Purnima Menon, PhD Research Fellow International Food Policy Research Institute New Delhi October 30, 2009 NUTRITION IN SOUTH ASIA : WHY GENDER MATTERS

2009 Global Hunger Index

Child nutrition in South Asia * For age group 6-59 months 1. National Family Health Survey, India, 2005-06 2. Nepal Demographic Health Survey, 2006 3. Bangladesh Demographic Health Survey, 2004 4. Pakistan Demographic Health Survey, 2007 5. Sri Lanka Demographic Health Survey, 2007

Reductions in child underweight from 1988-92 to 2001-2006 Source: Global Hunger Index 2008; Appendix C

The window of most damage…and of opportunity

Women’s status and reductions in child undernutrition Contributions to reductions in child malnutrition, 1970-95 Source: Smith and Haddad 2000

October 14, 2008

How do gender inequities in the “window of opportunity” lead to poor nutrition? Low education Early marriage Early pregnancy Constraints to use of antenatal services (mobility, access to resources) Poor diets High workloads (at home and at work); lack of rest during pregnancy Domestic violence Lack of support from family and community for infant care and breast feeding Resumption of work within and outside home soon after pregnancy Constraints to use of health and nutrition services (mobility, access to resources) Domestic violence* Gender-based differences in infant feeding and care seeking Pre-pregnancy and pregnancy First two years of life

Low education

Early marriage

Early pregnancy

Constraints to use of antenatal services (mobility, access to resources)

Poor diets

High workloads (at home and at work); lack of rest during pregnancy

Domestic violence

Lack of support from family and community for infant care and breast feeding

Resumption of work within and outside home soon after pregnancy

Constraints to use of health and nutrition services (mobility, access to resources)

Domestic violence*

Gender-based differences in infant feeding and care seeking

Pre-pregnancy and pregnancy

First two years of life

Social exclusion and undernutrition in India NFHS Report; India, 2005-06

Social factors and severe stunting in Nepal November 25, 2008

Why should we improve early childhood nutrition? % Source: Hoddinott et al. Lancet, 2008

Improving nutrition in early childhood and adult wage rates Age when exposed to intervention (months) p < 0.01 p < 0.01 p = 0.41 US$ / hour Source: Hoddinott et al. Lancet 2008

Pathways by which improving early nutrition increases wages BRAIN BRAWN Source: Behrman et al. in press Child development (early childhood) Height at 3 y Height, strength, CV resistance (adulthood) Schooling 1.2 grade (women) Cognitive skills (adulthood )(0.25 SD) More skilled jobs

Drivers of maternal and child undernutrition Social protection and gender policies and interventions are essential to make a difference! Black et al., Lancet 2008

SUMMARY: What we know about nutrition in S. Asia Overall levels of undernutrition are high and decline has been slow in the past 15 years throughout the region (except Sri Lanka) There is variability within the region – geographic, income-based, ethnic/social group-based, gender-based, etc. Addressing early childhood nutrition is crucial because of evidence of short term and long term gains The links between gender and nutrition are of particular concern but not often acknowledged in policies and programs

Overall levels of undernutrition are high and decline has been slow in the past 15 years throughout the region (except Sri Lanka)

There is variability within the region – geographic, income-based, ethnic/social group-based, gender-based, etc.

Addressing early childhood nutrition is crucial because of evidence of short term and long term gains

The links between gender and nutrition are of particular concern but not often acknowledged in policies and programs