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

<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review
needed to enable access to resources or decision-making (Mwenesi, Harpham & Snow 1995). In Yemen,
al-Taiar et al. (2009) conducted a survey and follow-up focus group discussions to explore knowledge
and practices for preventing malaria. They found that women were more financially constrained than
men which produced delays in their treatment-seeking for sick children. In focus groups women often
described ‘struggling’ with their husbands over obtaining financial support to take a child to the hospital
(al-Taiar et al. 2009).
The studies above have, on the whole, been focused on treatment-seeking for malaria but there are
benefits for other aspects of healthcare seeking which relate to and rely on the interaction between
women’s decision-making power and their access to and control over resources. These have been
investigated quantitatively in terms of outcomes (see Box 4 below) and qualitatively in terms of process
as discusses in the studies below.
Box 4: Pathways of influence: decision-making power and women’s access to healthcare
A quantitative study using data on 18,614 children from the National Family and Health survey in
rural India explored the relationship between indicators of women’s decision-making power and
access to and control over resources on use of prenatal care, hospital delivery and child
mortality. The study found that a unit increase in woman’s decision-making power and control
over household resources (combined to produce a “bargaining power index”) increased the
demand for prenatal care by 40% points and the probability of hospital delivery by 25%, both of
which contributed significantly to a reduction in the risk of child mortality (Maitra 2004).
A qualitative study of the determinants of infant feeding in the context of HIV conducted in three
resource-poor countries (Cambodia, Burkina Faso, Cameroon) revealed a complex relationship between
women’s access to and control over resources and their wider decision-making power (Desclaux &
Alfieri 2009). In Burkina Faso, a father’s approval of a decision to formula feed was seen as important by
most mothers, partly in order to secure resources to purchase formula. However, an infant’s paternal
grandmother was seen as having the main decision-making power regarding infant care and feeding,
and husbands who were supportive of women’s decision to formula feed due to their HIV status could
be helpful in influencing their mothers’ decisions. In all sites women’s ability to choose an appropriate
infant-feeding option for their HIV status (either exclusive breast or formula feeding) was positively
influenced by their degree of autonomy (influenced by their economic or educational capital or their
social status), the support of husbands (especially when HIV-positive and sharing this information in the
relationship), or inclusion in a research or NGO project (ibid.).
Aubel has argued that attention should be paid to the networks of carers that influence child health and
nutrition given that in many societies child care is carried out collectively and with complementary
inputs from different household members (Aubel 2011a). A study accompanying an intervention carried
out in Senegal found that the inclusion of grandmothers in participatory learning activities on child
nutrition and healthcare, led to significant gains in women’s nutrition practices during pregnancy and in
feeding practices of newborns. Through qualitative interviewing of the participants it was found that
these improvements were linked to the positive roles played by grandmothers in encouraging women to
eat ‘special’ foods, to decrease their work-load and to exclusively breastfeed for the first 5 months
(Aubel, Touré & Diagne 2004).
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