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

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<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review 1.1.1 MATERNAL EDUCATION AS A RESOURCE IN HOUSEHOLD BARGAINING There is a large body of evidence which demonstrates the strong link between women’s education and child survival (Caldwell & McDonald 1982; Chen & Li 2009; Cleland & Ginneken 1988; Gokhale et al. 2004; Hobcraft 1993; LeVine 2004; Rowe et al. 2005; Schnell-Anzola, Rowe & LeVine 2005). However there is less research on how or why education makes such a difference, although there is some evidence that more highly educated women benefit from: ‣ Direct access to resources through improved income earning potential. ‣ Indirect access to resources and decision-making power through women’s improved status in the household. Although many studies of the effect of maternal education on child health do not make direct comparisons with the effect of paternal education, a number of studies have established the relatively greater impact of maternal as compared to paternal education (Breierova & Duflo 2002; Maitra 2004; Uddin, Hossain & Ullah 2009). The advantages of education for child health have also been shown to vary by geographic setting. For example DHS survey data from 17 countries showed a stronger relationship between maternal education and child survival in urban as opposed to rural areas (Bicego & Boerma 1993). The authors hypothesise that in this case education can be shown to enable women to manipulate important bureaucratic structures (such as healthcare services) which exist in grater size and complexity within urban settings. They also suggest that children of women in rural areas may benefit less from education, if their mothers are constrained by more rigid traditional structures and norms. Links between higher maternal schooling and higher immunisation coverage in East Africa (Jones, Walsh & Buse 2008) may also reflect the importance of maternal education for enabling women to negotiate health services more effectively. Evidence from rural Punjab also found that maternal education improves child care practices such as the use of rehydration therapies as well as immunisation uptake (Das Gupta 1990). Box 2: Pathways of influence: Maternal education and psychological health Research has captured evidence of an interlinking chain of benefits around psychological wellbeing and education for women and their children. For example: there is evidence to suggest that women who have some degree of control over family-resource allocation are at lower risk for depression than women without control over resource allocation (Rahman, Iqbal & Harrington 2003) as well as evidence that increased education is associated with lower risk for depression (Patel, Rodrigues & DeSouza 2002). On the other hand, maternal depression increases the risk of growth failure for infants (odds ratio 3.91, 95% confidence interval 1.95-7.86) (Rahman et al. 2004). As the evidence on maternal education demonstrates, children benefit when their mother’s status is raised. It has been hypothesized that this is related (among other things) to increased decision-making 15
<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review power and increased access to and control over resources. These two factors are in fact often interrelated, since women in households may wield more control over their resources when they have greater decision-making power, or vice versa. However in some situations it is also conceivable that mothers might have access to resources and simultaneously be unable to influence the decision-making process involved in the use and control of those resources. Studies may therefore explore these factors separately or in combination. Decision-making power and access to and control over resources are key elements of women’s bargaining power within the household (see Box 3 for a definition of intra-household bargaining). Figure 1 (see below) provides an interpretation of the way in which women’s bargaining power reflects both decision-making power and access to and control over resources and the effect these may have on child health and nutrition and ultimately on child survival. The studies included in this section reflect multiple and interlinking aspects of intra-household bargaining power and processes. Box 3: Introducing intra-household bargaining Bargaining as a concept was established by Sen’s theory of ‘intra-household bargaining’ (Sen 1990) which illustrates how inequality between different members of a household effects its decision-making processes and allocation of resources. According to Sen, an individual’s ‘entitlements’ to make decisions and use resources are determined by their position within the household, both in terms of their ‘perceived contribution’ and in terms of their ‘breakdown position’ (their social and economic position were the relationship to end or break down). Where women have fewer opportunities to earn income outside of the home, and where child care and domestic duties are perceived as ‘lower status’ contributions, women’s bargaining power is diminished, as their position is more vulnerable in the event of a ‘break down’ in the relationship. REVIEW OF STUDIES 16
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Page 3 and 4: ACKNOWLEDGEMENTS This review was co
Page 5 and 6: TABLE OF FIGURES Figure 1: Diagram
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