|Care and Nutrition - Concepts and Measurement (IFPRI, 1997, 56 p.)|
The concept of "care" as a determinant of child nutrition is still new to many outside the nutrition field. Moreover, for those in the field, how to measure care is problematic because caregiver responses and practices vary substantially from one culture to another. This paper is intended to provide an effective introduction to the care issue for the former group and to offer a useful summary of attempts to find strategies for measuring care for the latter group.
Care is the provision in the household and the community of time, attention, and support to meet the physical, mental, and social needs of the growing child and other household members. The links between food availability, care practices, and nutrition of the child are well established but hard to measure. The significance of care has best been articulated in the framework developed by the United Nations Children's Fund (UNICEF 1990). This paper extends the UNICEF model in two directions. It defines resources needed by the caregiver and specific care practices, and it presents an argument that the child's own characteristics play a role in the kind of care that he or she receives. That is, the way that the child and the caregiver interact can affect the health and nutritional status of the child.
The resources that a caregiver draws on in giving care include education, knowledge, and beliefs; physical health and nutritional status; mental health and self-confidence; autonomy and control of resources; reasonable workload and availability of time; and family and community social support. Seeing that the caregiver has the resources needed is providing care for the caregiver.
Several studies indicate that more educated women tend to commit more time and effort to child care than less educated women. They are also more likely to seek help if a child is sick and to participate in community health and nutrition programs.
Large numbers of women in developing countries are chronically ill or undernourished. For example, 60 percent of women in South Asia have iron deficiency anemia. How does this affect their ability to care for their children? Studies in developed countries show that depression and stress affect the ability of mothers to interact with their children and can lead to failure of the child to thrive. Little research has been done in this area in developing countries, however.
Who controls household resources may also affect the nutrition of children. When women control household income, for example, they may direct larger amounts of food to children. How much time women have to devote to child care and how much other work they have to do are also factors influencing child outcomes. Whether a mother's work for income adversely or positively affects her child's nutrition depends on many other factors, especially the adequacy of alternate caregivers. The level of family and community support may be a deciding factor in this issue.
This paper discusses in detail two of the least studied care practices: complementary feeding and psycho-social care. (The other recognized care practices are care for women, breast-feeding, food preparation, hygiene, and home health practices.) Feeding practices that can affect a child's nutritional status include adaptation of feeding to the child's abilities (offering finger foods, for example); responsiveness of the caregiver to the child's cues (perhaps offering additional or different foods); and selection of an appropriate feeding context (deciding where, when, and with whom the child eats, for example).
Psychosocial care is the provision of affection and attention to the child and responsiveness to the child's cues. It includes physical, visual, and verbal interactions. The specific ways that affection is shown and patterns of interaction with children depend on cultural norms and cultural goals for children, but the underlying purpose of these interactions is consistent across cultures.
This paper also discusses measurement of care and suggests appropriate tools for measuring resources for care and the two care practices, based on a summary of recent literature. More research is required on the causal linkages between care and child nutrition, and that research will depend on further development of measurements of care.