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The zero-sum game: A framework for examining women and nutrition


Judith S. McGuire and Barry M. Popkin


This article emphasizes the time and energy constraints on women who are the targets of programmes and are expected to participate in them. It outlines a framework for examining women's roles in providing food and nutrition for their families and presents some of the problems faced by women in their social roles. The authors propose that there should be more symposia to explore the issues involved in making programmes more effective for women.



What if we launched a programme and our key target group was so overworked, so overcommitted with time demands, and so poor that the intended beneficiaries could not participate without sacrificing some other essential functions? That is precisely what we are doing in programmes in agriculture, education, health, nutrition, and family planning when the target group is women. If targeting women meant that only a small proportion of the population were excluded from participation, we might shift our focus to slightly better-off groups. But if, as is in fact the case, those left out represent 50% to 100% of the population that needs the programme, we must address ourselves to the obstacles to effective participation as a part of programme implementation.

Women are, in essence, involved in a zero-sum game: a closed system in which time or energy devoted to any new effort must be diverted from their other activities. Taking advantage of new technology, market opportunities, or even social services-those benefits we associate with economic development and improvements in the quality of life-often requires an initial investment of a woman's time, energy, or income. And this investment may mean sacrificing her own health or the health and economic security of her family. The implications of women's overburdened condition are far-reaching; their participation and productivity in the economic system are adversely affected by (1) their own malnutrition and (2) their demanding household and mothering responsibilities for which acceptable purchased replacements are beyond their limited economic means.

The challenge before individuals and institutions promoting economic development is to help women overcome the resource constraints that limit their participation in the development process and thwart the fulfilment of their economic, biological, and cultural roles.

This paper briefly outlines a framework for examining women's roles in food and nutrition and proposes that the UN Administrative Committee on Coordination's Sub-committee on Nutrition should sponsor a series of symposia at future meetings to examine the major issues in more depth.

The first section will review women's own resources and their contributions to the family's resources. This is followed by an examination of the biological, economic, and cultural roles in the lives of women that pertain to household food security, nutrition, growth, and development. The next section discusses the ways that role conflicts and resource constraints act together to adversely affect nutrition and decrease women's participation in programmes. The final section touches on programme and policy issues related to these conflicts.


Women's resources and contributions to family resources

For poor women as well as poor men, income and many material resources are inadequate. Food, water, clothing, housing, and services such as medical care, education, and welfare programmes are not sufficient to guarantee an adequate quality of life. A woman's economic, biological, and social roles cause conflicts when resources are inadequate. If food is inadequate, she must allocate it among family members. As a wife she is supposed to give her husband preference above herself and her children, but as a mother she should feed her more vulnerable children or feed herself to nourish her child in utero or at the breast. As a labourer she should give high priority to feeding herself. Because the poor spend most of their income on food, decreases in maternal income inevitably result in reductions in household food availability. Women are so short of time and energy that they cannot work any harder and longer to make up for income or other resource losses.


Women's economic contributions

Women comprise 40% of the employed work force in low-income countries, are the sole income earners in one-quarter to one-third of the households, and provide a significant proportion of all agricultural labour [1]. Their economic contributions also include production of non-marketed goods and services in the home that are responsible for the health and wellbeing of all family members.

A number of time-allocation and economic studies have examined women's unpaid household production [1-6]. Using standard economic accounting techniques, it is estimated that women's household production is worth 25%40% of the world's gross national product (GNP) [1]. Most of this labour and its products, however, are not counted in standard estimates of production such as GNP.


Women's roles in food marketing, processing, and preparation

In all post-harvest activities related to food, women play a major role. These include marketing, processing (as housewives, as factor workers, and as street vendors), food purchasing, and food preparation in the home [7].



Despite their own under-nutrition, women bear many children and nourish them during pregnancy and lactation. In Africa, the average is seven children, in the Near East, five, and in Asia and the developing Americas, four. Women and girls six to eighteen years old are responsible for nearly all the child care in developing countries [2, 8], and women spend a large proportion of their reproductive years under nutritional stress.


Health care

As the implementers of the child-survival revolution, women are responsible for many critical aspects of child health and nutritional care. They are expected to (1) bring children to be immunized four times during the first year of life, (2) procure or produce oral rehydration salts and administer them to the sick child many times over the course of each day during every bout of diarrhoea, (3) breast-feed their babies on demand until the child is six months to two years old, (4) process and feed proper weaning foods in frequent meals to small children, and (5) bring the children under five years of age into a weight-surveillance programme each month. Women are also supposed to procure sufficient fuel and water to undertake these activities. All this time must be diverted from other essential activities, as leisure constitutes an infinitesimal amount of women's time in most parts of the developing world.


Overall time-allocation patterns

Poor women lack many resources, but one that stands out in studies of nutrition is their lack of time. A day, of course, has a fixed length, so that one cannot increase the absolute amount of time available. But one can increase productivity per unit of time and overall efficiency of time use. Technology can, theoretically, buy time for women. Mechanical mills can replace time- and energy-intensive hand pounding; wells can reduce the time and energy involved in water-carrying; improved cooking-stoves can reduce fuel requirements and thus fuel procurement time.

For most women, however, the great promise of "appropriate technology" has yet to be fulfilled.

Improved time-management might help-for instance, shortening the time required for cooking, washing clothes, or reaching the fields. However, these measures require motivation, energy, and planning ahead, which may not be possible because of women's nutritional, educational, and cultural histories.

Women can also gain time by obtaining better wage rates, but their bargaining power is weak. Women in the same jobs as men uniformly earn lower wages throughout the world. If those women earned more money, they might not have to take other jobs to support their families, or they might be able to afford time-saving convenience items or mother substitutes (e.g. better substitute child-care).


Women's nutritional status

Women are often exhausted by the combination of reproductive demands, heavy work loads, and inadequate diets. Maternal depletion over the course of numerous or closely spaced pregnancies is an often hypothesized but little measured phenomenon. Of particular importance is the prevalence of iron deficiency anaemia, which reduces work capacity, increases fatigue, and elevates risks of haemorrhage and death in childbirth. A majority of the world's women are anaemic, largely because of iron deficiency resulting from inadequate dietary iron and excessive iron losses due to parasites and closely spaced births. An undernourished woman is at increased risk of giving birth to a low-birthweight baby, who faces greater mortality risks.

Since most of the energy consumption of households is human energy, a woman's income falls if she cuts back on her energy expenditure for work. If she exerts less effort in home production and management, the nutrition and health of herself and her family are put in jeopardy. If she is too tired to attend a community meeting or religious ceremony, she may lose access to some institutional sources of support.

Some interventions-food supplementation, food subsidy programmes, small-scale food production programmes-attempt to alleviate nutritional stress on women. But poor women are notoriously difficult to reach. They have too little time, and they do not consider boosting their own energy intake to be of high priority.

Careful, systematic analyses of the diet and nutritional status of women are rare. Data from small and infrequent studies of women's anthropometry, iron status, and dietary intake suggest that they are at high nutritional risk, but better surveillance of women's nutrition is needed [9].


Education and management skills

Although absolute inadequacy of women's time, energy, and material resources holds back nutrition, women's management of these resources does make a marginal difference. Styles of child care reflect cross-cultural differences in resource availability and social values. Within cultures, however, different child-care behaviours reflect resource scarcity, behaviour patterns of children, and maternal skills and competence. Recent data on nutritional "positive deviance" from Bangladesh, Kenya, Mexico (Zeitlin, personal communication), and the Philippines suggest that, among households at the same poverty level, some mothers handle child care, hygiene, and feeding in a better, more adaptive way, and their children are better nourished as a result.

Evidence from around the world suggests that higher levels of education for women are associated with better health and nutrition, increased programme participation and effectiveness, and generally better economic development. Moreover, researchers in other fields (e.g. sociology and agricultural economics) have shown that improved education plays a major role in efficient resource allocation.


Women's roles

During each stage in their life cycle, women have clear-cut biological, economic, and cultural roles. Table I presents these roles, some of the obvious conflicts, and the adverse effects on women and their families. In numerous cultures, girls are seen as a net drain on family welfare. From birth onward, girls may receive less food, nurturing, and health care than boys, with important effects on growth, development, and survival. Socialization of girls to be acquiescent and self-sacrificing adds additional nutritional stress with respect to access to food.

Older girls experience conflicts over their use of time. Instead of playing or attending school they are expected to work at home or on the family farm. At times their work causes energy conflicts: carrying water and babies may require so much of their energy that they have none left over for growth or learning from their environment. Children's heavy disease and parasite burdens often limit their available energy, so that a heavy work load thrusts a double stress on children. While both boys and girls are usually assigned work, the long-term nutritional implications are worse for girls. If a girl's growth is stunted, her reproductive risks increase. Moreover, male school enrolment usually exceeds that of girls, which effectively increases the work load on girls and limits their human resource development.

As girls grow to maturity, their economic contributions to their households increase, but cultural expectations for early marriage and childbearing detract from both their economic and biological well-being. Once married, the number of conflicts between women's roles increases.

Women of childbearing age are under the greatest role stress. Their management of resources as mothers, wives, income earners, and individuals determines the welfare of the women themselves and their families. The conflicts they encounter are detailed in the next section.

When they are no longer of childbearing age, women often gain considerable respect, power, and economic control. Older women are freer to operate in the markets, manage their own farmland, and make household decisions. In patriarchal societies, widows may have to rely on the charity of their sons. brothers-in-law, or brothers, but usually older widows have sufficient freedom of movement to participate in market activities even where females are secluded and veiled. Because women have greater life expectancy than men, they need to be economically competent, but failing health may jeopardize their ability to support themselves.


The zero-sum game: The closed system of women's time, energy, and income

Crucial conflicts face poor women in low-income countries as they attempt to fulfil their economic, biological, and social roles at each stage in the life cycle, particularly during the childbearing years. Changes in behaviour to enhance their contribution to one of their roles often create crucial negative effects on their other roles and activities because of the tremendous time, energy, and economic constraints facing these women. The resources are interchangeable above certain minimal levels of requirements; however, resource shortages and bottlenecks preclude women from making significant substitutions among resources. We focus on several conflicts between the economic, reproductive, and cultural roles of women that have crucial implications for the nutrition of these women and/or their families.

TABLE 1. Role conflicts at various stages in the life cycle of women that affect nutrition, growth, and development

  Biological roles Economic roles Cultural roles Promoted rolesa Conflicts and constraining resourcesb Adverse effects of conflicts
Birth to 5 years Survival Growth and development Minimal household production (older children) "Daughter" and female'': learn social rules. gender identity, obedience. kin- ship rules, respect of age. sex, power. status "Child": play Play Possibly tension between socializa- tion and growth and development Female infanticide and neglect Subservience of females and chil dren (access to food and health care) Female malnutrition and mortality Inadequate cogni- tive development Poor growth and development
5 years to puberty Maturation Growth and development Increasing participa- tion in agricul- tural labour. household produc- tion, and possibly labour market Assumption of greater respon- sibility for household main- tenance and child care Possibly education "Daughter'': obedi- ence to parents. transfer of earn- ings, preservation of chastity "Female'': learning sex roles Education Play Learning rudimeets of reproduction to prevent teen-age pregnancy ''Self'' Education vs labour in household. on- or off-farm (time) Hard labour and deferential female behaviour vs. growth (energy) Cognitive devel- opment vs. economic and social roles (time) Low school enrol ment, retention. and achievement Stunted growth Suboptimal devel opment Limited occupa tional options
Puberty to menopause Pregnancy Lactation Nurturing dependent young children Maintenance of own health and nutrition Household produc- tion: food, fuel. water. child care. health care Income generation: on-farm labour, off-farm labour, entrepreneurial ''Wife'': deference to husband's decisions, sacrifice for husband. obedience to hus- band. chastity " Daughter-in-law'': obedience to mother-in-law "Mother": respon- sibility for chil- dren's well-being Education Employment Family planning Community development Leadership ''Self'' Household produc- tion vs. income generation (time, energy) Income generation vs. "wife" and mother'' (time, breast milk. en- ergy. resources) Physical labour vs. pregnancy, lacta- tion, health (energy) "Wife" vs "mother" (time, resources) "Daughter-in- law" vs. mother'' (time, authority) 'Mother'' end "wife" vs. family planning (social rewards. authority) "Self'' vs "mother" and "wife" Maternal malnutri tion and low birth weight Poor child growth and development Maternal stress Inadequate breast feeding Closely spaced, high-parity births External locus of control, learned helplessness Low economic pro ductivity
Menopause to death Senescence Death Often increased market activities, decreased house- hold production Possibly increased agricultural labour (including control over land in- herited from father or husband) Male equivalent Non-sexual " Grandmother'': supernatural power, family decision control, discretionary child care " Mother-in-law ": control of daughter-in-law Senior member of household: com mands labour and respect of others in household "Widow" Midwife or other health worker Economic survival vs. widowhood (social support ) Physical strength and health vs. economic needs (energy) Stress Dependency and rejection Morbidity and mal nutrition Low productivity Exploitation of her own children and daughters-in-law

a. Roles and activities promoted by aid donors and others.
b. Constraining resources shown in parentheses.

Biological versus cultural roles

The status and quality of lives of poor women are embedded in their reproductive roles in many societies. The status of a woman and often even the survival of her marriage are based on this role. Primary and secondary infertility, important problems in sub-Saharan Africa, carry with them a certain degree of social and economic ostracism. On the other hand, women who give birth to one or more children (preferably male in many societies) gain important benefits. This childbearing role is associated with repeated pregnancies, numerous known and unknown foetal deaths, delivery complications, and extensive periods of lactation, all of which may have significant adverse effects on the energy and nutrient stores of women.


Economic versus cultural roles

Poor women are expected to play the central role in child care and food processing even when their economic roles also require extensive time and/or physical energy. Several conflicts may arise.

The first is the situation in which women are expected to nurture the infant or preschooler and concurrently play a key role in family economic life. This is the case particularly in societies where female headed households abound or in areas where economic roles take the women away from the household and are otherwise incompatible with child care. In addition to the one-quarter to one-third of households headed by women, there are a large number of de facto female-headed households as a result of increased male migration in recent years.

When mothers work away from their children, breast-feeding is limited or not even initiated. Also, poor or nonexistent substitutes for child care leave the infant vulnerable to infection and poor diet. Certain kinds of employment where the mother is not at home (for instance, agricultural, home-based industry, and market work) are not compatible with good child care. In fact, the quality of care may be worse under these conditions. For instance, in fields or public marketplaces there may be health hazards that jeopardize a child's health.

The second major area of conflict is the relationship between women's biological needs and their economic roles, household food security, and the intra-household allocation of food. In general, researchers in the area of women in development feel that increased participation by women in economic activities will be associated with greater expenditures on food. Ultimately, the diet of vulnerable groups will improve because of these expenditures. It is also believed that such improvements would be related to the enhanced power and status of these working women. Women do spend a greater proportion of their earnings on food than do men; however, in most low-income societies women's roles involve them in food purchasing while male roles involve them in the purchases of other types of goods and services. Increased physical activity obviously increases the energy expenditures of women If the quality or quality of their diet is not improved accordingly, there will be adverse changes either in the household activities or in their nutritional status.


Biological versus economic roles

Poor women in most societies continue to undertake heavy physical activity during pregnancy and resume this activity soon after delivery of their children. These physical stresses may result in additional foetal loss and most likely lead to reduced gestational duration and/or birth weight. Moreover, decreases in work time or work productivity associated with childbirth and lactation may adversely affect the family's income and food security.

The effects of this double burden on women and their offspring are considerable. Approximately 20 million infants worldwide (about 17.6% of all newborns in low-income countries) have birthweights below 2,500 grams [10], and about one-third of these children are born prematurely. There are well documented negative correlations between low birth weight and a child's growth, survival, and development. Moreover, repeated miscarriages, stillbirths, and foetal losses affect a mother's nutritional status.


Programme and policy responses

Development programmes often require major inputs of time and energy from women not only in the utilization of services but also, ideally, in the process of project design and implementation.

Programmes and policies that promote effective participation by women should have one or more of the following effects:



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