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Maternal skills and efficiency

To optimize her own or her family's welfare, a woman must manage the resources under her control efficiently. (Lack of control over many resources contributes to women's low productivity and adverse outcomes, but that is discussed later.) Some families are more successful than others in producing wellnourished children under poverty conditions [101; 102]. Many studies show that maternal literacy and schooling are associated with improved child nutrition after controlling for the effect of education on income and fertility [103]. Bairagi [104] found in Bangladesh that increased income had a greater impact on the nutritional status of children of literate mothers than on those of illiterate mothers.

The mechanism through which education is presumed to act is through women's better management of household resources. Rosenzweig and Schultz [105] found in Colombia that maternal education can compensate to some extent for lack of access to public health and family-planning services. In rural areas, maternal education - but not health institutions or public expenditures - was associated with reduced child mortality. Another study in Nicaragua, however, found that the impact of women's education on their health and on child nutrition disappeared after controlling for community and material endowments [106].

Women's education is also associated with lower fertility [107], which constitutes management of reproductive resources. Lower fertility by itself has been associated with improved maternal and child health.

In Mexico, LeVine et al. [108] found educated women to be more aware of the larger world and to have made a higher use of health-care services (prenatal care, well-child care). Most importantly, they found that, with more education, women changed their behaviour toward their children: they became more child-centred. Tucker and Sanjur [109] found in Panama that a mother's "differentiation" (which incorporates nutrition knowledge, formal education, frequency of reading, and participation in home production) is consistently related to better diets and improved nutritional status for her children even when employment is taken into account. On the other hand, increased maternal education is associated with decreased breast-feeding, which increases infant morbidity and mortality.

aldwell [110] maintains that an educated woman is more successful in child-rearing because (1) she is less tradition-bound and more likely to try innovative solutions to her problems; (2) she is more "capable of manipulating the modern world"; (3) she tips the balance of power in the household in her favour; and (4) she is more likely to challenge her husband or mother-in-law and they are more likely to accept her judgement.

Maternal education, behavioural-change messages, and technology can positively affect these child outcomes without significant changes in household incomes. A nutrition-education project in Indonesia which modified specific child-feeding and care-giving behaviours erased the adverse effects of low levels of maternal education on nutritional status [111]. This finding suggests that maternal education acts through maternal-child interactions to improve nutrition. Similarly, evidence from Bangladesh [112] also suggests that education and even appropriate technology (jute playpens) can compensate for or replace childcare behaviours that promote malnutrition.

Little is known of women's management of household finances, food supplies, and the labour they control. One would assume that technology and institutional support (consumer co-operatives, for instance) might improve women's home-production efficiency. Numerous studies [e.g., 113] show that education affects women's agricultural productivity positively, suggesting that other spheres of work (including market and home production) might be responsive to female education [24].

Women's self-confidence

Women's lack of self-confidence has been cited as a major determinant of programme success in maternal-child health [114]. Lack of self-confidence has also been called "silence," extreme in self-denial and dependence on external authority for direction [115]. Silence keeps women from seeking help for themselves and their children - whether it is prenatal care, education, or fair wages. Authority figures have been used to persuade women to seek family planning or prenatal care or to continue breast-feeding, but increasing women's self-confidence is needed to help them to change behaviour and use an array of services and commodities correctly.

- Griffiths [114] found in Swaziland that mothers had sufficient self-confidence to persist in feeding their anorectic children even when the sick children refused to eat. In Cameroon, on the other hand, the mother cedes power to the child and gives in to its self-destructive behaviour. Differences in the mothers' self-images are positively correlated with their children's health and nutrition.
- Kagitcibasi [see 116] found in Turkey that, to reach children successfully, it was necessary to build self confidence in the mothers. To educate women about stimulating early cognitive development, women were first given tasks they could successfully complete, such as feeding the child. Not surprisingly, husbands and mothers-in-law sometimes disapproved of the programme because it gave women self-assurance, but it has been successful in terms of participation rate, educational measures, and broadly applicable maternal skills.
- In India, Griffiths [114] found that mothers felt powerless to undertake independent action. As a result, fathers and grandmothers of at-risk children are educated. Mothers are encouraged to come together to listen to and discuss a radio programme designed to motivate them to change some behaviours.

With self-confidence, women will have greater success in breast-feeding, introducing weaning foods, changing practices, and persisting in recommended behaviours against resistance by the child or by opinion leaders in the household and community.

Roles

TABLE 10. Role conflicts at various stages in the life cycle of women that affect nutrition, growth, and development

TABLE 10-Continued

a. Roles and activities promoted by international agencies and others.
b. Constraining resources shown in parentheses.

During each stage in the life cycle, females have clear cut biological, economic, and cultural roles. In table 10 we present 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 in some parts of the world 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 if it reduces their 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 these tasks cause energy conflicts: carrying water and babies may require so much of the girls' energy that they have none left for growth or learning from their environment. Heavy disease and parasite burdens limit their available energy, so a heavy work load thrusts a double load on children. While boys and girls tend to be assigned productive work, the long-term nutritional implications are worse for girls. If female growth is stunted, reproductive risks increase. Moreover, boys' school enrolment usually exceeds that of girls, which effectively increases the girls' work load and exacerbates their disadvantages in the labour market.

As girls mature, their economic contribution to the household increases, but cultural expectations for early marriage and child-bearing detract from their economic and biological well-being. Once married, the number of conflicts among women's roles increases.

Women of child-bearing age are under the greatest role stress. In particular, child-bearing incurs high costs to the mother (who spends her income disproportionately on children) at the same time that it reduces her income-earning capacity. Collier [117] argues that this situation makes women perfect candidates for savings and credit schemes - borrowing to finance consumption while their children are very young and saving money when their child-care burden decreases sufficiently to enable them to become net earners again. Their management of resources as mothers, wives, income earners, and individuals determines their welfare and their family's welfare. The conflicts they encounter are detailed in the next section.

After they leave child-bearing behind, women often gain considerable respect, power, and economic control. Because they are no longer sexually threatening, older women are freer to operate in the markets, manage their own farmland, and make household decisions. In patriarchal societies, widows may have access to productive resources only through their sons, brothers-in-law, or brothers, but usually older widows have sufficient freedom of movement to participate in market activities where younger females are secluded and veiled. The livelihoods open to aged women may barely allow them a subsistence wage. Because women have greater life expectancy than men, they need to be economically competent, but failing health and reduced strength may jeopardize their ability to support themselves.

The closed system of women's time, energy, and income

Crucial conflicts face poor women in low-income countries as they try to fulfil their economic, biological, and social roles at each stage in the life cycle, particularly during the child-bearing years. Changes in behaviour that enhance their contribution to one role can have crucial negative effects on their other roles and activities. This role conflict relates to the tremendous time, energy, and money-resource 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. Conflicts between the economic, reproductive, and cultural roles of women can have detrimental effects on their nutrition and/or that of their families.

Biological versus cultural roles

The status and quality of life of poor women are inseparable from their reproductive role in many societies. For example, primary and secondary infertility, important problems in sub-Saharan Africa, carry with them a certain degree of social and economic ostracism [118; 119]. 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 stressful. Repeated pregnancies, numerous known and unknown foetal deaths, delivery complications, and extensive periods of lactation have significant adverse effects on women's energy and nutrient stores as well as on their physical performance.

Some researchers postulate the existence of a maternal-depletion syndrome related to repeated and closely spaced pregnancies and extended lactation [53; 120]. Under this scenario a woman with inadequate nutrient intake may not be able to replenish energy reserves between pregnancies. Each additional pregnancy and bout of illness thus further compromises her nutritional status. As discussed above, up to 33%-50% of a women's reproductive life is spent being pregnant and/or lactating.

An extensive body of literature documents the effects of repeated, closely spaced pregnancies on two key reproductive outcomes - birth weight and child survival. While this research ignores the woman's nutritional condition, it has found that short birth intervals, particularly under 24 months, are associated with increased risks for the infant [123-125]. Since the maternal environment is the source of most immediate risk factors, this association of birth spacing with infant health indirectly supports the maternal depletion hypothesis.

Strong positive relationships between maternal mortality, age, and parity also provide evidence of maternal depletion [126]. In general, maternal mortality increases with age, with a sharp rise found after age 30-34. Similar relationships are found with parity increases above three. Some studies have also linked spacing in a crude manner with these age and parity relationships.

Multivariate analysis has encountered methodological problems in confirming those relationships [124; 127; 128]. While these studies have focused mainly on infant health, they have begun to consider carefully the effects on the mother, in particular the conceptual and statistical issues that must be considered to examine these issues adequately.

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. This responsibility causes several conflicts.

Women are expected to nurture the infant or preschooler and concurrently play a key role in family economic life. 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 (e.g., many urban settings, selected rural ones), many nurturing roles cannot be fulfilled. In addition to the one-quarter to one-third of households headed by women, a large number of de facto female-headed households have resulted from increased male migration in recent years.

A major debate exists concerning the consequences of maternal market employment on the health and development of children [129; 130]. The importance of this debate has increased as urbanization and industrialization have increased the proportion of women in the paid labour force - which has risen from 28% in 1950 to 32% in 1985 [31]. Of some concern, however, is the increase in informal-sector employment of women, especially piece work done at home, that can expose women and children to dangerous chemicals and other hazards [131].

When mothers work away from their children, breast-feeding may be very short or not even initiated, weaning food may be contaminated and of poor nutritional quality, and poor child-care substitutes (or non-existent ones) leave the infant vulnerable to infection and malnutrition [132]. O'Gara [133] and Oppong and Abu [134], however, provide examples of working mothers who have been able to continue breast-feeding in spite of employment. Leslie [135] summarizes this literature. Women engaged in market work often have malnourished children, but it is difficult to unravel a clear causal relationship between women's employment and child nutrition.

The belief that certain kinds of employment (for instance, agriculture, home-based industry, and market work) are compatible with child care because the mother is present may be incorrect [137]. Presence alone does not guarantee that the mother is interacting with her child, and the quality of care may be worse under these conditions. It is unclear whether urban low-income women are any less able to engage in work compatible with child care than are rural women [41]. For instance, in agricultural fields or public marketplaces, certain health hazards may outweigh the benefits of the mother's presence. Where precision and concentration are important, women may have to neglect their children to gain an income. A major issue related to modifying any negative relationship between maternal work and child nutritional status is the quality of the child-care substitutes (see below).

Biological versus economic roles

One conflict relates to women's child-bearing roles. Poor women in most societies continue to undertake heavy physical activity during pregnancy and resume this activity soon after delivery of their children. Extreme physical stresses may result in additional foetal loss, prematurity, or low birth weight [138]. In addition, reduction in work time or work productivity associated with childbirth and lactation may adversely affect the family's income and food security.

Pregnant and postpartum women have very heavy work loads in most low-income countries. In a cross cultural study of 202 traditional societies, the most common single pattern of work activity during pregnancy was that of continuing full duties until the onset of labour [139, p. 173].10 Women in 66% of these societies worked until labour, and an additional 14% stopped only in the ninth month. Women in about half of the societies resumed work within two weeks of birth. Another quarter of the societies reported women's return to full activity in the fifth or sixth week, and in only 12% did women rest for two or more months postpartum.

Extensive physical activity while pregnant may have an adverse effect on pregnancy outcome. A number of components of physical activity can be harmful to the foetus. A major factor hypothesized to have an adverse effect on pregnancy outcome is physical stress [140], which may occur in combination with poor nutrition [141], fatigue [142; 143], or harmful body posture [144]. Various dimensions of low income women's work in home and market activities may have significant adverse effects on pregnancy outcome [138].

Effects of this double burden on women and their offspring are considerable. Roughly 20 million infants worldwide (about 17.6% of all births in low-income countries) are born with weights below 2,500 g [145]. In developing countries about 80% of low birth weight (LBW) is from intra-uterine growth retardation, largely a result of maternal malnutrition [122; 146]. The resultant effects of LBW and/or pre-term status on growth, survival, and development are well documented [100]. Repeated miscarriages, stillbirths, and foetal losses combine with the LBW-related infant deaths to potentiate the effects of mothers' cultural roles on their nutritional status - issues discussed above.

Second is the conflict between women's economic roles and their own nutritional needs. This issue is affected by changes in energy expenditures and intra-household food allocation associated with an enhanced economic role for women. Increased economic participation may increase energy expenditures - for instance, for women engaged in agricultural labour.

A crucial linkage is the impact of women's economic roles on household food security and the intra-household allocation of food. The few studies on intra-household allocation of food show that women get less food than men both in absolute terms and relative to their nutritional needs [52; 147; 148]. There is some evidence that a mother's income goes more directly to her child than that earned by the father [149; 150]. In most low-income societies women's roles involve them in purchasing food, while males purchase other types of goods and services.

A woman's access to and control over income and assets would be a major determinant of her dietary adequacy [52]. Income control enables women to decide whether to trade food items within a social or marketing network or to consume household food production. Within some cultures, the woman's contribution to household income is a direct measure of her economic influence and social value. Some argue that economic power is the most important determinant of women's relative equality, which affects decision making, life-style options, and control of resources such as food [151; 152].

Recent reviews of intra-household resource allocation suggest that the nutritional impact of increased household income is a function of income earner, source of income, its periodicity and reliability, and kind of income (cash or goods) [153; 154].

Market work affects personal dietary needs through occupational energy requirements. Poor women, particularly in rural areas, are more likely to engage in strenuous physical labour that increases their energy needs. They have fewer time- and energy-saving household assets such as piped water and gas or kerosene stoves. They cannot afford child-care substitutes or labour-saving purchases such as processed or prepared foods. Energy expenditures and needs are thus closely intertwined with income and time allocation decisions discussed below.

Enhancing resource availability, allocation, and efficiency: Programme and policy responses

Policies and programmes affecting women and nutrition can be lumped into two categories - intentional and unintentional. All too often, actions have unintentional yet detrimental effects on women. Structural adjustment, for instance, may rectify foreign-exchange imbalances but may compromise the low-income family's consumption basket. Women as consumers, child-readers, nutritionally vulnerable people, and income earners are acutely affected by fiscal constraint, economic restructuring, and changing prices of foodstuffs. National policies, even some with positive social outcomes in mind, may have important negative effects on women.

Deliberate attention to women's multiple roles needs to accompany any analysis of policy change lest economic efficiency and welfare (including nutrition) be compromised.

Women divide their day among three major types of activities: market production, household production, and investment/restorative activities (sleep, learning, fostering social ties). Development programmes and policies often entail some reallocation of time within or between these areas, either temporarily or permanently. To predict the effect of this reordering of tasks on nutrition necessitates examining the direct and indirect adjustments. Figure 5 (see FIG. 5. The effect of women's time allocation on nutrition) shows how development efforts can affect nutrition positively by changing the way women use their time. Each concentric circle represents increased resources for nutrition, with the outermost circle containing more distal effects than the inner circle. The resulting improvements in human resources then enhance productivity, further generating, one hopes, an upward spiral in output and well-being.

Of course we cannot increase the number of hours in the day, but, by increasing productivity (through increasing skills, improving technology, or providing access to productive resources, shown inside the arrows in figure 5), we can help women to either increase their output or decrease the time necessary to produce the same output in market or household production. With this added output (or thee), they can improve the household food supply, health, and child care, and their own work load. This in turn results in improved health and nutritional status for all members of the family, reduced stress, and enhanced female status.

In order for women to be able to get more rest or invest in their own human or household resources, they need increased productivity, as described above, but also the motivation and permission to use their newfound time for sleep, for using health or education programmes, or for spending more time taking care of their children. Sleep and rest are productive uses of time to the extent that they reduce nutritional depletion and restore energy stores in the muscles and fat, thus increasing strength and endurance. Reduced maternal energy expenditure (if it is not matched by reduced dietary intake) may also make more nutrients available to the foetus or nursing child. Increased time spent on child care is productive if it enhances the child's health or development, which is promoted through maternal skill-building efforts.

Opportunities do exist for intentionally improving nutrition through addressing women's needs. The linkages between immediate project outcomes and nutrition are not necessarily direct, however, and the effectiveness of an intervention in improving nutritional status may vary from one population to another. Part 2 of this paper will address these issues and review programmes and policies to create a positive-sum game by addressing the issues of income, child care, productivity, and health. Urgent issues requiring further research will be summarized.

Acknowledgements

We thank the Advisory Group on Nutrition of the ACC/SCN, Dr. Abraham Horwitz, and Dr. John Mason for their encouragement and advice in all phases of the development of this overview article. We thank the ACC/SCN for providing financial support for its preparation. We thank Martha Burdick, Samya gurney, Patricia Dargent, Lionel Deang, and Anna Viggh for research assistance. We also thank Linda Adair, Corazon Barba, and Chloe O'Gara for comments on earlier drafts. We thank Lynn Moody Igoe, Frances Dancy, Catheryn Brandon, Mary Ann Daly, and Ealise Crumb for editorial and secretarial assistance. None of these persons is responsible for the final views presented here.

Notes

1. There results represented studies with more than 20 women as subjects from low-income countries in Asia and Africa. Approaches for collecting these data vary widely from careful, precise observation of activities to recall of one to seven days of activity. Market work includes all agricultural, wage, animal husbandry, and handicraft activities. Home production includes child care, food marketing/preparation, washing, cleaning, caring for the sick, and other activities traditionally not remunerated Leisure activities were excluded since their measurement depended on the length of daily observation in each survey.

2. Fertility and lactation experiences are reviewed by using nationally representative, comparable surveys conducted in a large number of countries. The results presented in table 7 and figure 2 are based on standardized tabulations for 27 countries prepared by the International Statistical Institute in the first Country Report for the World Fertility Surveys. Most of these surveys were conducted in the 1970s. In a technical appendix available on request, we present the methods used to derive the Iength of time a women is pregnant or lactating. These results represent a conservative estimate of the number of months of pregnancy because of very low estimates of the number ending in miscarriage or stillbirth. Also we assume that a woman's reproductive life is 35 years, a time longer than the span in many low-income countries.

3. Little is known about the functional significance (e.g., on physical performance in home or market production) of various distributions of dietary intake, weight, or fat composition, inter alia.

4. A number of researchers, particularly the group involved in a large comparative study of energy requirements during pregnancy and lactation, feel that these RDAs overestimate the women's needs [87; 88]. If their findings are correct, women may not be as undernourished as these data suggest.

5. We use weight-for-height standards for US women with small frames to obtain some sense of the distribution of women in terms of body composition.

6. The description of the maternal-depletion syndrome began with a broadly based set of factors: physically demanding labour, poor diet, heavy infection levels, and repeated pregnancies. It has narrowed over time to a focus on repeated pregnancies and prolonged lactation [see, e.g., 121].

7. Brems and Berg [122] hypothesize that many women in low-income countries, particularly those without access to modern obstetrical care, may not adequately increase their diet during pregnancy. They hypothesize, in fact, that in many cases they may decrease it because of fear of delivery complications felt to be associated with pelvic disproportionality. "Eating down" during pregnancy, they feel, may be a rational response. This hypothesis is unexplored. Brems and Berg cite a set of anthropological studies documenting beliefs on food avoidance or reduced weight gains during pregnancy; unfortunately none has documented the impact of these beliefs on dietary behaviour [cf. 52].

8. More systematic research on this question following a more comprehensive biological systematic research on this question following a more comprehensive biological model and using longitudinal research on 3,000 Filipino women is being conducted by Linda Adair, Eilene Bisgrove, and Barry Popkin. Initial multivariate findings indicate a strong relationship between the duration of lactation and postpartum weight loss.

9. Researchers on this topic ignore some crucial issues, including the sequencing of maternal work and child-care outcomes and the nature of the decision-making processes concerning maternal work and child-feeding decisions. If women make decisions jointly to work and to cease breast-feeding (or other feeding choices), if they go to work because they need to try to improve poor child nutrition, or if those who work away from the home have less concern for infant well-being than those who select jobs compatible with child care - jobs that are lower paying - then, although poorer child nutrition may be associated with women's work, it would not be women's work per se that has caused this relationship. These issues must be considered before we can understand whether and how women's economic roles conflict with child-care roles. These shortcomings and problems must be considered in examining the broad sets of conclusions found by the numerous studies on this topic [cf. 135; 136].

10. It is not clear whether these 202 societies are representative of modern third-world societies. Data came from the Human Area Relations file, representing predominantly isolated rural groups.

References

1. United Nations, Department of International Economic and Social Affairs. World survey on the role of women in development. (A/Conf.116/4Rev.1, ST/ ESA/180) New York: UN, 1986.
2. Birdsall N. McGreevey WP. Women, poverty, and development. In: Buvinic M, Lycette MA, McGreevy WP, eds. Women and poverty in the third world. Baltimore, Md, USA: Johns Hopkins University Press, 1983.
3. Buvinic M, Lycette MA, McGreevey WP, eds. Women and poverty in the third world. Baltimore, Md, USA: Johns Hopkins University Press, 1983.
4. Youssef NH, Hetler CB. Rural households headed by women: a priority concern for development. Rural Employment Policy Research Program. World Employment Programme Research Working Papers (WEP 10/WP.31). Geneva: ILO, 1984.
5. Seager J. Olson A. Women in the world: an international atlas. New York: Simon & Schuster, 1986.
6. White K, Otero M, Lycette MA, Buvinic M. Integrating women into development programs: a guide for implementation for Latin America and the Caribbean. Paper prepared for US Agency for International Development, Bureau for Latin America and the Caribbean. Washington, DC: International Center for Research on Women, 1986.
7. United Nations. La mujer en el sector urbano: America Latina y el Caribe. [Santiago, Chile], 1985.
8. Caldwell JC, Jalaluddin AKM, Caldwell P. Cosford W. The control of activity in Bangladesh. Working Papers in Demography, 12. Canberra: Department of Demography, Research School of Social Sciences, Australian National University, 1980.
9. Cain M, Khanam SR, Nahar S. Glass, patriarchy, and the structure of women's work in rural Bangladesh. Center for Policy Studies Working Paper no. 43. New York: Population Council, 1979.
10. Nag M, White BNF, Peet RC. An anthropological approach to the study of the economic value of children in Java and Nepal. Curr Anthropol 1978;19(2):293-306.
11. Acharya M. Time use data and the living standard measurement study. Living Standard Measurement Series Working Paper no. 18. Washington, DC: World Bank, 1982.
12. King E, Evenson RE. Time allocation and home production in Philippine rural households. In: Buvinic M, Lycette MA, and McGreevey WP, eds. Women and poverty in the third world. Baltimore, Md, USA: Johns Hopkins University Press, 1983.
13. Mueller E. The value and allocation of time in rural Botswana. J Dev Econ 1984; 15(1-3):329-60.
14. Bureau pour le Développement de la Productivité Agricole. Rapport final de l'étude sur les temps de travaux en zone cantonnière. Bangui, Central African Republic, 1960.
15. Bério A-J. The analysis of time allocation and activity patterns in nutrition and rural development planning. Food Nutr Bull 1984;6(1):53-68.
16. Kamuzora CL. Constraints to labour time availability in African smallholder agriculture: the case of Bukoba District, Tanzania. Dev Change 1980;11: 123-35.
17. Evenson RE, Popkin BM, King-Quizon E. Nutrition, work, and demographic behavior in rural Philippine households: a synopsis of several Laguna household studies. In: Binswanger HP, Evenson RE, Florencio CA, White BNF, eds. Rural Asian household studies Singapore: Singapore University Press, 1980;290-365.
18. Popkin BM. Time allocation of the mother and child nutrition. Ecol Food Nutr 1980; 9(1):1-14.
19. Goldschmidt-Clermont L. Economic evaluation of unpaid work in the household: Africa, Asia, Latin America and Oceania. Women, Work & Development Series, no. 14. Geneva: ILO, 1987.
20. Anwar S. Bilquees F. The attitudes, environment and activities of rural women: a case study of Jhok Sayal. Research Report no. 98. Islamabad: Pakistan Institute of Development Economics, 1976.
21. Ho TJ. Time costs of child rearing in the rural Philippines. Popul Dev Rev 1979;5(4):643-62.
22. Hanger J. Moris J. Women and the household economy. In: Chambers R. Moris J. eds. Mwea: an irrigated rice settlement in Kenya. Munich: Weltforum Verlag, 1973:209-44.
23. Fruzzetti L. Farm and hearth: rural women in a farming community. In: Afshar H. ed. Women, work and ideology in the third world. London: Tavistock, 1985:37-65.
24. Evenson RE. Food policy and the new home economics. Food Policy 1981 ;6(Aug): 180-93.
25. Szalai S. ed. The use of time: daily activities of urban and suburban populations in twelve countries. The Hague: Mouton. 1972.
26. Boserup E. Women's role in economic development. New York: St. Martin's Press, 1970.
27. Holmboe-Ottesen G. Mascarenhas O. Wandel M. Women's food chain activities and implications for nutrition: problems and policy issues. Paper prepared for the UN ACC Sub-committee on Nutrition. [Geneva: ACC/SCN], 1986.
28. Acharya M. Time use data from Nepalese villages: policy implications. Paper presented at the annual meeting of the Population Association of America, Washington, DC, 28 Mar 1981.
29. Farouk A, Ali M. The hardworking poor: a survey of how people use their time in Bangladesh. Dacca, Bangladesh: Bureau of Economic Research, Dacca University, 1975.
30. Goldschmidt-Clermont L. Unpaid work in the household. Geneva: ILO, 1982.
31. Sivard RL. Women: a world survey. Washington, DC: World Priorities, 1985.
32. Acharya M, Bennet L. Women and the subsistence sector: economic participation and household decision making in Nepal. World Bank Staff Working Paper no. 526. Washington, DC: World Bank, 1983.
33. Rondinelli DA. Cities as agricultural markets. Geogr Rev 1987;77(4):408-20.
34. Ahmed I. Technology and rural women. London: Allen & Unwin, 1985.
35. International Rice Research Institute. Women in rice farming. Brookfield, Vt, USA: Gower, 1985.
36. Bunster B. Market sellers in Lima, Peru: talking about work. In: Buvinit M, Lycette MA, McGreevey WP, eds. Women and poverty in the third world. Baltimore, Md, USA: Johns Hopkins University Press, 1983.
37. Musgrove P. Galindo O. Do the poor pay more? retail food prices in Northeast Brazil. Econ Dev Cult Change (in press).
38. Zeitlin MF, Houser R. Johnson C. Preliminary report to the Ford Foundation of the association between mother-child feeding behaviors and nutritional status of 8-20 month old infants in a Mexican squatter community. Medford, Mass, USA: School of Nutrition, Tufts University, 1988 (draft).
39. Valdecanas OC, Florentino RF, Pedro MRA, Vicente LM, Maninang SS. Nutritional patterns and adjustment to the economic deviation of 1983-1984 among selected households in Metro Manila. Food and Nutrition Research Institute Monograph Series, no. 1. Manila, Philippines: Food and Nutrition Research Institute, 1984.
40. Cornia GA, Jolly R. Stewart F. Adjustment with a human face. Oxford, UK: Clarendon Press, 1987.
41. Popkin BM, Bisgrove EZ. Urbanization and nutrition in low-income countries. Food Nutr Bull 1988;10(1): 3-23.
42. Popkin BM, Bilsborrow RE, Akin JS. Breast-feeding patterns in low-income countries. Science 1982; 218(10):1088-93.
43. Scrimshaw S. Mitzner K, Scrimshaw N. Health seeking behavior at the household level: a summary of data from sixteen developing countries. (Forthcoming)
44. Leslie J. Time cost and time savings to women of the child survival revolution. Health Policy Plann (in press).
45. Akin JS, Griffin CC, Guilkey DK, Popkin BM. The demand for primary health services in the third world. Totowa, NJ, USA: Rowman & Allenheld, 1984.
46. Akin JS, Griffin CC, Guilkey DK, Popkin BM. The demand for primary health care services in the Bicol region of the Philippines. Econ Dev Cult Change 1986;34(4):755-82.
47. Akin JS, Griffin CC, Guilkey DK, Popkin BM. Determinants of infant feeding: a household production approach. Econ Dev Cult Change 1985;34(1):57-81.
48. Popkin BM, Bilsborrow RE, Akin JS, Yamamoto ME. Breast-feeding determinants in low-income countries. Med Anthropol 1983;7(1):1-31.
49. Solon FS, Fernandez TL, Latham MC, Popkin BM. An evaluation of strategies to control vitamin A deficiency in the Philippines. Am J Clin Nutr 1979; 32(7):1445-53.
50. Solon FS, Popkin BM, Fernandez TL, Latham MC. Control of vitamin A deficiency in the Philippines: a pilot project. Part 1, Baseline analysis and program design; part II, Evaluation and benefit-cost analysis. Food Nutr (Rome) 1980;6(2):27-36,43.
51. Wong EL, Popkin BM, Guilkey DK, Akin JS. Accessibility, quality of care and prenatal care use in the Philippines. Soc Sci Med 1987;24(11):927-44.
52. Hamilton S, Popkin BM, Spicer D. Women and nutrition in third world countries. New York: Praeger Special Studies; South Hadley, Mass, USA: Bergin & Garvey, 1984.
53. Measham AR, Rochat RW. Slowing the stork: better health for women through family planning. Paper prepared for the International Conference on Better Health for Women and Children through Family Planning, Nairobi, Kenya, 6-9 Oct 1987.
54. Winikoff B. The effects of birth spacing on child and maternal health. Stud Fam Plann 1983;14(10):231-45.
55. Rasmussen KM, Habicht J-P. Nutrition of women. Ithaca, NY, USA: Cornell University, 1988.
56. Edgerton VR, Gardner GW, Ohira Y. Gunawardeno KA, Senewiratne B. Iron-deficiency anaemia and its effect on worker productivity and activity patterns. Brit Med J 1979;2(6204): 1546-49.
57. Spurr GB. Physical activity, nutritional status, and physical work capacity in relation to agricultural productivity. In: Energy intake and activity. New York: Liss, 1984:207-61.
58. Joint FAO/WHO/UNU Expert Consultation. Energy and protein requirements. Technical Report Series, no. 724. Geneva: World Health Organization, 1985.
59. Gebre-Medhin M, Gobezie A. Dietary intake in the third trimester of pregnancy and birth weight of offspring among nonprivileged and privileged women. Am J Clin Nutr 1975;28(11):1322-29.
60. Prentice, AM. Adaptations to long-term low energy intake. In: Pollitt E, Amante P. eds. Current topics in nutrition and disease, vol. 2. New York: Liss, 1984.
61. JA, VanSteenbergen WM, Lakhani SA, Jansen AAJ, Renqvist U. Food consumption in pregnancy and lactation. In: Van Ginneken JK, Muller AS, eds. Maternal and child health in rural Kenya: an epidemiological study. London: Croom-Helm, 1984:127-42.
62. Bleiberg FM, Brun TA, Goihman S. Gouba E. Duration of activities and energy expenditure of female farmers in dry and rainy seasons in Upper-Volta. Brit J Nutr 1980;43(1):71-82.
63. Panscha S. A survey of dietary intake in a group of poor, pregnant and lactating women. Ind J Med Res 1958;46(4):605-09.
64. Karmarkar MG, Kapur J. Deodhar AD, Ramakrishnan CV. Diet survey of lactating women in different socio economic groups and the effects of socio economic status and stage of lactation on the proximate principles and essential amino acids of human milk. Ind J Med Res 1959;47(3):344-57.
65. Sundararaj R. Pereira SM. Dietary intakes and food taboos of lactating women in a south Indian community. Trop Geogr Med 1975;27(2):189-93.
66. Korean Statistical Association. Food and nutrient intake studies of rural population in Kora. [Seoul], 1977.
67. Ringrose H. Zimmet P. Nutrient intakes in an urbanized Micronesian population with a high diabetes prevalence. Am J Clin Nutr 1979;32(6):1334-41.
68. Durnin JVGA. Food consumption and energy balance during pregnancy and lactation in New Guinea. In: Aebi H. Whitehead RG, eds. Maternal nutrition during pregnancy and lactation: a Nestle Foundation Workshop, Lutry/Lausanne, April 26-27th 1979. Nestle Foundation Publication Series, no. 1. Bern: Hans Huber, 1980:86-95.
69. Ulijaszek SJ, Hyndman DC, Lourie JA, Pumaye A. Mining, modernisation and dietary change among the Wopkaimin of Papua New Guinea. Ecol Food Nutr 1987;20: 143-56.
70. Florencio CA, Aligaen MB. Food and nutrient distribution in Filipino urban households. Nutr Rep Int 1980;21(3):375-85.
71. Bisgrove EZ. Women's diet and reproductive status: a prospective Filipino study. Chapel Hill, NC, USA: Carolina Population Center, University of North Carolina at Chapel Hill, 1988 (manuscript).
72. Banerjee B. Tan PY, Saha N. Calorie and nutrient intake of pregnant Asian women. Trop Geogr Med 1972;24(3):249-52.
73. Adair L. Marginal intake and maternal adaptation: the case of rural Taiwan. In: Pollitt E, Amante P. eds. Current topics in nutrition and disease, vol. 2. New York: Liss, 1984.
74. Dhanamitta S. Suvanus P. Tankeyura C, Nimmannitaya SC. Thailand. Country reports on food habits, national nutrition problems, national plan on food and nutrition development. ,[Bangkok: Institute of Nutrition, Mahidol University]; Washington, DC: Clearinghouse on Infant Feeding and Maternal Nutrition, American Public Health Association, 1978.
75. Desai ID, Garcia-Tavares ML, Dutra de Oliveira BS, Douglas A, Duarte FAM, Dutra de Oliveira JE. Food habits and nutritional status of agricultural migrant workers in Southern Brazil. Am J Clin Nutr 1980; 33(3):702-14.
76. Mora JO, Sanchez R. De Paredes B. Herrera, MG. Sex related effects of nutritional supplementation during pregnancy or fetal growth. Early Hum Dev 1981 ;5(3):243-51.
77. Murillo S, Ulate E, Mata L. Maternal nutrition during pregnancy: study of women from a rural area of Costa Rica. Bol Sanit Panam 1988;104(4):345-54.
78. Arroyave G. Nutrition in pregnancy in Central America and Panama. Arch Latinoam Nutr 1976;26(2):12957.
79. Schutz Y, Lechtig A, Bradfield RB. Energy expenditures and food intakes of lactating women in Guatemala. Am 1 Clin Nutr 1980;33(4):892-902.
80. Valverde V, Delgado HL, Hurtado E, Klein RE. Maternal weight changes and energy intake during pregnancy and lactation. Paper presented to the 12th International Congress of Nutrition, San Diego, Calif, USA: 16-21 Aug 1981.
81. Lechtig A, Arroyave G. The nutrition problem in Latin America: definition, causes, and remedial actions. Bull Pan Am Health Org 1977;11(4):319-31.
82. Geissler C, Calloway DH, Margen S. Lactation and pregnancy in Iran. II. Diet and nutritional status. Am J Clin Nutr 1978;31(2):341-54.
83. Demarchi M, Isa A, Al-Saidi S, Al-Azzawee M, Ali M, Elmilli N. Food consumption and nutrition status of pregnant women attending a maternal child health centre in Baghdad. J Fac Med-Baghdad 1966;NS8(1):20-30.
84. Buchanan R. Effects of childbearing on maternal health. Popul Rep, Ser J, Fam Plann Prog 1974: (8): 125-39.
85. De Maeyer EM, Adiels-Tegman M. The prevalence of anemia in the world. World Health Stat Q 1985; 38(3):302-16.
86. Royston E. The prevalence of nutritional anaemia in women in developing countries: a critical review of available information. World Health Stat Q 1982; 35(2):52-91.
87. Durnin JVGA. Energy requirements of pregnancy: an integrated study in five countries - background and methods. Lancet 1987;2(8564):895-96.
88. Durnin JVGA. Energy requirements of pregnancy: an integration of the longitudinal data from the five-country study. Lancet 1987;2(8564): 1131-33.
89. Jansen AAJ, Kusin JA, Thiuri B. Lakhani SA, Mannetje W. Anthropometric results in pregnancy and lactation. In: Van Ginneken JK, Muller AS, eds. Maternal and child health in rural Kenya: an epidemiological study. London: Croom-Helm, 1984: 143-52.
90. Kusin JA, Kardjati S. DeWith C, Sudibia Ig K. Nutrition and nutritional status of rural women in East Java. Trop Geogr Med 1979;31 :571-85.
91. Adair L. Postpartum nutntional status changes in lactating and nonlactating Filipino women. Chapel Hill, NC, USA: Carolina Population Center, University of North Carolina at Chapel Hill, 1988 (manuscript).
92. National Institute of Nutrition. Annual report, January I, 1979 to December 31, 1979. Hyderabad: Indian Council of Medical Research, 1980.
93. Chowdhury AKMA. Changes in maternal nutritional status in a chronically malnourished population in rural Bangladesh. Ecol Food Nutr 1987;19:201-11.
94. Gueri M, Jutsum P. Sorhaindo B. Anthropometric assessment of nutritional status in pregnant women: a reference table of weight-for-height by week of pregnancy. Am J Clin Nutr 1982; 35(3):609-11.
95. Cerqueira MT, Fry MM, Connor WE. The food and nutrient intakes of the Tarahumara Indians of Mexico. Am J Clin Nutr 1979;32(4):905-15.
96. Hijazi SS. Child growth and nutrition in Jordan. Amman: Royal Scientific Society Press, 1977.
97. Hauck HM. Weight changes during pregnancy, Awo Omamma, Nigeria, 1960. J Obstet Gynaecol Br Commonwealth 1963;70(5):885-90.
98. Thomson AM, Billewicz WZ, Thompson B. McGregor IA. Body weight changes during pregnancy and lactation in rural African (Gambian) women. J Obstetr Gynaecol Br Commonwealth 1966;73(5):724-33.
99. Venkatachalam PS, Shankar K, Gopalan C. Changes in body-weight and body composition during pregnancy. Ind J Med Res 1960;48(4):511-17.
100. Martorell R. González-Cassio T. Maternal nutrition and birth weight. Yearbook Phys Anthropol 1987; 30: 195-220.
101. Mata LJ. Sociocultural factors in the control and prevention of parasitic diseases. Rev Infect Dis 1982; 4(4):871-79.
102. Zeitlin MF, Mansour M. Positive deviance in child nutntion, with emphasis on psychosocial and behavioral aspects and implications for development. Report prepared for the WHO/UNICEF Joint Nutrition Support Program. Medford, Mass, USA: Tufts University School of Nutrition, 1986.
103. Cochrane SH, O'Hara DJ, Leslie J. The effects of education on health. World Bank Working Paper 405. Washington, DC: World Bank, 1980.
104. Bairagi R. Is income the only instrument of child nutrition in rural Bangladesh? Bull WHO 1980;58(5): 767-72.
105. Rosenzweig MR, Schultz TP. Child mortality and fertility in Colombia: individual and community effects. Health Policy Educ 1982;2(3/4):305-48.
106. Behrman JR, Wolfe BL. How does mother's schooling affect family health, nutrition, medical care usage, and household sanitation? J Econometr 1987;36(1/2):185-204.
107. Cochrane SH. Fertility and education: what do we really know? World Bank Staff Occasional Papers, 26. Washington, DC: World Bank, 1979.
108. LeVine RA, Richman A, LeVine S. Correa CS. Reproductive correlates of maternal schooling in Mexico. Paper presented at the Rockefeller Foundation Workshop on Women's Status and Fertility, May 1985.
109. Tucker K, Sanjur D. Maternal employment and child nutrition in Panama. Soc Sci Med 1988:26(6):605-12.
110. Caldwell JC. Education as a factor in mortality decline: an examination of Nigerian data. Popul Stud 1979; 33(3):395-415.
111. Zeitlin MJ, Griffiths M, Manoff RK, Cooke TM. Nutrition communication and behavioral change component, Indonesian Nutrition Development Program. Vol. 6, Household evaluation. Report by Manoff International, Inc., to Department of Health, Republic of Indonesia. Washington, DC: RK Manoff, 1984.
112. Ahmed NY, Ahmed MA. An evaluation of the effects of a hygiene intervention in five villages of Bangladesh. Draft report to US Agency for International Development. Medford, Mass, USA: Tufts University School of Nutrition, 1987.
113. Moock P. The efficiency of women as farm mangers: Kenya. Am J Agric Econ 1976;58(5):831-35.
114. Griffiths M. Maternal self-confidence and child wellbeing. Paper presented at annual meeting of the Society for Applied Anthropology, Tampa, Fla, USA, 2024 Apr 1988.
115. Belenky MF, Clinchy BM, Goldberger NR, Mattuck Tarule J. Women's ways of knowing: the development of self, voice, and mind. New York: Basic Books, 1986.
116. Bassett L. A head start: preschool education in Turkey. IDRC Rep 1985;14(2).
117. Collier P. Women in development: defining the issues. Oxford, UK: Unit for the Study of African Economies. Institute of Economics and Statistics, 1987.
118. Frank O. Infertility in sub-Saharan Africa. Center for Policy Studies Working Paper no. 97. New York: The Population Council, 1983.
119. World Health Organization. The epidemiology of infertility. Report of a WHO scientific group. Technical Report Series, 582. Geneva: WHO, 1975.
120. Jelliffe D, Maddocks I. Ecological malnutrition in the New Guinea highlands. Clin Pediatr 1964;3(7):432-38.
121. Jelliffe D, Jelliffe EP. Human milk in the modern world: psychosocial, nutritional, and economic significance. Oxford, UK: Oxford University Press, 1978.
122. Brems S, Berg A. Eating down during pregnancy. Washington, DC: Population, Health, and Nutrition Department, World Bank, 1988 (draft).
123. Hobcraft J. Does family planning save children's lives? Technical background paper for the International Conference on Better Health for Women and Children through Family Planning, Nairobi, Kenya, 6-9 Oct 1987.
124. Rinehart W. Kols A. Healthier mothers and children through family planning. Popul Rep, Ser J. Fam Plann Prog, no. 27, 1984.
125. Wishik SM, van der Vynckt S. Nutrition, mother's health and fertility: the effects of childbearing on health and nutrition. PAG Bull 1975;5(3): 11-17.
126. Fortney JA, Susanti I, Gadalla S. Suleh S. Rogers SM, Potts M. Reproductive mortality in two developing countries. Am J Public Health 1986;76: 134-38.
127. Haaga JG. Mechanisms for the association of maternal age, parity, and birthspacing with infant health. Background paper prepared for NAS Working Group on the Health Consequences of Contraceptive Use and Controlled Fertility. Washington, DC: Labor and Population Studies Program, Rand Corp., 1987.
128. Pebley A, DaVanzo J. Maternal depletion and child survival in Guatemala and Malaysia. Paper presented at annual meeting of the Population Association of America, New Orleans. 21-23 Apr 1988.
129. Carloni AS. The impact of maternal employment and income on the nutritional status of children in rural areas of developing countries: what is known, what is not known, and where the gaps are. Rome: FAO. 1984.
130. Engle PL. The intersecting needs of working women and their young children: 1980 to 1985. San Luis Obispo, Calif, USA: Department of Psychology and Human Development, California Polytechnic State University, 1986.
131. Beneria L. Roldán M. The crossroads of class and gender: industrial homework, subcontracting, and household dynamics in Mexico City. Chicago: University of Chicago Press, 1987.
132. Popkin BM, Solon FS. Income, time, the working mother and child nutriture. J Trop Pediatr Environ Child Health 1976;22:156-66.
133. O'Gara C. Breastfeeding and maternal employment in urban Honduras. In: Leslie J. Paolisso M, eds. Women's work and child welfare in the third world. AAAS Symposium Series. Boulder, Colo, USA: Westview (in press).
134. Oppong C, Abu K. Seven roles of women: impact of education, migration and employment on Ghanaian mothers. Women, Work and Development Series, no. 13. Geneva: ILO 1987.
135. Leslie J. Women's work and child nutrition in the third world. In: Leslie J. Paolisso M, eds. Women's work and child welfare in the third world. AAAS Symposium Series. Boulder, Colo, USA: Westview (in press).
136. Myers RG, Indriso C. Women's work and child care: supporting the integration of women's productive and reproductive roles in resource-poor households in developing countries. Revised version of paper prepared for a workshop on Issues Related to Gender, Technology, and Development, Rockefeller Foundation, 26-27 Feb 1987.
137. DaVanzo J. Lee DLP. The compatibility of child care with market and nonmarket activities: preliminary evidence from Malaysia. In: Buvinic M, Lycette MA, McGreevey WP, eds. Women and poverty in the third world. Baltimore, Md, USA: Johns Hopkins University Press, 1983:62-91.
138. Barnes DL, Adair L, Popkin BM. Women's physical activity and pregnancy outcome: a longitudinal analysis from the Philippines. Chapel Hill, NC, USA: Carolina Population Center, University of North Carolina at Chapel Hill, 1988 (ms).
139. Jimenez MH, Newton N. Activity and work during pregnancy and the postpartum period: a cross-cultural study of 202 societies. Am J Obstetr Gynecol 1979; 135(2): 171-76.
140. Bragonier JR, Cushner IM, Hobel CJ. Social and personal factors in the etiology of premature birth. In: Fuchs F. Stubblefield PG, eds. Preterm birth: causes prevention, and management. New York: MacMillan, 1984:64-85.
141. Tafari N. Naeye RL, Gobezie A. Effects of maternal undernutrition and heavy physical work during pregnancy on birth weight. Br J Obstetr Gynaecol 1980; 87(3) :222-26.
142. Mamelle N. Munoz F. Occupational working conditions and preterm birth: a reliable scoring system. Am J Epidemiol 1987;126(1):150-52.
143. Mamelle N. Laumon B. Layar P. Prematurity and occupational activity during pregnancy. Am J Epidemiol 1984;119(3):309-22.
144. Naeye RL, Peters EC. Working during pregnancy: effects on the fetus. Pediatr 1982;69(6):724-27.
145. World Health Organization. The incidence of low birth weight: an update. Weekly Epidemiol Record 1984; 59:205-12.
146. Falkner F. Maternal nutrition and fetal growth. Am J Clin Nutr 1981;34(suppl 4):769-74.
147. Carloni AS. Sex disparities in the distribution of food within rural households. Food Nutr 1981;7(1):3-12.
148. Haaga JG, Mason JB. Food distribution within the family: evidence and implications for research and programmes. Food Policy 1987;12(2): 146-60.
149. Guyer JL. Household budgets and women's incomes. Working Paper no. 28. Brookline, Mass, USA: African Studies Center. Boston University, 1980
150. Safilios-Rothschild C. The role of the family: a neglected aspect of poverty. In: Knight PT, ed. Implementing programs of human development. Washington, DC: World Bank, 1980:311-72.
151. Blumburg RL. Fairy tales and facts: economy, family. fertility, and the female. In: Tinker 1, Bramsen MB, Buvinic M, eds. Women and world development. Washington, DC: Overseas Development; New York: Praeger, 1976:12-21.
152. Sacks K. Social bases for sexual equality: a comparative view. In: Morgan R, ed. Sisterhood is powerful: an anthology of writings from the women's liberation movement. New York: Random House, 1970:455-69.
153. Rogers BL, Schlossman NP. Intrahousehold resource allocation: issues and methods for development policy and planning. Tokyo: United Nations University (in press).
154. Von Braun J, Kennedy E. Commercialization of subsistence agriculture: income and nutritional effects in developing countries. Working Papers on Commercialization of Agriculture and Nutrition, no. 1. Washington DC: International Food Policy Research Institute, 1986.

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