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Women’s Status and Child Health
by Basudeb Guha-Khasnobis and Gautam Hazarika
Nearly 30 per cent of the world’s population is currently suffering from one or more forms of malnutrition. Approximately 840 million people are undernourished or chronically food insecure, and as many as 2.8 million children and 300,000 women die every year because of malnutrition in developing countries. Without rapid progress in reducing hunger, achieving the other MDGs related to poverty reduction, education, child mortality, maternal health, and disease will be impossible. The health and nutrition status of women and children were studied intensively within the WIDER twin projects titled ‘Hunger and Food Security’ (2004-5) and ‘Gender and Food Security’ (2006-7). This article, taken from these projects, reports the findings from a case study of Pakistan.
Womens’ status and child-health
Food security, defined as access to sufficient food for an active and healthy life, is pivotal to early childhood development. Children’s food security is a factor in economic growth since well-developed children are more productive as adults. Yet, malnutrition afflicts about a third of preschool aged children in less developed countries. It is associated with over half of worldwide child mortality. South Asia has the world’s highest rate of child malnutrition, with 49.3 per cent of its 0 to 5 year old children underweight despite the fact that South Asia fares better than for example sub-Saharan Africa by a number of measures of economic development: the so called South Asian Enigma. It has been argued that this is due in part to the particularly low status of women in South Asia.
The measures of women’s status chosen in our study are: an indicator of whether a woman is working for cash income, her age at first marriage, the per cent age difference between a woman and her spouse, and the difference between their years of education and the unearned income from remittances accruing to a household’s women. It is acceded that none of these five measures is unambiguously exogenous. A woman’s decision to work for cash income may, in fact, be the outcome of bargaining. A woman’s age at first marriage, the per cent age difference between herself and her spouse, and the difference between their years of education may be endogenous because of marriage market selection. Income from remittances too might be endogenous if, for example, a neglected woman in an unequal marriage were more likely to receive material assistance from her natal family. Children’s food security is assessed by anthropometric measures of nutrition, as well as by means of the examination of household expenditures.
In the context of Pakistan we found that the more educated a child’s mother relative to her father, the better her long-term nutritional status as measured by the height-for-age standard. Further, the earning of cash income by mothers improves children’s shorter-term nutritional status as measured by the weight-for-height standard. Additionally, children’s weight-for-age anthropometric nutritional Z-scores increase in these two measures of mothers’ status. Women’s status as gauged by the difference between the educational attainments of his wife and household head, and the per cent age difference between them, is significantly negatively related to the share of the household’s budget allocated to tobacco, adult clothing, and adult footwear. This suggests that resources allocated to children and, by plausible implication, their food security increase as women’s intra-household status improves.
Curiously though, the earning of cash income by a household head’s wife raises the share of the household’s budget applied to adult goods. This ‘crowding out’ effect is not uncommon for other countries and is worth investigating in more detail.
Gender inequities in health outcomes
By some estimates, there may be 105 females per 100 males in North America and Europe. In contrast, sex-ratios are considerably below even parity (100) in many less developed countries. For instance, there are 93.8 females per 100 males in India. India had 549.23 million males in 2003. Therefore, the number of absent females may be calculated as 61.5 million, or 34 million if parity is taken as the norm. Indeed, Amartya Sen, in the early 1990s, estimated there were more than 100 million ‘missing women’ worldwide. That this is not naturally occurring (as suggested by some) but is instead brought on is suggested by two facts. First, poorer health outcomes are likelier among higher birth order females, particularly among those with greater proportions of sisters among their older siblings. Second, females seem to enjoy a health advantage in developed countries, where, presumably, there is little intrahousehold gender discrimination. For example, male healthy-life expectancy at birth in the US was 67.2 years in 2002 as against 71.3 years for females, and the male child (under 5) mortality rate was 9 (per 1000 live births) as opposed to 7 for females. On the other hand, in Pakistan, male healthy-life expectancy at birth was 54.2 years whereas the corresponding figure for females was 52.3 years, and the child mortality rate was 98 for males but 108 for females. Thus, it is widely held that the neglect of females in intra-household allocations of food and health care explain much of the observed skew in sex-ratios. There is a body of evidence of such intrahousehold gender discrimination in less developed countries. Since it is plausible discrimination is particularly consequential in childhood, we examined the possibility of parental favouring of boys in Pakistan.
A rise in women’s status will reduce the incidence of children’s illnesses
We first investigated whether 0 to 5 year old boys in Pakistan are more likely to receive vaccinations than girls in this age group and whether boys enjoy better long-term nutrition than girls. Thereafter, the effect of both immunization and nutrition upon children’s susceptibility to illness was examined. Since a child’s stock of health may not be observed in household data, it useful to view this as a latent variable. The child may be considered ill when her stock of health falls below a threshold, and, hence, illness may be seen as a dichotomous measure of health. If immunization and long-term nutrition are factors in children’s health so measured, and if gender plays a role in both immunization and nutrition, then, logically, gender would be a factor in children’s health. We finally analysed gender differences in medical consultations following illness so as to discover whether gender plays a role in children regaining lost health. Data from the 1991 Pakistan Integrated Household Survey (PIHS) reveal that boys are significantly likelier to be immunized than girls in the 0 to 5 age group. On the other hand, no evidence of significant gender bias in children’s longterm nutritional status, as measured by height-for-age, is unearthed. Neither immunization nor long-term nutrition is a statistically significant determinant of children’s infectious illnesses within 30 days preceding the PIHS, though non-infectious illnesses are significantly less likely among better nourished children. Boys’ illnesses are significantly likelier to be referred to medical professionals than girls’ illnesses. In general, i.e., sick or not, boys appear to enjoy greater access to medical professionals than girls.
In sum, these studies indicate that women’s intra-household status in Pakistan and children’s nutrition are positively related, and that children’s nutrition and their susceptibility to illnesses are negatively related. It may be surmised, therefore, that a rise in women’s status will reduce the incidence of children’s illnesses.
Further reading:
Guha-Khasnobis, B., S. S. Acharya, and B. Davis (eds) (2007). Food Insecurity, Vulnerability and Human Rights Failure. Studies in Development Economics and Policy, Palgrave Macmillan.
Guha-Khasnobis, B., S. S. Acharya, and B. Davis (eds) (2007). Food Security: Indicators, Measurement, and the Impact of Trade Openness. UNU-WIDER Studies in Development Economics. Oxford University Press.
Basudeb Guha-Khasnobis is a Senior Research Fellow at WIDER. He holds a PhD in Economics from the University of Rochester and his research interests are international economics, development economics, emerging market finance, informal labour markets, and food security.
Gautam Hazarika holds a PhD in Economics from the University of Rochester. He is Assistant Professor of Economics at the School of Business of The University of Texas at Brownsville. His current research focuses on child labour in less developed countries, and on the effects of trade liberalization on labour markets in transition countries.