender discrimination over a lifetime is provided by the fact that the life expectancy of women in south Asia is lower than that of men by a greater margin than anywhere else in the world. It is well known that for biological reasons, women tend to have a longer life expectancy than those of men. While in all the regions, Life expectancy for women relative to that of men is lower than in CEE / CIS countries it is the lowest in south Asia. This can only happen as a result of systematic discrimination against women over a lifetime, which gets perpetuated over generations. It is precisely this phenomenon that Sen had referred to in his analysis of the “missing millions” of women, since lower life expectancy translates into a lower than possible female-to-male ratio in the total population of a country.
6. WHO-UNICEF guidelines recommend that an infant must be exclusively breast-fed for first six months. In South Asia half of all infants were exclusively breast-fed (Ramalingaswami, 1996). Although the share of breast-fed babies may be higher in South Asia (and India) compared to SSA but the general health status of women in SA is worse than in other parts of the world. Their poorer health status would prevent SA women from breast-feeding adequately.
Data and Methods
We are going to examine how gender inequality and child health status are related in a cross-national framework. The relationship has been established taking cross section data of the developing countries of the world. The objective is to get the view whether in the DC’s with an improvement in gender inequality child nutritional status improves or not. Now let us discuss about the variables to be used for numerical analyses.
Description of the independent variables: -
We take Gender Development Index (GDI), Human Development Index (HDI) and then derive a new indicator namely GI which is nothing but the ratio of absolute difference between HDI and GDI and HDI that is GI= (hdi-gdi)/hdi. Now it is important to examine the gap between HDI and GDI indicated by GI to isolate the gender component of the HDI, which absorbs the overall development well being of a society. Using the gap ensures that the effects reported are due to gender inequality and not simply economic development. Apart from that in order to capture gender disparity in the health, education and economically active labour force participation rate we have taken the ratio of female life expectancy at birth and male life expectancy at birth (defined as LEB), female adult literacy and male adult literacy (defined as AL), female labour force participation rate and male labour force participation rate (defined as LFP) to. Besides that we are going to deal with infant mortality rate (IMR), Under 5 mortality rate (U5MR) and maternal mortality rate (MMR) and child mortality rate (CMR) where CMR is the ratio of female child mortality rate (CMRf) and male child mortality rate CMRm. This ratio will more intensely reflect female discrimination than male since the rate of CMR is much more among female children. The problem that we face is that the figure for the CMR is not available for all the DC’s in the time frame we are working with (1999-2005). On the other hand, CMR and U5MR are very closely associated concept and statistically speaking there is a high possibility of double counting if both of them are included. So we choose only U5MR for statistical analyses. MMR is another important indicator in the equations to be estimated since child nutritional status is a direct outcome of mother’s. So, despite the fact that it is not a gender segregated /specific figure actually it depends upon an intra-household gender inequality which could in turn determine the nutritional status of mother’s.
A reduction in any types of mortality rate (be it for the IMR, the MMR, or the U5MR) would mean betterment in the survival chance. The lesser the death rate the better it is for the children of young age and mother’s. So, a possibility remains that an improvement in health status may guarantee which should necessarily accompany an overall progress in the nutritional status. So the percentage of LBW, WAG or HAG should fall. This leads us to expect a directly proportional relationship between these variables and food security. Similarly, any improvement in the LEB and the AL suggest increase in gender equality and hence a corresponding reduction in the child nutritional status. So here the expected association is of inverse. The general expectation about the association between above-mentioned indicators and food security will be positive (for IMR, U5MR, MMR, LFP) and negative (for LEB, AL).
Description of the dependent variables: -
Now let us consider the dependent variables. Basically we have taken three variables to represent food security or child nutritional status. They are 1.Percentage of Low Birthweight infants (LBW), 2. Weight-For Age (WAG), 3. Height-For-Age (HAG).
1. LBW is taken to capture the nutritional status of the infants. The greater the percentage the worse is the status of the corresponding country in terms of LBW. The idea is to incorporate the inadequacy of nutritional status on that age group. When a baby is newly born he or she needs more food (in terms of nutrition) for his/her living.
2. If children have low WAG they are said to be underweight. WHO and UNICEF as a composite, one-dimensional index of the overall prevalence of child undernutrition in third-world countries use WAG. All children who have a WAG below 2 S.D. of the NCHS median are defined as undernourished use this. The intention is to capture both the stunted and wasted.
3. Stunted (HAG) children are those who are short for their age; the height-for age measures the prevalence of chronic under-nutrition, which could result from inadequate nutrition over a period of time or chronic or recurrent diarrhoea. The underlying theory is that chronic undernutrition in childhood retards growth in stature, although there is no consensus on the relative importance of nutrition, on the one hand, and disease and unfavorable socio-economic environment, on the other. Height-for –age is not affected by the season in which data are collected.