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Gerd Holmboe-Ottesen, Ophelia Mascarenhas, and Margareta Wandel
The authors review the literature on the subject of how women's work along the food chain may affect their nutritional status and other aspects of their lives. They point out the discrimination against women in food and work allocation: women often work harder and have greater energy expenditures than men but get less food. Bennett makes this point in her article too, and McGuire touches on it as well.
Introduction
Since the 1970s, the increase in scientific documentation on women's issues has also been reflected in the nutrition literature. From a narrow focus on women's biological role and needs, there has been a shift towards a more expanded perspective on women and nutrition to include the economic and social aspects of their life situation. One example of this more holistic approach is the report published by the Protein Advisory Group of the United Nations system in 1977 [1]. In this report, women's roles in food production, food handling, and nutrition were analysed on the basis of a review of documentation from the social sciences as well as nutrition and medical research.
The increased interest in the relationship between women's food-related work and nutrition has, however, mainly followed one line of investigation: a focus on the link between women's work and child nutrition. Unfortunately, the nutrition-related literature has rarely dealt with the impact of women's food-related work on the nutrition and health of ,the women themselves.
There has been a tendency to regard women only as wives and mothers and not as individuals in their own right. The growing demand for integrating a women's perspective into agricultural development calls for more knowledge about how women's activities in the food chain may affect their own welfare and life situation. Considerations for women's quality of life will have important implications for the formulation of development plans and projects aimed at increasing women's productivity in the food chain and their effectiveness as family food providers.
The present article is an attempt to discuss some issues that are relevant in this respect. In this context it is necessary to take into account the possible conflict that may arise between women's expected role in providing nutrition to their families and the opportunities for improving their own quality of life.
Women and the basic-human-needs concept
As a point of departure for discussing the possible impact of women's quality of life, the concept of basic human needs (BHN) will be used as defined by the International Labour Organisation (ILO) World Employment Conference in 1976 in its strategy for development [2]. Interestingly, the two aspects of women's life and work situation are brought into the discussion of policy implications of the adoption of the concept:
There are thus two facets to a basic-needs strategy for women in developing countries. One is to enable them to contribute more effectively to the satisfaction of their families' basic needs, within the framework of their traditional responsibilities. The other, which is a fundamental need of the women themselves, is to ease their work burden while furthering their economic independence and their more equitable integration into the community, beyond the narrow circle of the family. [2, p. 6]
Because of its relevance to women, the BHN approach to analysing women's conditions has also been suggested in the PAG report [1] and by Palmer [3]. It is argued that the BHN concept provides a universally relevant framework for analysing women's conditions, irrespective of socio-cultural differences. Two broad categories of the concept can be distinguished: material needs (e.g., food, health, shelter, and education) and non-material needs (e.g., decision-making participation, cultural needs, and self-realization).
In the ILO report to the World Employment Conference, the BHN concept is discussed in relation to strategies for development:
A basic needs oriented policy implies participation of people in making the decisions which affect them.... For example, education and good health will facilitate participation, and participation will in turn strengthen the claim for the material basic needs. [2, p. 321]
A BHN strategy especially geared towards women is also outlined in the report. It includes the need to ease women's work burden, further their economic independence, and ensure a more equitable integration into the community.
The BHN concept can be useful in analysing how women's food-related work affects their quality of life. Such elements include women's access to health and adequate nutrition, access to resources relevant for the procurement of food, access to education relevant to their activities in the food chain, and opportunities for self-realization which, apart from being fundamental rights, are judged necessary for the satisfaction of the other basic needs [2].
Women's work-women's quality of life: What are the links?
Women's activities in the food chain influence their resource situation in two ways. On the one hand, food and cash are generated through their food-chain activities. On the other hand, their labour and time are spent in the process. The food and cash generated as well as the total work load implied in such food-related work will, in turn, influence women's nutrition and quality of life both positively and negatively.
On the positive side, a greater participation of women in food production may: (I) increase total household food availability, including improved access to a more varied diet [4]; (2) give women more control of food and cash in the household; and (3) increase women's status and decision-making power.
These positive effects have frequently been pointed out by both social scientists and nutritionists. Concerning points 2 and 3 above, it has been argued that women's participation in productive activities tends to increase their economic value and that this may improve their rights to household resources, including food and cash. There is also evidence that the food and cash that women generate themselves are more likely to remain in their own control [5]. In addition, many studies have shown that women put higher priority on their families' basic needs than men do [4, 6]. Therefore, it can be assumed that the more control women have over household food and cash, the more potential there is for satisfying not only the nutritional needs of their children but also their own needs.
On the negative side, greater participation in food production and income generation may increase women's work load to the extent that time and energy available for other necessary activities, both within and outside the food-related field, will not be sufficient to secure the basic needs of their family or themselves. In addition, the physical labour involved may in itself be so heavy that it is detrimental to the women's health.
The effects of women's work load on their nutritional status, and on other aspects of their quality of life, have received little attention in the nutrition literature. This paper will, therefore, focus on this aspect. However, because of the lack of research in the area, this discussion is based primarily on documentation that does not deal with this problem area directly.
Before examining the literature on women's work and nutrition, it is useful to highlight certain social factors related to women's role as the main providers of food and other basic needs within their families.
Women's status and priorities
One decisive factor, not only for family nutrition but also for women's opportunities to satisfy their own basic needs, is their status in a given society and the roles they are expected to fulfil. The successful fulfilment of their role as main providers of nutrition to the family is particularly important to women in traditional societies, in that it is linked to their identity as women. In other words, women's food-related household work is also a moral obligation tied to general conceptions of "male" and "female." The priorities that women set concerning the allocation of their own labour, their cash expenditures, and the distribution of food among family members may then be dependent not only on their access to and control of resources but also on the existing socio-cultural norms for a woman's roles in society [8].
Several authors have discussed women's "sacrificing role" in intra-household food distribution. Rizvi [9] describes how girls in Bangladesh, from puberty onward, learn to become the least demanding in the family and to give priority to the needs of the male members of the household when food is scarce.
The same phenomenon has been observed in Sri Lanka: the poor women took pride in being able to provide their husbands and children with satisfying and adequate meals every day, even if they had to work extra hours or reduce their own food intake [10]. Katona-Apte [11] describes how women from southern India feed their husbands first, then the children (boys before the girls), and only then do they think of themselves. The best and most nourishing portions of the food are served to males. Maletnlema et al. [12] summarize results from food consumption surveys in five villages in different regions in Tanzania and state that "food in made by women for men and often the better share in quality and quantity is given to men."
Anwar and Ijaz [13] present data from a sociological study in Pakistan, clearly showing the subordinate position of women with regard to intra-familial distribution of food. Both husbands and wives were asked which family members needed the most healthful foods. Most husbands and an even greater proportion of wives responded that husbands most needed such foods. The food needs of infants were ranked much lower than those of men, followed by the elders. Almost never did either husbands or wives mention wives as the ones needing the most healthful foods.
Schofield summarizes the results of surveys from 898 villages around the world: "Our data indicate that in the family food distributive system, priority is usually given to males rather than females" [14, p. 131]. This statement clearly indicates that women's self-sacrificing role in food distribution is a universal feature.
There is evidence that the degree of discrimination against females may vary from one country to another. Findings from India, Bangladesh, and Pakistan have revealed discriminatory feeding and health practices, favouring male children right from childhood [15, 16]. In Sri Lanka such practices vis-à-vis children seem not to exist; data on the prevalence of malnutrition from a field survey from the southern district of Sri Lanka showed no difference between boys and girls [17].
Ware [18] reviews weight-for-height data as a measure of nutritional status among male and female children and adults in different African villages, finding no coherent pattern of difference between the sexes. She suggests that women may enjoy a better nutritional status in places where they have a major role in productive activities. This role may result in a reluctance to accept an inadequate share of the family food supply. This notion is supported by Hamilton et al. [19] and Katona-Apte [20]. Katona-Apte points out that the extent to which women contribute income to the family may determine their share of food among the family members.
Food taboos specifically directed towards women, especially pregnant and lactating women, are common throughout the world. In reviewing this phenomenon, Hamilton et al. [19] note that restrictions are characteristically put on protein foods, which are particularly needed by women in pregnancy and lactation. They conclude, however, that little is known about the nutritional importance of these taboos during other phases of the life cycle.
It is interesting to note that, as pointed out by Ware [18], few traditional cultures seem to recognize the increased nutritional needs of women during pregnancy and lactation. She exclaims: "The suggestion that the best food should be given to your wives is a revolutionary one in most traditional cultures where the best is reserved for old men" [18, p. 60]. There are, however, important exceptions to this general picture of a failure to recognize pregnant women's nutritional needs. For example, in Sri Lanka, women are given special nutritious foods during both pregnancy and lactation [21].
A study by G. Lewis in 1975 [22] may give an indication about how role expectations influence women's priorities for responding to their own health needs. Lewis found that women in New Guinea were expected to be very ill before they gave up their work. Men, on the other hand, lay down when they felt unwell. This point is underlined by findings from India, Korea, and Bangladesh, where parents put less priority on the health of female children than on that of male children. For example, girls are taken to the hospital for treatment less often than boys [15].
Ware sees the "under investment in females" as a general feature in the third world, pertaining not only to food and health but also to other basic needs, such as education, time, and affection. A WHO report to the World Conference of the UN Decade for Women in 1980 states: "Attitudes which discriminate against girls from infancy to adolescence have negative influence on their potential contribution and participation as workers, mothers and members of society" [15, p. i]. It can thus be concluded that women's subordinate role and status in society reduce the potential that women have for responding to their own needs through their food-chain activities. In the conflict that arises between fulfilling their role as food providers for their families and catering to their own needs, the latter lose out. In this way, women can be said to contribute to reproducing and perpetuating their subordinate position in society. It is, therefore, evident, from the point of view of policy, that apart from attempts to uplift women's material standard of living, attitudinal changes also have to take place among both women and men.
Women's health and nutritional status
The biological advantage in longevity that women have over men is not reflected fully in life-expectancy and mortality statistics for women in most developing countries. Life expectancy in these parts of the world is usually lower for women than for men in age classes below 50 years [15, 18, 19]. This statistic can be explained by higher mortality rates for women of childbearing age (between 15 and 44 years) and a generally higher mortality rate for female children above five years of age. In India and Pakistan, the mortality rate among girls zero to five years old is higher than for boys in the same age group, despite the fact that the infant mortality rate among boys in most countries is substantially higher than among girls. These findings indicate discriminatory practices against girls from the time of birth. Complications associated with childbirth are among the five leading causes of death for women aged 15 to 44, and nutritional factors have been associated with these complications. Lack of nutrients, such as calcium and vitamin D, may cause deformities of the pelvic bones and result in difficulties during childbirth [15].
Nutritional anaemia is also listed as one of the major causes of death among women [19]. It is estimated that at least half of the non-pregnant women and two-thirds of the pregnant women in developing countries are anaemic [15]. Anaemia has been shown to affect psychological and physical health by increasing susceptibility to diseases, lowering resistance to fatigue, and affecting work capacity. Hamilton et al. [19] cite studies in which women's work capacity and endurance were significantly increased by the supplementation of iron.
The influence of work load on health
Studies dealing with the relationship between women's work load and health have most often examined how the work load influences child nutrition and health. Those studies indicate that the nutritional and medical professions have been more interested in women's nutrition from the point of view of childbearing and lactation than from the perspective of the health of the women for their own sakes. However, many studies that relate women's work to child health may also give indications of the effects of this work on women's own health. For instance, studies relating work load in pregnant women to low birth weight in their children illustrate this point. Low birth weight is not only an indicator of the child's nutritional status but also of the mother's.
It can be assumed that the work load can affect women's nutrition and health status in both direct and indirect ways. Examples of direct effects include increased energy use in heavy work that is not matched by a corresponding increase in food consumption, or "wear and tear" effects causing body pains, arthritis, or premature deliveries. Indirect effects may be mediated through changes in women's diet or dietary patterns, which may occur during periods of heavy work.
Studies have shown that women's work load is heavy, and that it varies with seasons. The work load is especially high in peak agricultural seasons for women who participate in field work. The total time women allocate to work on a yearly basis seems to average between 8 and 10 hours a day [23, 24, 25]. In peak seasons women's total daily work time can amount to as much as 15 hours [26]. However, time-allocation studies do not give a clue as to the energy that women put into their various work tasks. Such information would be necessary to judge the "heaviness" of women's work burden.
Bério [27] calculated the energy expenditure for men and women on the basis of time-allocation data from a national survey in Cote d'Ivoire. These data were collected in a period that was not the peak season in agriculture, and women's total work per day was seven hours. Bério found that the energy expenditure over a week's period was higher for women than for men. A study by Haswell reported a similar finding in the Gambia [28, 29]. More interestingly, Bério's computations proved that women in Cote d'Ivoire spent more energy on the average than the level set as standard for heavy physical activity for women by the FAD/WHO expert groups on energy and protein requirements [27]. Bleiberg et al. [30 estimated the energy expenditure of female farmers in Upper Volta (Burkina Faso) by season. In the dry season the women were found to have a total daily expenditure classified as moderate to very active, according to the FAD/WHO grading system, while in the rainy season their energy expenditure was classified as exceptionally active. The results indicate that women's work is much heavier in traditional societies than has been supposed.
It is reasonable to assume that such heavy work burdens will affect women's health. A good example of women's hardship is given by Haswell [28] in her field work in the Gambia; she reported that, when women returned home from working in the fields, they collapsed from overwork and lack of food.
The best documentation on the relationship between women's work burden and their health focuses on pregnant women. In a cross-cultural study of 202 societies Jimenez and Newton [31] show that the most common pattern of work during pregnancy in traditional societies is that of continuing full duties until the onset of labour. However, the authors also point out that there are some traditional societies where women are relieved of performing heavy tasks, as, for example, in parts of India and Sri Lanka. The cross-cultural study also showed that in more than one-fourth of the societies women returned to full duties one to seven days after delivery, while in one-half of the societies women returned to full work after two weeks. The traditional Asian societies seemed to be more restrictive in regard to a new mother's resumption of duties, probably because women in Asia are not as involved in field work as in regions such as sub-Saharan Africa.
Studies on the relationship between women's work load and weight gain in pregnancy or low birth weight in infants indicate that heavy work loads do affect women's health. Thomson et al. [32] found that all women in a remote village in the Gambia tended to lose weight during the peak of the agricultural season and to regain this weight when activity levels were lower. In the period of low activity, the average weight gain of pregnant women was 5.5 kg, while in the peak season it was only half of that. A study from Ethiopia [33] confirms these results, finding that women engaged in heavy labour had a weight gain in pregnancy of 3.3 kg, while less active mothers gained 5.9 kg. The difference in the mothers' physical activity also appeared in the birth weight of the children delivered at full term. The children carried during the heavy work season weighed 3,060 g at birth, while the children carried during the season of lower activity weighed 3,270 g. A relationship between high work load and low birth weight has also been found in India [34].
Hamilton et al. have shown that low weight gain during pregnancy, low birth weight, and weight losses during seasons with heavy work are caused by a combination of high work load, low food availability, and increase in infectious diseases [19].
Schofield [14] examined data from 25 African villages and found a significant difference between the percentage fulfilment of energy requirements during the peak season for agricultural labour and the low-activity season in the village populations. This difference was related to a difference in energy intakes and not in requirements, because the estimates of energy requirements were based on the non-working pare of the population. The data indicate an overall reduction in food consumption in the high-activity agricultural season. Haswell [29] in her study from the Gambia found the lowest food intake among the women in the pre-harvest period, the peak season for work, when women's energy expenditure rose fourfold compared to the season with the lowest work. Thus, an energy deficit was created which caused weight losses in women. Seasonal variations in weight have been shown for many societies [30, 35], including pastoral societies [36, 37]. Both men and women tend to lose weight, depending on the season. Women, however, seem to lose more weight than men [19, 37].
Some studies indicate not only that the energy deficit created by a combination of low food intake and high work load may be detrimental to women's health but that high work load in and of itself may influence health negatively. Bantje [38] showed in a study from Tanzania that women had a high risk of giving birth to low-weight children when food was plentiful but agricultural labour was demanding. The birth weight appeared to be affected by changes in work conditions even just before delivery, which indicates that high work intensity may lead to premature deliveries. A similar phenomenon has been observed in Sierra Leone. Tommy [39] found that the survival rate of infants born to women who operated heavy farm tools while pregnant was lower than that of infants whose mothers had used lighter tools or worked less frequently with heavy tools. Data from Thailand show a doubling or a trebling of the incidence of miscarriages in women during the seasons for rice transplanting and harvesting [40].
A heavy work load for women may also lead to a poorer diet not only for their children and other members of their families but also for women themselves. The diet may be poor because there is less time for preparation and cooking. As Schofield [14] points out, the combination of low food availability and less time for food preparation during peak agricultural seasons may result in meals of smaller quantity, with less variety, and more poorly prepared. Meal frequencies have also been reported to be reduced. Bleiberg et al. [30] found in Upper Volta (Burkina Faso) that lunch was skipped because women were working in the fields at noon. The PAG report cites a study by Thompson and Rahman in the Gambia where women were involved in swamp rice production to demonstrate the detrimental effect of women's work on child nutrition: "When the mothers were heavily engaged in farming, those who did not cook the morning meal might go for days and almost never see their children. At times they left early in the morning when it was dark and returned after sunset" [1, p. 81]. From this account one may wonder when the women themselves had time to eat. It is reasonable to assume that this type of work pattern will not only affect child nutrition but also have detrimental effects on women's own health.
Women's time use: The potential for satisfying their own needs
There is a general lack of documentation directly addressing how women's work in the food chain affects their basic human needs such as access to education, social services, and opportunities for participating in community life. It is, however, evident that women's time constraints will limit their opportunities to participate in any activity apart from their primary tasks in household work and food-related work.
The universal pattern, as evidenced by time-allocation studies, is that women have less time than men to spend on their personal needs [19, 23, 41]. After analysing men's and women's allocation of time in Cote d'Ivoire, Bério concludes: "While women work more, men are left with more time for rest, leisure, and social activities, i.e. for most decision-making and self-promoting activities at community level" [27]. In a year-round time-allocation study from Zambia, Skjønsberg [41] describes the implications of the discrepancies in women's and men's leisure time in this way:
Perhaps more than any other data, the amount of time spent on "leisure" throws light on the obligations and opportunities that mark the sex roles in this community. While men spent 40% of their recorded time on "leisure activities," women spent 23%.... In a typical oral society, being informed and having decision-making power are often a matter of "being present," but women often find themselves too busy to participate in probing opinions, gathering information and forming social networks.
Several researchers report that females spend less time on education than males [23, 42, 43]. This pattern holds true both for school-age children and for adults. The main reason for keeping girls out of school does not seem to be the cost of education or conservatism but rather the family's dependence on the girl's labour at home and in the fields [23]. Daughters from an early age on (often from as young as five years old) help in the home, look after small children. and assist women in the field. Usually girls are assigned responsibilities much earlier and work longer hours than the boys [23, 44]. Also, the long working hours of the women leave little time for educational activities. Palmer [43] suggests that the poor attendance of women in literacy classes, compared to men, is due to their time constraints.
The lack of time is generally considered a serious constraint on any attempt to bring women into the mainstream of development. As pointed out in many studies, technological modernization in agriculture has often had the effect of increasing women's work burden while reducing men's work load. Development projects aimed at increasing the participation of women have, therefore, had limited success when they have implied further demands on women's time. The results of such efforts have been either to increase women's work load and make their work day longer or to attract little participation from women because of their already heavy time constraints [19, 23]. For example, Palmer, in her Nemow case study [43], points out that the nutritional advice offered on cooking and diet by extension workers is not always taken, partly because women lack time for implementing such advice.
The introduction of techniques and tools that can reduce the time and labour women spend on certain tasks in the food chain may have the potential to reduce the drudgery of women's work and to give women more time to spend on other activities. However, studies show that this extra time is not commonly used for leisure or for increased participation in community affairs. Usually such time will be spent on family needs, such as cooking and child care or on production and income-generating activities. Reviewing the possible effects of a proposed food and nutrition intervention programme in Senegal, Carr [45] put forward the hypothesis that time saved for women in water collection will be devoted to more work on their husband's fields. Studies on seasonal variations in time allocations reveal that, when women do not have heavy work in the field, they spend more time on cooking, food processing, and income-earning activities, such as beer brewing [1, 30].
The main picture that emerges from the literature seems to be that women will put high priority on activities that can generate extra income for the household. Caughman [46] reports that women in Mali spent more time in income-generating activities when they were relieved from part of their domestic drudgery. In a pre-project study in Ethiopia, women were asked what they would do with the time saved by improvements in water supply. The majority answered that they would like to spend the extra time on income-generating activities (cottage production) as well as on housework [47]. Also in Sri Lanka (Wandel, field data) women were found to spend the "free" time available on weaving palm-leaf thatches and straw mats for sale.
Conclusion
In conclusion, women's time can be regarded as a scarce productive resource. Devices or organizational arrangements that can reduce the time and labour women spend on certain tasks in food-chain activities may increase their productive potential. They may also improve their potential for responding to their own needs, although this opportunity is often not used. Besides meaning that women can spend less time and effort in activities that may be detrimental to their health, such changes can make more time available for activities such as income generation, education, and learning skills. These activities may increase women's status and their command of food and cash as well as their bargaining power vis-a-vis their men. A potential may thus be created for them to cater to their own needs. More research is needed, however, to throw light on women's priorities in time allocation.
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