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5. Food deprivation
Measurement of food deprivation
Sara R. Millman and Laurie F. DeRose
Food deprivation is synonymous with individual malnutrition. Food deprivation will inevitably occur if there is food shortage or food poverty, but deprivation also affects individuals in households whose food supply would be adequate were it distributed evenly.
Our focus in this chapter is on variation along lines of age and sex. Women and children are often identified as "vulnerable groups" in the hunger literature. Accompanying discussions imply two distinct meanings for this term. Vulnerable groups may be likelier than others to experience hunger. In addition, probable consequences if they do experience hunger may be more serious for vulnerable groups than for others. Whole sets of households - for example the landless, those living in rural areas, those headed by women - are sometimes identified as vulnerable. Contrasts across groups of households were considered in chapter 4. We focus here on intra-household distribution of food. One of the questions this chapter will help answer is whether the burden of food poverty is shared equally among household members. Another is what types of individuals are likely to suffer from food deprivation in the absence of food poverty.
Causes of deprivation
Households that cannot secure control over enough food to meet the needs of all of their members are food poor. In chapter 4 we demonstrated that, although there are more food-poor households in food short regions, food poverty is a significant problem in regions where food is adequate as well. Inequitable food distribution creates hunger even when supply is adequate.
The relationship between food deprivation and food poverty is quite similar to the relationship between food poverty and food shortage. Food deprivation is more common in households where there is food poverty, but food deprivation is a significant problem in households where food is adequate as well. Inequitable food distribution creates hunger even when supply is adequate.
Although these parallels are informative in conceptualizing the causes of the various levels of hunger, it is also important to recognize that distribution within - in contrast to across - households is governed by household economic conditions, discrimination, and understandings of nutrient needs. Food poverty is not likely to have the same kind of profound effect on the social rules and norms that govern the intra-household distribution of food that food shortage has on household entitlements. There are exceptions to this generalization that will be discussed below as we explore the causes of food deprivation and how likely they are, given household food poverty or the lack of it.
Discrimination is the most easily understood reason why individuals go hungry in households with adequate food. Discrimination results from some members being deemed more valuable than others. Although some discrimination is a household-level manifestation of inegalitarian attitudes pervasive in the society as a whole (e.g. women are less valuable than men, children are not fully human until after their first birthday, elderly people deserve higher honour), other discriminating behaviours reflect economically rational response to adverse circumstances.
For example, households can sometimes avoid food poverty by favouring wage-earners in the allocation of food. Protecting the productivity workers can enhance the total amount of available food, but household members who are not economically active are deprived relative to the income-generating members. Whether or not they are absolutely deprived depends upon whether their intake matches their nutritional needs. Even if their intake is less than their requirements, it still might compare favourably with a situation in which there was no discrimination in favour of earners. Since the 1970s, there has been reliable evidence that households in developing countries actually make these kinds of decisions (Gross and Underwood 1971; Pitt et al. 1990). There has been a resulting emphasis on improving total household income to make favouring preferred or productive members over others less likely to result in absolute deprivation.
Food deprivation also results from misunderstood individual nutritional requirements. Individual need varies according to relatively stable factors such as basal metabolic rate and sex, but also with life-cycle variations such as age and maturation, reproductive status, and activity levels. Not just caloric needs but also micronutrient requirements vary among individuals within the same household, especially growing children and pregnant and lactating women in comparison with most other adults. Therefore, it is not surprising that households do not fully comprehend the nutritional requirements of all of their members or the synergism between nutrition and disease.
The ill have elevated and sometimes qualitatively different nutritional requirements that are another potential source of misunderstood need. However, disease also affects nutrition in ways unrelated to household decisions about food allocation. Even where sufficient and appropriate food is offered, unhealthy individuals are more likely to be food deprived because disease suppresses appetite and reduces absorption. Gastrointestinal diseases, in particular, impair the body's ability to absorb both micronutrients and calories.
Measurement of food deprivation
Only individual-level measurement can provide evidence of variations in food deprivation related to patterns of intra-household food allocation or other nutritional influences that affect people in the same household differently. Anthropometry is based on individual measurement and offers the largest body of evidence directly relevant to questions of age and gender variations in hunger. Unfortunately, comparability of such measures over the life cycle is limited.
The abundant anthropometric data on child malnutrition are very informative about comparisons across different groups of young children. We are less well situated to address possible discrimination against the elderly or between young children and others. Earlier chapters considered variation in the prevalence of child malnutrition
across countries, or across socio-economic groups within countries, as evidence of variations in hunger along these lines. In this chapter, we use anthropometric data to show variations in the prevalence of childhood malnutrition by gender and across detailed age categories. The results both critically evaluate the notion that discrimination against girls is the rule and illustrate weaning as a crucial stage in children's malnutrition.
Data permitting comparison of dietary intake for individual members of a household are much less widely available. Where such data have been obtained, they must be combined with appropriately specified dietary requirements before we can reach conclusions about intra-household variations in dietary adequacy. In subsequent sections of this chapter we assemble comparisons of dietary adequacy by age and gender for a number of countries. Best represented is South Asia, in which discrimination against females in intra-household food allocation, as in other matters, is often thought to be widespread and extreme.
The data show that women in South Asia (as elsewhere) eat less than men in absolute terms. But women are also smaller and so need less food. The simple observation that certain people consume less than others is not necessarily evidence of discrimination. When consumption is expressed as a proportion of requirements, comparisons become more informative but also more complicated. For example, in India, Pakistan, and the Philippines, adult women who are neither pregnant nor lactating actually consume a higher proportion of their energy requirements than adult men (see evidence below), but dietary adequacy deteriorates sharply with pregnancy and lactation. The expected female disadvantage appears when average dietary adequacy for all women is compared with that for men. An explanation that relies on general discrimination against women in intra-household food allocation does not fit a situation in which those women who are neither pregnant nor lactating are better fed than men.
An additional complication, however, is that female requirements may incorporate gender bias. First, women's requirements are lower in part because women are smaller, and body size is partly determined by dietary intake. Thus, low intake is one cause of small size, which in turn is used to justify low intake. Second, most definitions of caloric requirements incorporate the assumption that women are less active physically than men. In situations where women undertake as much physical labour as men (or more), definitions of requirements incorporating this assumption underestimate their need. Finally, "the extra nutrition requirements of the pregnant women and lactating mothers require further acknowledgment" (Sen 1988). This argument is similar to the one developed earlier in this volume (chapter 2) with regard to the Hyderabad standard of weight-for-age by gender. Measurement of discrimination requires comparing intake with requirements, and estimates of requirements for both men and women need to incorporate realistic energy expenditures more carefully.
Indirect measures: Consequences and causes of hunger
Given the difficulties of obtaining and interpreting data on intake adequacy for large enough samples to support meaningful analysis, some researchers have relied on inference from data reflecting variables more or less directly affected by hunger itself. An arguably more important reason why indirect measures are sometimes favoured is that they measure consequences resulting from hunger; they measure hunger that is having an impact on people's functioning.
Disease and death are the most severe consequences used as indirect indicators of hunger. For example, Sen (1989) interprets a higher-than-usual ratio of female to male mortality rates (or even less directly, an unusually low proportion of females in a population) as evidence that females get less than a fair share of whatever food is available. Similarly, evidence of lesser access to health care for girls and women (Kynch and Sen 1983) is interpreted to reflect a pattern of gender discrimination that is likely to apply to nutrition as well. And if mortality goes up more sharply during a famine for one age/sex group than for others, it suggests that this group bears the brunt of the crisis (Watkins and Menken 1985).
Practices presumed to affect intra-household food allocation have also been interpreted as evidence of differential adequacy of diet for different members. For example, those who are served last at meals are often presumed to get less than a fair share (e.g. den Hartog 1973; Katona-Apte 1975; Senauer 1990). Similarly, it is often assumed that, when all family members eat out of a single dish, small children will be disadvantaged. Customs that reserve particular foods for certain members or forbid them to others are also cited as evidence of differences in dietary quality.
Use of such indicators of the causes or effects of intra-household food allocation are suggestive, but need further empirical investigation and confirmation. Customary preferential feeding of certain foods to males versus females may receive lip service, without shaping actual behaviours. Mortality is affected by causes other than nutrition, and differentials exist despite equitable distribution of food. Less access to health care (Kynch and Sen 1983) is in itself a potential explanation of female disadvantage in mortality that is sometimes taken as proof of sex bias in intrahousehold food allocation. Ratios of males to females in the population, in turn, are a function of gender-specific migration patterns as well as mortality differences. And reported gender ratios may also be affected by the tendency for censuses and other counts to miss people who are less visible, less valued, or viewed as less fully a member of the group. This last argument may apply most to Indian women who have migrated away from their natal villages into their husband's households, where they have relatively little status.
In sum, indirect evidence makes plausible the hypothesis that one group is less well nourished than another, but poor health outcomes can result from inadequate food, inadequate health care, or other forms of discrimination. To test the hypothesis that a group receives less food, it is necessary to focus more closely on either the balance of intake and requirements or its more immediate outcome, the individual's nutritional status.
Direct measures: Nutritional status and dietary adequacy
In the following sections we assemble both anthropometric and food-consumption data to explore issues of differential food deprivation and discrimination in intra-household food allocation by age and gender. The conventional wisdom in this area would tell us that females and children are likeliest to go hungry. For example, in the 1985 edition of UNICEF's annual report The State of the World's Children, Grant (1985: 37) asserts:
From girlhood to womanhood, the females of many societies are fed last and least. Malnutrition in girls is much more common than among boys and the fact that, on average, an American woman weighs approximately 25 per cent more than an Indian women is to be explained not by race but by food.1
Similarly, Hunger 1992, a widely circulated report on world hunger from the private voluntary organization Bread of the World, states:
Pregnant and nursing mothers and children from birth to age five have greater nutritional needs than the rest of the population, but they are the least well-nourished people within low-income households in developing countries. Males tend to receive more and better food than females.
The conventional wisdom seems plausible and rests on a sizeable body of literature (for useful reviews see, e.g., Haaga and Mason 1987; Rogers 1983; Van Esterik 1984). However, the present review concludes that, while there are undoubtedly situations in which women and children are targets of discrimination in intra-household food allocation, this conclusion has been applied too broadly. Much of the widespread disadvantage of children and their mothers can be better understood in terms of childhood diseases and consumption patterns that restrict maternal intake during pregnancy and lactation, plus restricted access by females of all ages to health care, rather than as the result of food-distribution patterns that routinely discriminate against women and children.
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