Women and Nutrition Security

The third pillar of food security is the achievement of nutrition security - that is, adequate nutritional status in terms of protein, energy, micronutrients, and minerals for all household members. Adequate availability of food at the household level is necessary to achieve nutrition security, but it is not sufficient. Other key contributors to good nutrition are adequate health and child care and access to clean water and good sanitation. Ensuring the nutrition security of the household, through the combination of both food and other resources, is almost the exclusive domain of women. Women’s ability to manage these resources is especially important for the more vulnerable members of the household, such as children.

Women’s Time Allocation

A critical underpinning to both the availability and use of these complementary inputs is time. Almost without exception, nonfood contributors to nutrition require complementary time investments, and in general this investment is made by women.

Agricultural and Domestic Production

Given women’s roles in agricultural production, domestic production, and reproduction, women in developing countries are relatively short of time compared with men. Given that domestic production and reproduction are almost entirely within the female domain, one might expect that their time in agricultural production would be lower than men’s.

However, data from Botswana, Burkina Faso, Kenya, Nigeria, and Zambia show that this is not the case (Box 7).³⁶

Added to the burden of agricultural production is the role of domestic production, including food preparation and the collection of fuelwood and water. In many regions of the world, women spend up to five hours per day collecting fuelwood and water and up to four hours per day preparing food.³⁷

Care of Household Members

The provision of “care,” namely, paying adequate time and attention to meeting the physical, mental, and social needs of growing children and other household members, is a crucial input into good nutrition. Care affects nutrition security in two broad ways: first, through feeding practices such as breast-feeding and the preparation of nutritious foods for weaned infants and others in the household, and second, through health and hygiene practices such as the bathing of children and the washing of hands before food preparation. These caring behaviors, particularly in relation to children, are time-intensive, yet time allocation studies consistently show relatively low periods of time being spent in direct child care. In a study of Bangladesh, Botswana, Ghana, Kenya, and the Philippines, time recorded in direct child care was generally less than one hour, except in Botswana and the Philippines. By design, all households in the Philippine sample had at least one preschool child, and yet even there time in child care was generally only around two hours per day.³⁸

Women constantly face difficult choices in their time allocation decisions. During times of economic hardship, women often assume the burden of adjustment. They absorb shocks to household welfare by expanding their already tightly stretched working day, often to the detriment of their own health and nutrition. The rapid pace of urbanization in many countries and increased female labor force participation imply even greater demands on women’s time. Women turn to processed foods and “street foods” to save time and try to find substitutes for child care so they can participate in the labor market. Increased time spent in income-generation activities (translated into higher food expenditures) and in using health and education facilities can improve child nutrition, but the loss of direct time spent in child care may offset this. Devoting more time to generating income may also worsen women’s own nutrition.³⁹ However, increasing female employment outside the home may increase women’s bargaining power within the household. Development of technology that relieves women’s time burdens in agricultural production and household maintenance without sacrificing their ability to earn independent incomes is therefore critical.

Women’s Nutritional Status as an Input to Child Nutrition and Health

Protecting female nutritional status is important in providing a head start for children’s nutritional status. Through prepregnancy nutritional status, weight gain during pregnancy, diet during lactation, and breastmilk production, better-nourished mothers lead to higher-birth-weight infants and better-nourished children. Birth weight is the single biggest determinant of neonatal and infant mortality and of child growth up to the age of seven.

A number of maternal factors have been shown to be significant determinants of birth weight; most important are the mother’s prepregnancy weight and weight gain during pregnancy. Women entering pregnancy with a low weight are several times more likely to produce a low-birth-weight baby (that is, an infant weighing less than 2.5 kilograms). As the prepregnancy weight of the mother increases, mean birth weight increases and the incidence of low birth weight decreases.⁴⁰

Infant birth weight and maternal weight gain during pregnancy are highly correlated. In addition, this prenatal weight gain is associated with a decrease in the incidence of premature birth (gestational age of less than 37 weeks). Moreover, if nutritional status before pregnancy, as measured by low prepregnancy weight, is inadequate, weight gain during pregnancy becomes even more important in influencing neonatal outcomes.

Evidence also suggests that fetal and early childhood malnutrition can lead to other serious disease, such as non-insulin-dependent diabetes, coronary heart disease, hypertension, and strokes, occurring in mid-adulthood onward.⁴¹ Additionally, the micro-nutrient status of HIV-infected pregnant women, who compose up to 30 percent of pregnant women in some of the worst-affected countries, has been shown to influence whether an infant is born HIV infected. A study in Malawi indicated that as the vitamin A status of the pregnant woman worsened the likelihood of the infant’s being born HIV positive increased.⁴²

A less well documented observation is that women may act as shock absorbers through the liquidation of their own nutritional status. Studies of the seasonality of maternal and preschooler nutrition status have observed that in times of food surplus women’s nutritional status returns to normal more quickly than that of preschoolers, but in the lean season female nutritional status is depleted more rapidly than that of preschoolers.⁴³ The physical labor performed by Ghanaian women, for example, particularly in agriculture, appears to have a negative effect on their own nutritional status.⁴⁴ In Ghana women participating in a credit program designed to intensify the cultivation of rice and vegetables had a lower nutritional status than women participating in a credit program targeted to food processing that reduced the energy required to do the task.⁴⁵

Food Distribution within Households

Most of the evidence on biases in the allocation of food within households emanates from South Asia, strongly suggesting that a strong pro-male and pro-adult bias in terms of the quantity of food intake exists in that region.⁴⁶ Some of this bias can be explained by the specialization of adult males in energy-intensive tasks.⁴⁷ However, boys are also favored in food distribution, especially during the lean season.⁴⁸ There is less evidence for a pro-male bias from Latin America and Sub-Saharan Africa.

Distribution of Other Resources within Households

While the discrimination within households in terms of food distribution in South Asia may be one factor explaining higher female mortality rates among infants and children, it is probably better explained by inequities in other inputs into child survival. The unequal distribution of resources other than food, such as health care and mother’s caregiving time, within the household may be detrimental to the health and nutrition of women and girls. Evidence of boy-girl discrimination in the allocation of such resources also comes mostly from South Asia.⁴⁹ Quantity and quality of health care and survival probabilities after diarrhea episodes are all reported to favor boys. In Pakistan, lower-income households seek care more often for boys than for girls and are likely to use higher-quality providers for boys.⁵⁰ Indeed, in India, breast-feeding duration is longer for boys, partly because there is less urgency to have another child after a boy.⁵¹ In rural Bangladesh the risk of dying from severe malnutrition is more than twice as high for girls as for boys.⁵²