Gender influences on child survival, health and nutrition: a ... - Unicef

<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review
1 REVIEW OF STUDIES EXPLORING GENDER INFLUENCES ON CHILD
SURVIVAL, HEALTH AND NUTRITION
1.1 WOMEN’S STATUS AND INTRA-HOUSEHOLD BARGAINING POWER AND PROCESS.
This section explores one of the main ways in which women’s status (see box 1 below) impacts on child
health and nutrition outcomes within the household through women’s bargaining power relative to
other members of the household.
A body of research spanning more than 20 years focusing on aspects of gender and child health and
nutrition has found links between women’s status and child survival. As this is a well established
literature, we have drawn on some key reviews and quantitative studies in order to highlight its
relevance to child survival (Caldwell & Caldwell 1991) (Smith & Haddad 2000). In brief, the mechanisms
hypothesised to explain the effect of women’s status on child survival include better literacy, better
adherence to health services, more autonomy, more bargaining power, more access and control over
resources. Among the dimensions of women’s status explored, maternal education is one of the bestresearched
mechanisms through which improvements in women’s status (i.e. through better education
for women) leads to gains in child health and nutrition. This is explored in more depth next.
Box 1: What is women’s status?
Women’s ‘status’ refers to the position women hold vis-à-vis men in a given community or
society which usually mediates their decision-making power and ability to access resources
within the household or the wider community.
Studies have adopted different approaches to measuring women’s status through proxy
indicators. Caldwell’s review focuses on maternal education (discussed further in section 1.2.2).
Others have combined measurements of women’s education with other indicators. For example,
Smith and Haddad (2000) show that women’s status (as measured by female to male life
expectancy) and improvements in women’s education (as measured by female secondary
enrolments) are associated with positive impacts on nutritional status. The study estimates that
improvements in women’s status account for 11.61% of global reductions in the proportion of
children who are underweight (low weight for age), and improvements in women’s education
secondary enrolments account for 43.01% of global reductions in the proportion of children who
are underweight (low weight for age). Taken together, the two indicators accounted for over
half of the reductions in child underweight in the 1970-1995 period. More recently, Apodaca
(2008) uses the ratio of female to male primary school enrolment as a proxy measure of women’s
status in a multivariate statistical analysis of data from 137 developing countries and finds that
more equal enrolment ratios are associated with reduced child stunting rates The effect of the
ratio of female to male primary school enrolment was significant in four Ordinary Least Squares
regression models used to measure the effects of health conditions on childhood stunting [-0.22
(0.13); -0.05 (0.14); -0.16 (0.13); -0.15 (0.13)] (Apodaca 2008).
REVIEW OF STUDIES
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