The mortality rates for children under five in Nepal are among the highest in the world, with substantial differences existing between the rates for boys and girls. If efforts to reduce child mortality are to be more effective, an understanding is needed of how gender influences households' decisions to seek health care for their children.

Nepal’s health care infrastructure is poorly utilised and offers a low quality of care, particularly in rural areas where about 80 percent of the population lives. The mortality rate for young girls compared to boys in Nepal deteriorated in the 1970s. In 1970, 1985 and 1996, the number of one to four year old female child deaths per 100 male child deaths was 108.7, 128.2 and 124.2 respectively. Studies have shown that in South Asian societies, including Nepal, there is a strong son-preference.

While the overall child mortality rates have declined in the past decade, the government of Nepal has introduced a five-year plan and a long-term health plan which aim to reduce the deaths further by prioritising preventive and curative care for childhood diseases. If these programmes are to be implemented effectively, programme managers and policymakers need to look at the factors influencing household decisions on the use of child health care.

A study by Tropical Medicine Heidelberg, Germany, focuses on the extent to which gender influences child health care. It considers four stages of a health seeking action, including reporting of illness; choosing external care; choosing a health care provider; and spending money on treatment for the ill child. Gender was found to be a factor in all four stages. While being a boy only marginally affected the reporting of illness, it played a stronger role in choosing external care as well as public provider and money spent with private health providers.

Further findings include:

• A boy was 15 percent more likely to be reported ill than a girl, irrespective of the family’s income.
• For a boy, the likelihood of external care being sought was 42 percent higher than for a girl.
• Boys were 43 percent more likely to be taken to the public health care provider than girls.
• Households spent more money with private health care providers for a male child.

While the strong son-preference in Nepal may offer an explanation for the gender difference in health care choices, it appears that discrimination against girls may not be mainly the result of economic difficulties. Furthermore, because the study focuses on the outcome of households’ health care choices and not the process of making these choices, it can offer no explanation as to why households show son-preference in child health care use. Thus the study is not able to make policy suggestions for reducing these gender disparities.

However, it suggests that:

• Health policies should focus on changing families' perceptions of girls’ illnesses. Studies have shown, for instance that women’s education increases their use of health care.
• Increasing the number of health care outlets and removing financial barriers to care by subsidising the supply side may not have the desired effect, due to the wider social and cultural roots of gender bias, including the perception of illness.
• However, providing the poorest households with demand-side subsidies for health insurance may help reduce the gender gap.

Source(s):
‘Gender role and child health care utilization in Nepal’, Health Policy 74, pages 100-109, by Subhash Pokhrel et al, 2005
HINARI subscribers can access the full-text article here. Full document.

id21 Research Highlight: 2 June 2006

Further Information:
Subhash Pokhrel
Department of Tropical Hygiene and Public Health
University of Heidelberg
INF 324
D-69120 Heidelberg
Germany

Tel: +49 6221 564886
Fax: +49 6221 565948
Contact the contributor: subhash.pokhrel@urz.uni-heidelberg.de

Department of Tropical Hygiene and Public Health, University of Heidelberg, Germany

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'Helping children survive: assessing health prevention coverage'

'Women’s literacy programmes improve social and economic development in Nepal'

'Spreading safe motherhood messages in Nepal'

'Mothers’ meetings: reducing neonatal mortality in Nepal'

'Teaching women well – health and education in rural Nepal'

'Keeping it in the family: care during childbirth in rural Nepal'

'Home delivery – childbirth practices in Nepal'