Moderate malnutrition is highly prevalent in South Asia – 53 per cent of children under five years old in India were underweight in 1993. Why have decades of child nutrition programmes failed to reduce malnutrition? What are the links between the status of women, access to healthcare and child growth?

Research from the Institute of Child Health assesses the literature and draws on interviews with tribal and rural women in south India and growth assessments of their children under two on two separate occasions (six months apart) to understand moderate malnutrition and to suggest more effective ways of tackling it.

A third of all births in South Asia are low birth weight (less than 2 500 grams), compared with only one sixth of births in sub-Saharan Africa. Low birth weight is a significant risk factor for subsequent malnutrition. Malnourished children suffer repeated diarrhoeal disease episodes, acute respiratory infections and impaired psychomotor development. The cumulative experience of childhood malnutrition is far-reaching and its effects continue into adulthood.

Throughout South Asia, underweight prevalence is declining slowly. Food supplementation programmes that target young children are expensive for the benefits they deliver and they often fail to reach the most vulnerable under-twos.

Key research findings are that:

• Children’s nutritional status improves when their mothers are involved in household decisions and have greater freedom of movement; these two variables explain a greater proportion of the variance seen in nutritional status than do maternal education or employment.
• Though maternal employment is considered a pathway to autonomy, poor women are forced to work to support their families; they lack employment opportunities and are paid inadequately, and this has a detrimental effect on their children’s nutritional status.
• Over time, a mother’s employment before the birth of her children has a positive effect on subsequent growth.
• Maternal experience of psychological abuse is negatively associated with children’s nutritional status.
• Women’s experience of domestic violence, sexual coercion, dowry problems and their husbands’ alcoholism undermines their decision-making capabilities and freedom of movement.
• Investing in girls’ education, female literacy and income-generation initiatives have limited success if they are not accompanied by an analysis of the underlying reasons why some women can or cannot take advantage of the available opportunities.

In itself, poverty does not preclude improvements in nutrition. The Indian states of Kerala and Manipur have shown that equitable access to healthcare and education can reduce the prevalence of malnutrition where there is political will.

In search of new pathways of influence and nutrition interventions, the report suggests the need for:

• holistic approaches to tackle all the causes of  malnutrition in children
• recognition that women may not be free to decide whether or not to participate: all adult family members, particularly husbands and mothers-in-law, must be involved in programmes
• greater employment opportunities for poor women: only when daughters are viewed as important economically will marriages be delayed and wives be able to enhance their capacity to bargain and to negotiate with their husbands on reproductive and childcare issues
• health and nutrition surveys to measure maternal nutritional status and women’s status in addition to child anthropometry (studying of body measurements and proportions)
• research to understand how domestic violence, maternal depression and low self-esteem affect the rate of malnutrition
• investing in women’s groups to create legitimate local forums for women to meet: to raise awareness and address child development issues by way of play groups which could be linked to credit schemes.

Source(s):
‘Effects of the status of women on child growth: a study undertaken in the Mysore region of Karnataka, India’, PhD thesis, Centre for International Child Health, Institute of Child Health, University College, by Kavita Sethuraman, January 2002

id21 Research Highlight: 6 October 2003

Further Information:
Kavita Sethuraman
International Centre for Research on Women
1717 Massachusetts Avenue, Suite 302
Washington DC 20036
USA

Tel: +1 202 797 0007
Fax: +1 202 797 0020
Contact the contributor: ksethuraman@icrw.org

International Centre for Research on Women

Centre for International Child Health
Institute of Child Health
University College London
30 Guildford Street
London WC1N IEH
UK

Tel: +44 (0)20 7905 2122
Fax: +44 (0)20 7404 2062
Contact the contributor: cich@ich.ucl.ac.uk

Centre for International Child Health, UCL, UK

Other related links:
'Fed up? Examining child malnutrition in India'

'Thin end of the wedge – under and over-nutrition in Indian women'

'The size of the problem: malnutrition and obesity in urban India'

'Lean times - adolescent nutrition in Bangladesh'

'Halving child malnutrition by 2020: is income growth the answer?'

'Hitting the mark: Can under five mortality be cut by two thirds?' Insights Health #4