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Conclusions

Evidence reviewed in this chapter qualifies widely held beliefs about patterns of advantage and disadvantage in food allocation within households. We find little support for the notion that the youngest children tend to get less than a fair share of household food supplies: estimates of their food consumption have often been biased downwards by the omission of breastmilk from food-consumption data.

Rates of child malnutrition measured by caloric intake and anthropometry for boys and girls are quite similar in most countries. In household surveys, where both boys and girls fail to meet their nutritional needs, the usually small differences are as likely to favour females as males. These data do not only counter the notion that girls suffer hunger more than boys, almost everywhere: they contradict it even for India - the source of many of the studies that claim to document discrimination against girls in intra-household food allocation and from which broad geographic generalizations have been drawn. Although the sweeping generalization that Indian girls are discriminated against in the intra-household allocation of food is not supported by the data, there is strong evidence of such discrimination among Indians of high socio-economic status. The simple fact that the Hyderabad standard, which is normed from the anthropometric measurements of the Indian elite, incorporates gender bias would serve as adequate evidence of discrimination, even in the absence of village studies showing more discrimination against females in wealthier households.

We find that the generalization that adult women receive less than an equitable share of household food also requires qualification. For countries where women's intake data can be categorized by reproductive status, the diets of non-pregnant, non-lactating women are more adequate than those of men (though in most of these countries men and women are both undernourished). However, there is also compelling evidence of nutritional disadvantage for pregnant and lactating women in these same countries. Thus, even in populations in which women's status in general is low, we cannot assume that a simple pattern of gender discrimination in intrahousehold food allocation explains the poor diets of pregnant and lactating women.

The association of the most severe undernutrition with pregnancy and lactation implies that it really is in their roles as mothers that women experience the greatest nutritional stress. The particularly inadequate diets of women at these times compromises both their own and their children's health. This pattern calls for targeted interventions seeking to improve women's nutrition during pregnancy and breast-feeding. Most efforts to deal with hunger among women are oriented towards the nutritional stresses of reproduction; this orientation appears quite appropriate. A better understanding of the reasons for the declining adequacy of women's diets during pregnancy and lactation, however, may be necessary in order to develop interventions that will succeed in countering it. But, even with the available information, we conclude that these interventions need to do more than improve women's general status. The more favourable intakes of reproductive-aged women who are neither pregnant nor lactating argues against generalized discrimination and indicates that the nutritional needs during pregnancy - but particularly while breast-feeding - are either not well understood by women and their households or (for other reasons, including poverty) not addressed. The effect of other possible contributing factors, such as consumption of foods that are not sufficiently nutrient dense, might be countered by greater awareness of increased need as well.

Given that data on women's energy expenditures are generally unavailable, we must draw attention to the possibility that women's caloric needs are underestimated by common methodologies. The energy needs of women whose domestic and/or paid work is particularly arduous are especially likely to be underestimated. Interventions that target these women and improve understanding of their increased needs may also be appropriate.

If better information on actual energy expenditures in developing countries revealed higher energy needs for women (but not for men) than are commonly assumed, the adequacy of women's diets relative to need would be lower than indicated by the data presented in this chapter, while men's would stay the same. Non-pregnant, non-lactating women might continue to enjoy a relative advantage over men (but a smaller one), a picture of equitable food distribution might emerge, or men's diets might prove to be more adequate relative to need than women's - depending on the magnitude of the adjustment. Finally, the detailed age data on children's malnutrition also pinpoint the critical importance of weaning problems. Data permitting documentation of the weaning practices in different populations in comparable form are now available for the first time from the series of Demographic and Health Surveys (currently in Round III). Further investigation of weaning practices actually used in different populations, and the consequences of these practices for children's health and development, should be a high priority.

Notes

1. There is little room for doubt that nutritional differences are largely responsible for the smaller body sizes of Indians compared with Americans. However, this comparison provides no information about women's food deprivation relative to men's within the same society. In fact, while, on average, Indian women weigh about 75 per cent as much as American women, the comparable figure for males is only 65 per cent (James and Schofield 1990). Indians are less well fed than Americans, but this particular comparison provides no support for the belief in a female disadvantage within India.

2. Since sample sizes are not given, this can be identified only as a possibility.

3. Chen et al. (1981) refer to the physical activity adjustment as "the most crude and difficult adjustment" which they make. They used labour force participation data from the 1974 census and WHO/FAO guidelines to calculate a 26 per cent average incremental requirement for men aged 15-44 years; the increments for adolescents and men over 45 were slight. Adjustments for female work using the same set of recommendations yielded a 6 per cent increase for adult women, in part because of lack of quantitative information on the energy demands of household and home-based work.

4. The higher mortality of females in India may be a thing of the past; the more usual pattern of a female advantage in life expectancy seems to be emerging (Dyson 1989).

5. Brown et al. (1992) provide data on proportions of children still breast-fed and on amounts of breastmilk consumed by children by detailed age; they also cite previous analysis of the composition of breastmilk in the same poorly nourished population. These elements combine to define the caloric value of breastmilk consumption by detailed age of children in rural Bangladesh.

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