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<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review This section has demonstrated that there are a number of ways in which women’s bargaining power (as measured through different variables) is linked to children’s survival, health and nutrition outcomes: ‣ There is evidence from countries across three regions (South Asia, Sub Saharan Africa and Latin America and the Caribbean) that children’s nutritional status improves when women have greater decision-making power within the household although there are variations by region: o Improvements in women’s decision-making power in the household had the strongest effect on child nutrition status in South Asia; o The effect was less strong, though still significant for Sub Saharan Africa; o In Latin America and the Caribbean there was only a positive effect on children’s short-term nutrition status effect and only in households where women’s relative decision-making power is very low. ‣ These improvements in women’s status appear to have a stronger effect on child nutritional outcomes among poorer households; ‣ The pathways to these outcomes include improvements in women’s own health and nutrition and improvements in caring practices such as prenatal and birthing care for women, in feeding practices, treatment of child illness and immunization; ‣ Breastfeeding is the only care practice which may become compromised by improvements in women’s status. The reasons for this are as yet unknown but may be linked to women’s exposure to marketing and promotion of breastmilk substitutes, including by health professionals, , to a lack of knowledge about the benefits of breastfeeding, a shift in social norms around infant feeding accompanying economic development, urbanization and other social factors, or to inflexibility in paid work conditions. ‣ Studies also show correlations between indicators of women’s autonomy and child health and nutrition outcomes, including increased maternal age, education and residence in a female headed household, women’s lifetime exposure to employment and whether they are part of a family structure amenable to empowerment and finally their able to make decisions to travel outside the home to pay visits to health institutions and to make decisions about household purchases. 29
<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review Table 1: Summary of quantitative studies on aspects of women’s bargaining power and outcomes for child survival, health and nutrition Study author(s) and title A brief explanation of the study is included where the bargaining aspect of the study is not clear from the title Smith, Ramakrishnan, Ndiaye, Haddad & Martorell (2003) “The importance of women’s status for child nutrition in developing countries” Kishor (2000) “Empowerment of women in Egypt and links to the survival and health of their infants” Dancer & Rammohan (2009) “Maternal autonomy and child nutrition: Location Source of data <strong>Gender</strong> index of bargaining power Key findings and gender indicators significant for aspects of child survival, health and nutrition 36 countries across South Asia (97% of population covered), Latin America & the Caribbean (55%) & Sub Saharan Africa (61%) Egypt Nepal (rural households) National Demographic and Health Surveys conducted between 1990 and 1998 Cross-sectional study using data from a sample of 117,242 children across 36 countries 1995/96 Egypt Demographic and Health Survey (EDHS95) A study using a nationallyrepresentative sample of ever-married women aged 15-49 (n=7,121) 2006 Nepal Demographic Health Survey A cross-sectional study using data from 4,360 rural First index of women’s decision-making power used data on the difference between partners’ education levels, their age difference, women’s age at first marriage and finally whether she had independent access to income. Second index of “societal gender equality”, was constructed using the difference in ageadjusted weight-for-age Z-scores of girls and boys under five years, the difference in ageadjusted vaccination score of girls and boys under five, and the difference in years of education of adult women and men. Indices of empowerment were constructed based on a core of over 30 indicators from the DHS data. 10 dimensions of empowerment were identified: financial autonomy, participation in the modern sector, lifetime exposure to employment, sharing of roles and decision-making, family structure amenable to empowerment, equality in marriage, devaluation of women, women’s emancipation, marital advantage, traditional marriage. Women’s household decision-making autonomy were measured through surveying the following questions: Questions 1-3 aimed to provide a measure of a woman’s The decision making power index was significantly correlated with child weight-for-age in South Asia; raising the decision making index by 10 points over its current mean would increase the region’s mean weight-for-age z-score (WAz) by 0.156. Raising the decision making index in Sub Saharan Africa by 10 points over its current mean would raise the region’s mean WAz by 0.046 Raising the decision making index in Latin America & the Caribbean would only have an effect on weightfor-height (WHz) up to a certain point (53 on the index) after which it would start to reduce. Indices of empowerment significant in logistic regression models of both infant survival and health (proxied by whether 12-23 month children had received 8 recommended immunisations): woman’s lifetime exposure to employment [infant survival model: 1.47 (p
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