Women’s Autonomy and Child Nutrition in IndiaWiji ArulampalamAnjor BhaskarNisha Srivastava

ESRC Funded ProjectPartnersWiji Arulampalam, University of WarwickAnjor Bhaskar,Nisha Srivastava, University of Allahabad

Duration1st April 2010 – 31st March 2011

Aim To study the relationship between women’s autonomy

and child nutrition

Data Characteristics•Data from the 3rd round of the NFHS •Anthropometric data (Z scores) for 37714 children. •Age Group 0-5 years•These are born to 27578 mothers•Data for 29 states

Motivation- Importance of Child Nutrition

• Evidence: nine months during pregnancy and two years after birth offer a window of opportunity for the child’s physical and mental development, which if lost, leads to permanent and irreversible damage.

• Therefore: Proper nutrition is important for the proper physical and mental development of a child

• Lack of proper nutrition contributes ▫ towards nearly 50% of child mortality▫susceptibility to diseases▫ inability to develop to full mental and physical and therefore

economic potential

Measures of child nutrition• The most common and widely accepted measures of child

nutrition are anthropometric z-score measures (WHO 2006 multi-country study)

▫Height-For-Age (HAZ)▫Weight-For-Height (WHZ)▫Weight-For-Age (WAZ)

• Z-score deviation more than 2 std deviations▫HAZ: stunted (chronically undernourished)▫WHZ: wasted (acutely undernourished)▫WAZ: underweight (comprehensively undernourished)

India has one of the highest rates of undernutrition

• India’s children under 3 (NFHS 3): ▫ underweight: 48%

▫ stunted: 42% are stunted and

▫wasted: 19% are wasted

• much higher than most countries of the world including countries which have a much lower per capita income.

• 60.7 Million children under five in India are Stunted. This is 31.2% of the developing world total (195.1 Million)

• India also has 42% of the developing world’s Underweight children under five(total 129 million)

• More than one-third of the developing world’s wasted children under five live in India (Source: United Nations, Tracking Progress on Child and Maternal Nutrition, 2009)

Improvements over time ???

•Not changed much over the past two decades.

Stunting Wasting Underweight0

10

20

30

40

50

60

70

80

90

100

Trends in malnutrition among children 0-3 years of age, all India (NFHS I, II and III)

NFHS I (1992-93)

NFHS II (1998-99)

NFHS III (2005-06)Pe

rcen

tage

Source: Author's estimates based on data from NFHS I (1992-93), NFHS II (1998-99) and NFHS III (2005-06)

Lot of studies on trends and determinants of child nutrition

Previous Literature

•Several developing countries: (i) Smith & Haddad (2000); (ii) Ray (2004)

•Indian studies looking at the persistence of the problem: (i) Shiv Kumar (2007); (ii) Onis et al (2000); (iii) Radhakrishna et al (2006); (iv) Barooah (2002); (v) Ray (2004); (vi) Bassole (2007).

What have they found?Important determinants identified are:•Maternal characteristics: mother’s age at child birth,

birth interval, education and nutritional status•Household characteristics: religion, ethnicity,

rural/urban, socio-economic status•Public infrastructure: availability of water, electricity and

health services•Mother’s autonomy: measured as mother’s education,

mother’s employment status, some measure of mother’s decision making power.

Actions based on those studies•Essential Interventions been identified by Coalition

for Sustainable Nutrition•The ICDS has been running since 1975

Still….•Yet, the ‘South Asian Enigma’ persists

Possible Explanation…

• Great deal of consensus regarding the practices which need to be adopted to ensure proper child nutrition.

•Most are low cost and affordable for all. Yet, their adoption does not take place.

• Part of the reason: the woman, the primary care-giver to the child, does not have the autonomy to go out and learn about these practices nor to make decisions regarding adoption of these practices. (Smith and Haddad, 2000) It is this hypothesis that we wish to verify through this study.

What is women’s autonomy ???General definition:• “…the capacity to obtain information and make decisions about one’s

private concerns and those of one’s intimates,” (Dyson and Moore 1983).

• ..the ability to influence and control one’s personal environment,” (Safilios-Rothschild 1982).

• “..the extent to which women exert control over their own lives within the families in which they live, at a given point in time.” (Jejeebhoy 2000)

• Our definition – the freedom and ability to participate in decisions and actions.

Literature on role of women’s autonomy in child nutrition (2)

Very few studies have explored this relationship in detail

• Studies have linked child survival, violence against women to indicators of women’s decision making power: Desai and Johnson (2005); Prakasam (xx); Ghuman (2003); WHO (2003); Jejeebhoy (1998).

• Child nutrition and characteristics of the mother or household: Education of the mother (Desai and Alva, 1998; Reed et al 1996; Frost et al 2005; Glewwe 1999), women’s decision making (Desai and Johnson 2005); Women’s work (Ukwuani and Suchindran 2003); Economic status of the household (Case et al 2001).

• Very rarely has the link between women’s autonomy and nutritional status of children been examined in the Indian context. (Dancer and Rammohan 2009 for Nepal; Brunson et al 2009 for Kenya)

Lacunae•These studies look at individual aspects of women’s

autonomy such as Education, Decision Making, Employment etc.

•They use single level logistic regression to determine how it affects probability of child being malnourished

Our approach•We look at Five dimensions of Women’s autonomy

through five separate questions•Emotional Autonomy- through view on wife beating•Decision Making Autonomy- through actual

participation in household decisions•Economic Autonomy- through access to money for

own use•Physical Autonomy- mobility in community•Sexual Autonomy- View on refusing sex to husband

20-30% women say wife beating is justified in different circumstances

If she go

es out w

ithout t

elling h

im

If she negle

cts th

e child

ren

If she argu

es with

him

If she re

fuses t

o have se

x with

him

If she burn

s the fo

od

If she is

unfaithful

Is disr

espectf

ul toward

s in-la

ws0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Wife Beating Justified if she

don't knyesno

On own health care

On making large

household purchases

Making purchases for daily

needs

Visits to family or Friends

Spending Money husban earns

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

24.47

5.64

27.34

7.69 5.72

34.34

41.47

27

46.7559.24

31.77

33.6426.07 28.68

24.36

8

15.75 16.18 149.16

Who has the final say in making decisions about the following

OtherSomeone ElseHusband/Partner AloneRespondent and Husband/PartnerRespondent Alone

40-50% women are not involved in making household decisions

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

44.91 43.25

31.55

41.2152.21

59.47

13.88

4.548.98

Are you allowed to go to the following places

not at allwith someone else onlyalone

50-70% women are not allowed to go out of their house alone

Husband has STD Husband has other women Tired/Not in Mood0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

13.56 15.19 15.9

81.0282.42 81.39

5.41 2.39 2.71

Is it justified to refuse sex if

dkyesno

10-20% women say it is NOT justified to refuse sex to the husband even if he has STD, has other women or if she is Tired/not in mood

57% women do not have money for their own use

no yes0

10

20

30

40

50

60

70

57.47

42.53

Do you have money for your own use

Components of Women’s Autonomy (1)

Construction of our Measure of Autonomy: will use information on various family/mother specific characteristics and responses to the following questions:

Emotional AutonomyIs wife beating justified in the following cases:

a) If she goes out without telling himb) If she argues with himc) If she argues with himd) If she refuses to have sex with hime) If she burns the foodf) If she is unfaithfulg) Is disrespectful towards in-laws

Responses: 0). No ; 1). Yes; 8) Don’t Know

Dummy Variables for measuring Emotional AutonomyEmotional Autonomy

• wifebeatargue0: Wife beating NOT justifed if she argue with him• wifebeatargue8: Dont Know whether Wife Beating Justified if she argues with him

• wifebeatsex0: Wife Beating NOT justified if she refuses to have sex with him• wifebeatsex8: Don't Know whether wife beating justified if she refuses to have sex with him

• wifebeatinlaws0: Wife beating NOT JUSTIFIED if she is disrespectful to her in-laws• wifebeatinlaws8: DONT KNOW whether wife beating is justified if she is disrespectful to in laws

• wifebeatout0: Wife beating NOT justifed if she goes out without telling him• wifebeatout8:Dont Know whether Wife Beating Justified if she goes out without telling him

• wifebeatneglect0: Wife beating NOT justifed if she neglects the children• wifebeatneglect8: Dont Know whether Wife Beating Justified if neglects the children

• wifebeatburn0: Wife beating NOT justifed if she burns the food• wifebeatburn8: Dont Know whether Wife Beating Justified if burns the food

• wifebeatunfaithful0: Wife beating NOT justifed if he suspects her of being unfaithful• wifebeatunfaithful8: Dont Know whether Wife Beating Justified if he suspects her of being unfaithful

• Reference: Women who say that Wife beating IS JUSTIFIED in each case

Components of Women’s Autonomy (2)

Decision Making Autonomy

Who has the final say in the following household decision:a). On own health careb). Making large household purchasesc). Making small purchases for meeting daily needsd). Visits to relatives and friendse). Deciding what to do with money husband earns

Responses: 1). Respondent Alone; 2). Respondent and Husband/Partner; 3). Respondent and Other Person; 4) Husband/Partner Alone; 5). Someone Else; 6). Other; 7). Husband/Partner has no earnings

Dummy Variables for measuring Decision Making Autonomy

• finalsayhealth1: Respondent alone has the final say on own health care• finalsayhealth2: Respondent decides together with husband on own health care• finalsayhealth5: Somebody Else decides about Respondents Health Care• finalsayhealth6: Who decides about own health care- OTHER• finalsayhealthmis: Who decides about own health care- Missing observation

• finalsaylpurchase1: Respondent alone has the final say on Large household Purchases• finalsaylpurchase2: Respondent decides together with husband on Large household Purchases• finalsaylpurchase5: Somebody Else decides about Large household Purchases• finalsaylpurchase6: Who decides about own Large household Purchases- OTHER• finalsaylpurchasemis: Who decides about Large household Purchases- Missing observation

• finalsayspurchase1: Respondent alone has the final say on Small household Purchases for daily needs• finalsayspurchase2: Respondent decides together with husband on Small household Purchases for daily• finalsayspurchase5: Somebody Else decides about Small household Purchases for daily needs• finalsayspurchase6: Who decides about own household Purchases for daily needs- OTHER• finalsayspurchasemis: Who decides about household Purchases for daily needs- Missing observation

• finalsayvisits1: Respondent alone has the final say on visits to family or relatives• finalsayvisits2: Respondent decides together with husband on visits to family or relatives• finalsayvisits5: Somebody Else decides about visits to family or relatives• finalsayvisits6: Who decides about visits to family or relatives- OTHER• finalsayvisitsmis: Who decides about visits to family or relatives- Missing observation

• finalsayspending1: Respondent alone has the final say on spending money husband earns• finalsayspending2: Respondent decides together with husband on spending money husband earns• finalsayspending5: Somebody Else decides about spending money husband earns• finalsayspending6: Who decides about spending money husband earns- OTHER• finalsayspending7: Who decides about spending money husband Earns-He Has None• finalsayspendingmis: Who decides about spending money husband earns- Missing observation

• Reference: Husband decides alone

Who decides on large household purchases

Who decides on visits to relatives

Who decides on small hh purchases

Who decides on own health care

Who decides on spending money husband earns

Components of Women’s Autonomy (3)Economic AutonomyDo you have any money for your own use

Responses: 0) No; 1) Yes

Physical AutonomyAre you allowed to go to the following places

a). The Marketb). Health facilityc). Places outside the village/community

Responses: 1). Alone; 2). With Someone Else only ; 3). Not at all

Dummy Variables for measuring Economic and Physical AutonomyEconomic Autonomy• hasmoneyforuse: Women has money for her own use Physical Autonomy• allowedtomarket1: Woman is allowed to go to the market alone• allowedtomarket2: Allowed to go to the market with someone else only

• allowedtohealth1: Allowed to go to health facility alone• allowedtohealth2: Allowed to go to health facility with someone else only

• allowedtovillage1: Allowed to go to places outside the village/community alone

• allowedtovillage2: Allowed to go to places outside the village/community with someone else only

• Reference: Women who are NOT ALLOWED TO GO AT ALL

Components of Women’s Autonomy (4)Sexual AutonomyWhich of the following justify a wife’s decision to not have sex with her husband/partner

a). He has STDb). He has other womenc). Tired/Not in mood.

Responses: 0). No ; 1). Yes; 8) Don’t Know

Dummy Variables for measuring Sexual Autonomy

Sexual Autonomy• nosexstd1: Husband having STD is a justified reason for not having sex• nosexstd8: Dont Know whether husband having STD is a justified reason for not

having sex

• nosexother1: Husband having other women is a JUSTIFIED reason for not having sex

• nosexother8: Dont know whether husband having other women is a justified reason for not having sex

• nosexreason1: Being tired/not in mood is justified as a reason for not having sex• nosexreason8: DONT KNOW whether being tired/not in mood is a justified reason

for not having sex

• Reference: Women who say that Refusing Sex is NOT JUSTIFIED

Variables constituting women’s autonomy

• In total 53 dummies for women’s autonomy

•14 dummies for emotional autonomy•26 dummies for decision making autonomy•1 for economic autonomy•6 for physical autonomy•6 for sexual autonomy

Other Covariates

• v511 : age at first marriage [excludes: married gauna not performed]• caste1: Woman: schedule caste• caste2: Woman: schedule tribe• caste3: Woman: OBC• castenk: Woman: caste not known• hindu• muslim• Christian: • sikh: • girl: female child• pbrint1: preceding birth interval lt 18 months• pbrint2: preceding birth interval 18-24 months• pbrint3: preceding birth interval 24-36 months• educm1: mother has incomplete primary education• educm2: mother has complete primary education• educm3: mother has incomplete secondary education• educm4: mother has complete secondary education• educm5: mother has higher education• educfmis: Partner has missing education• educf1: Partner has incomplete primary education• educf2: Partner has complete primary education• educf3: Partner has incomplete secondary education• educf4: Partner has complete secondary education• educf5: Partner has higher education• educf8: partner's educ level not known by woman• wealthquintile2: v190==poorer• wealthquintile3: v190==middle• wealthquintile4: v190==richer• wealthquintile5: v190==richest

Caste

Religion

Sex

Birth Interval

Mother’s Education

Father’s Education

Wealth

Age at 1st Marriage

Variables we did not include

• bankaccount: Does the respondent have a bank or savings account

• givenaloan: Have you been given a loan

• relativeearning1: Respondent Earns MORE than Partner• relativeearning2: Respondent Earns Less than partner• relativeearning3: Respondent Earns Same As Partner• relativeearning4: Partner doesnt bring in Money• relativeearning8: Respondent Doesnt Know whether she earns more than partner

• respondentmoney1: Respondent Alone Decides how to spend the money she earns• respondentmoney2: Respondent decides together with husband/partner how to spend the

money she earns• respondentmoney4: Husband/Partner Decides Alone how to spend money respondent

earns• respondentmoney5: Someone else decides how to spend money respondent earns

Econometric Methodology

This study will use the GLAMM (Generalised Linear Latent and Mixed Models) framework.

Conclusion • Look at the role played by woman’s autonomy in

children’s nutritional outcomes.

•Describe the distribution of the Female Autonomy Index across states.