Women’s empowerment and child malnutrition in rural India
19 Jun 2015
Research has found mother’s empowerment to have a positive impact on the nutrition status of their children. This column analyses this relationship for data from rural India for the period 1992-2006. Among other factors, it highlights the importance of mother’s education in relation to father’s education in determining children’s nutrition.
Notwithstanding the impressive growth record in the recent past, India continues to have high rates of malnutrition. Although there has been a decline in the rates of moderately underweight and stunted children1, India continues to have one of the worst levels of low birth weight and underweight children when compared to other nations in BRIC (Brazil, Russia, India, and China) and SAARC (South Asian Association for Regional Cooperation). The percentage of under-five children who are moderately underweight and stunted is more than three times higher in India than in China. Also, the rate is higher than all of India’s less developed neighbours - Bangladesh, Nepal, and Pakistan (Institute of Applied Manpower Research (IAMR), 2011). This mismatch between India’s recent surge in economic growth and the persistence of high levels of malnourishment has led India to be characterised as the “Asian Enigma” (Smith et al. 2003). High levels of child malnutrition potentially result in lower cognitive skills and lower productivity in adult years. Additionally, the widespread prevalence of nutritional deprivation is a larger humanitarian issue. It is therefore not surprising that malnutrition in India is a serious policy concern.
Scholarly inquiries into determinants of child health and malnutrition in developing countries in general and in India in particular highlight the significance of economic, social, cultural and infrastructural factors (for example, see, Gaiha and Kulkarni 2005, Kravdal 2004, Gaiha et al. 2014). Specifically, mother’s characteristics such as her education, health, and presence of domestic violence have emerged as significant predictors of children’s nutritional status.
Empowered mothers, healthy children
The role of women’s characteristics in reducing the prevalence of malnutrition is echoed in the opinions voiced by experts across the globe. For instance, Olivier de Schutter in his presentation to the United Nations in March 2013 argued that “sharing power with women is a shortcut to reducing hunger and malnutrition, and is the single most effective step to realizing the right to food,” and urged “world governments to adopt transformative food security strategies that address cultural constraints and redistribute roles between women and men”. In the context of child health outcomes, given that women are typically the primary caretakers of children, redirecting of decision-making roles in favour of women has the potential to improve child health outcomes (de Schutter 2013).
In India, as in other parts of the developing world, the relationship between women’s characteristics and children’s nutritional status has been shown as positive in numerous studies. For instance, it has been seen that reduction in wage gap between men and women reduces severe stunting in terms of the number of stunted children in a household (Gaiha and Kulkarni 2005). Child health has been found to be affected by the use of healthcare services, which in turn is determined by women’s education, bargaining power within the household, and control over household resources (Maitra 2004). Women’s empowerment, as measured by women’s perception of whether a man is justified in beating his wife in certain situations, and women’s education have been found to have a significant association with child mortality levels (Kravdal 2004). Domestic violence and lack of education result in weak bargaining power of women relative to their male partners and to other household members which adversely impacts the nutritional status of women and their children. The other factors that are found to be relevant in predicting child nutritional outcomes are household income, number of children, caste affiliation, access to healthcare, and quality of sanitation (see, for example, Smith et al. 2003).
Data from rural India
Our recent study (Imai et al. 2014) aims to contribute to the existing knowledge on the association between women’s empowerment and child nutritional outcomes by examining relevant data from rural India for the period 1992-2006. We estimate how the nutritional measures for children under the age of three are related to their mother’s empowerment. The three indicators of nutritional status that we look at are: height-for-age (stunting), weight-for-age (underweight), and weight-for-height (wasting)2.
Our assessment of mother’s empowerment is based on three variables that are widely used in the literature to measure mother’s bargaining power, namely, mother’s educational attainment relative to the father’s, mother’s perception about presence of domestic violence and freedom of movement. Given that previous research has also shown indicators, such as caste affiliation, infrastructure, availability of healthcare, and access to sanitation and to portable water, we include these as well in our analysis to predict the levels of child’s health.
We use data on rural India from all three rounds of the National Family Health Survey (NFHS) - NFHS-I (1992-93), NFHS–II (1998-99), and NHFS-III (2005-06). The NFHS is a nationwide, multi-round survey conducted on a representative sample of households in India with a focus on health and nutrition of household members, especially of women and young children. The survey covers issues including fertility, family planning, maternal and child health, gender, HIV/AIDS, nutrition, and malaria. Data were collected at the individual level as well as household and community levels. Our analysis is confined to children aged zero to three years.
Mother’s education is key
Our results show that the ratio of the number of years of mother’s schooling to number of years of father’s schooling is positively associated with short-term measures of nutritional status of children, namely, weight-for-age and weight-for-height. The education gap between the parents is also correlated with a chronic measure of nutritional status, height-for-age. Second, access to health schemes or health insurance is associated with higher values of weight-for-age in 2005-063. Third, access to health facility, infrastructure (example, access to landline telephone lines) and environment (example, time required for getting water) are related to lower prevalence of child malnutrition. Access to a flush toilet is related to better nutritional status of children in terms of stunting and underweight. Easier access to water seems to be associated with higher scores on weight-for-height measure. Access to television is found to be correlated with lower prevalence of stunting and underweight. Also, children belonging to Scheduled Castes (SCs) tend to be more undernourished than those from non-SC households4.
In conclusion, our findings underscore the role of mother’s education as one of the critical indicators related to better nutrition of children. However, while enhancing women’s educational levels is necessary, it is not a sufficient condition for improving child health outcomes. Since women’s outside employment options, their own asset holding, income, or production skills are found to lead to women´s empowerment, appropriate policies should be designed to enable the same (see, for example, Doss 2013). Additionally, improved access to healthcare and sanitation expectedly, play a significant part. The relevance of these factors corroborates the recommendations made by previous work in this area. Future research should carry out rigorous evaluations of poverty alleviation measures, such as microfinance, in terms of whether they would affect these outside options that empower women and thus reduce the prevalence of child malnutrition in developing countries. Also, our findings call for concerted efforts to design more holistic development programmes that include investment in basic infrastructure, including provision of healthcare, sanitation, and water.
- The prevalence of underweight children declined from 53% in 2004 to 42% in 2010–11 with an average annual rate of reduction of 2.9% (The Naandi Foundation, 2011).
- The indicators are measured in terms of z-scores which capture how much a child’s weight/ height deviates from that of an international reference group of healthy children of the same age, as proposed by the World Health Organization (WHO) (2006).
- Data on health schemes or insurance is not available for other rounds.
- These variables are statistically significant at least at the 10% level. See Imai et al. (2014) for details.
- de Schutter, O (2013) ‘Empowering women is shortcut to tackling hunger – UN expert on right to food’, Louvain, Université de Louvain.
- Doss, C (2013), ‘Intrahousehold bargaining and resource allocation in developing countries’, Policy Research Working Paper 6337, World Bank, Washington D.C.
- Gaiha, Raghav and Veena S Kulkarni (2005), “Anthropometric failure and persistence of poverty in rural India’, International Review of Applied Economics, 19(2), 179–197.
- Gaiha, R, R Jha and VS Kulkarni (2014), Diets, Malnutrition and Disease: The Indian Experience, Oxford University Press, Delhi.
- Imai, Katsushi S, Samuel Kobina Annim, Veena S Kulkarni and Raghav Gaiha (2014), “Women’s Empowerment and Prevalence of Stunted and Underweight Children in Rural India”, World Development, 62(10), pp.88-105.
- Institute of Applied Manpower Research (IAMR) (2011), India human development report 2011: Towards social inclusion, Oxford University Press, New Delhi.
- International Institute for Population Sciences (IIPS) and Macro International (2007), National Family Health Survey (NFHS-3), 2005–06: India: Volume I, Chapter 15, pp. 493-524 IIPS, Mumbai. Available at http://dhsprogram.com/pubs/pdf/frind3/15chapter15.pdf.
- Kravdal, Øystein (2004), “Child mortality in India: The community-level effect of education”, Population Studies, 58, 177–192.
- Maitra, Pushkar (2004), “Parental bargaining, health inputs and child mortality in India”, Journal of Health Economics, 23: 259–291. Available at http://users.monash.edu.au/~maitra/JHE2005Maitra.pdf
- Naandi Foundation (2011), ‘HUNGaMA: Fighting hunger & malnutrition —The HUNGaMA Survey Report’.
- Smith, LC, U Ramakrishnan, A Ndiaye, L Haddad and R Martorell (eds.) (2003), ‘The Importance of Women’s Status for Child Nutrition in Developing Countries’, International Food Policy Research Institute (IFPRI), Series 131.