|How Nutrition Improves - Nutrition policy discussion paper No. 15 (UNSSCN, 1996, 106 p.)|
|Chapter 4: Human Resource Development and Nutrition|
The stronger socio-economic position of women in South East Asia (Thailand and Indonesia) is contrasted here with that of women in the Indian sub-continent and Nigeria.
Women have traditionally had a very strong role in Thai society. Female labour participation (which relates to educational status) was relatively very high, at 44% in 1981, as compared to 26% in India and just 6% in Pakistan (World Bank 1989). In 1990, female literacy was at 91% compared to 95% for men. The government prioritized maternal health in the 1980s, and the results can be seen in the marked decline in the maternal mortality rate from 270 per 100,000 live births in 1980 to 37 in 1988. Approximately 80% of the births since 1982 have had some prenatal care, almost all administered by trained medical personnel. However, Thai mothers living in rural areas avail themselves of prenatal services less frequently than their urban counterparts. Approximately 74% of the rural mothers received at least one prenatal test, as opposed to 94% of the urban mothers. Moreover, there exist wide regional disparities; in Bangkok, 96% of the mothers had some prenatal care, while the lowest use of prenatal care could be found in the South, 66%. By 1990, throughout the country, trained personnel attend about two thirds of all births, traditional mid-wives deliver about one fourth, and the remaining 7-8% of births occur with either some other form of help, or none at all. These figures show that delivery care has improved greatly; in a national survey in 1969, 57% of the women who replied said that their latest birth had been attended by a traditional mid-wife, and only 28% indicated that trained health personnel had delivered their last baby.
Thailand also provides a good example of the demographic transition (Tha p6). Owing to extensive private and public family planning programmes, the population growth rate declined considerably from 3.2% in 1970 to an estimated 1.5% in 1990. The nation's total fertility rate has also dropped from 5.5 in 1970 to only 2.5 in 1990, while the crude death rate declined from 13.5 per 1,000 in 1960 to 4.4 per 1,000 in 1989. Thailand's infant mortality rate, in addition, has declined from 125 per 1,000 live births in 1960 to 20 in 1990. Child mortality (age 1 -4) has been declining from 3.1 per 1,000 in 1980 to 1.2 in 1990. While an obvious disparity exists between urban and rural, there is however no evidence of female discrimination since the male has a slightly higher mortality rate both in infancy and early childhood. Further, the life expectancy has risen from 60 to 63.2 for males and 66 to 67.3 for females during the period of 1980-1990. Cumulatively, these demographic transitions have created a changed picture in terms of Thailand's population age-structure from that of a broad base, pyramid-like shape in 1970 to columnar base, pagoda-like form at present.
In Indonesia, fertility rates also declined significantly since the mid-1970s, implying a gradual reduction in the reproductive burden among Indonesian woman. Indonesian women find less barriers to their participation in the labour force, education, and public life than many of their other Asian and Muslim counterparts. The Indonesian constitution, written in 1945, recognizes no differences between men and women as regards labour, health, politics, and law. Labour laws state that women should receive the same wages for the same work as men. They also outlaw discrimination based on sex in the work place. A fully paid maternity leave is allowed, as well as leave after a miscarriage, and time off to nurse infants. Women can take off two days a month during their menstruation. Although all these laws give women extensive rights and protection, many of them are not widely enforced, and they remain poorly used by women who are uninformed about their legal rights. Some gender discrimination does exist, which can be illustrated by the increasing predominance of males moving up through the education system - in 1987, for example, some male/female ratios were: 1.6/1 in secondary and higher education, 1.3/1 in literacy, 2/1 in the labour force, and more than 10/1 in the policy making levels of government (UNICEF/Government of Indonesia 1988). While educational standards are still lower for women than for men, the difference has reduced in recent years. While the adult literacy rate for men increased by 33% from 66% in 1970 to 88% in 1990, the female literacy rate increased by 79% - from 42% in 1970 to 75% in 1990. This rapid rise in female literacy is mostly due to the improvements in school enrolment and retention rates of both sexes, but particularly girls.
Women in Pakistan are highly disadvantaged and discriminated against. The starkest proof of this is the sex ratio - the number of females per 100 males. On average for low-income countries, this ratio was 95 in 1985 (World Bank 1989). In Pakistan, there were only 91 females per 100 males - even fewer than in 1965 when the ratio was 93. This compares with sex ratios of 101 in Indonesia and 99 in Thailand. Female life expectancy at birth is lower than many developing countries, including China and India. Pakistani women suffer from poor health partly because of an excessive reproductive burden; during their child-bearing years, women bear the physical stress of almost continuous pregnancy and lactation. The total fertility rate per woman in 1990 was 5.8. Contraceptive prevalence in 1989 was only 12%. The maternal mortality rate in 1988 was high at 270 per 100,000 live births, although it had dropped significantly during the 1980s (from 600 in 1980). This may reflect some improvements in antenatal care - in 1990, nearly 65% of pregnant mothers had access to antenatal care by trained health personnel compared to 26% in 1983. The relatively poor health of Pakistani mothers affect their offspring. For example, there are only three countries in the world with a higher proportion of low birth weight babies than Pakistan's 30%, and the infant mortality rate in 1990 was high at 103 per 1000 live births.
Female education is a key factor affecting the ability of mothers to provide adequate care for their families. Female primary school enrolment of 26% (in 1990) is extremely low and almost half that of their male counterparts. 80% women in Pakistan are illiterate (compared to 50% men) - a situation that has persisted throughout the 1980s. Apart from the high reproductive burden, this poor educational level has negative consequences for labour force participation: official female rates are only 6% overall (as compared, for example, to 44% in Thailand).
As regards education inputs (e.g. school enrolment and retention rates) and outcomes, there is a significant anti-female bias in India. Rural-urban and gender differentials are pronounced in school enrolment, although the percentage of scheduled castes/tribes out of the children enrolled at primary level is at par with their population proportions. Retention rates in primary classes are quite low, particularly for girls, worsening from lower to higher classes. Overall in India, at the end of the 1980s, the female literacy rate had just reached the level it had reached for males in the mid-1960s. Female literacy rates improved threefold from 1961 to 1991 (from 13.3 to 39.4%) while for males the level has gone up from 34.4% to 63.8% during the same period. Clearly though the gender divide is still pronounced. The regional variation is also striking, with illiteracy clustering in the some of the poorest states such as Rajasthan, Madhya Pradesh, Uttar Pradesh, Bihar and Orissa. Female literacy in India has been found to be strongly associated with age at marriage, fertility rates and child mortality (Reddy et al. 1992). With the beneficial multiplier effect exerted by female literacy on nutrition, this obstacle clearly needs to be addressed if future nutritional improvement is to be accelerated in India.
While women generally occupy a very underprivileged position in Indian society, there are significant regional variations. Discrimination against females is generally more pronounced in north India (Harriss 1990) and may not be significant in many parts of southern India. Where it does exist, it begins early in life, with more females than males dying in infancy and childhood. In contrast to most of the rest of the world, female mortality is greater than male mortality up until the age of 35. It has been shown that if India had had the female-male ratio obtaining in sub-Saharan Africa (around 1.02) then, given the number of Indian males, there would have been 37 million more women in India in the mid-1980s. Anti-female bias may manifest itself in many ways, but particularly important for nutrition are the biases in food provisioning, health care utilization and general care.
Women in Nigeria rarely have a legal title to land, the rate of female literacy in 1990 was only 40% (compared to 62% for men), and women farmers are far more constrained than men in obtaining access to credit, inputs, or extension services. Although schooling of females is rising and nearly comparable to males, the rates are still low - only 17% of girls of school age in 1990 were in secondary school. The education sector, in general, was drastically affected during the economic decline in the 1980s with per caput government expenditures for education dropping from US$ 9 in 1975 to $2 in 1988. Women suffer disproportionately from constraints on the labour supply, while the very uncertain rights of women in marriage and divorce highly limit their choices in life. Data on labour participation of Nigerian women shows a declining trend over the last two decades, although the rate of economic participation was quite high at 35% in 1990. In spite of the generally long duration of breastfeeding in Nigeria, there is increasing evidence of a progressive decline in the practice in urban areas. In terms of reproductive burden, Nigerian women are severely disadvantaged. The maternal mortality rate in 1988 was by far the highest for all countries reviewed, at 800 per 100,000 live births (down from a frightening rate of 1500 in 1980); the total fertility rate is high at 6.0 in 1990, when only 6% women used contraceptives. The incidence of low birth weight in 1986-90 was high for an African country, at 17%.