Women's empowerment and child health outcomes in Ghana

This study investigates whether women's empowerment, measured by education attainment relative to her partner, decision‐making, and domestic violence is related to nutritional status of children in Ghana. Using the 2014 Ghana Demographic and Health Survey, the study examines the effect of women empowerment on child's nutritional status at different points in its conditional distributions using ordinary least squares and quantile regression estimation technique. The study observes that women's empowerment is associated with improvement in the nutritional status of children with Z‐scores less than ?4 and ?3 standard deviations, for acutely and severely malnourished children respectively in the long run. The study recommends that the Ministry for Gender and Social Protection should educate male partners on the need for women participation in decision‐making at the household level as well as make formal education accessible to women.     

Introduction to Special Issue on: ‘Inequalities in the Least Developed Countries – Some Lessons from Africa’

This special issue comprises six papers analysing different dimensions of inequalities in African countries. Three papers deal with the trend in inequality in consumption in Mozambique, with multidimensional poverty in four sub‐Saharan countries, and with the relationship between living conditions and subjective well‐being in African countries. The other three are focused on gender issues and are focused on Mozambique, dealing with gender inequalities in the access to contract farming arrangements as well as to employment out of subsistence agriculture, or with the effect of women’s empowerment on children’s health. This introduction provides a short overview of how they contribute to a better understanding of inequalities in low‐income countries.     

Bargaining Power within Couples and Health Care Provider Choice in Tanzania

This paper examines the pattern of health care provider choice in relation to couples’ bargaining power, in a country where most communities are basically patriarchal, with limited legal protection for women. We use the Tanzanian Demographic and Health Survey (2010) and a nested multinomial logit model to distinguish between public and private facility choice. Evidence suggests that cooperation in decision‐making, female discretion over household resources and low domestic violence increase the probability of childbirth in a health facility. We find that cooperation in household decision‐making and low incidence of domestic violence significantly increase the probability of private facility use. The effects of these social and economic dimensions of the distribution of power between spouses on health care use remain significant after controlling for household resource endowment. A policy option that encourages cooperation between couples, reduces domestic violence and/or ensures female empowerment is more likely to enhance the use of reproductive health services.     

Endogenous,Intra‐household Decision‐making and its Impact on the Labor Supply of Couples in Rural India*

Using data for rural India, this paper analyzes households' labor supply decision‐making, taking into consideration non‐participation, endogenous intrahousehold bargaining and nutritional status. Analyses of unitary and collective models suggest that bargaining between household members forms the basis of households' decisions, and these decisions alter households' internal power balance. Analysis of households' internal bargaining process suggests that women's bargaining power increases when their wages are higher and they are better educated. The results indicate that it is crucial to account for the mechanics of decision‐making within households when studying the effects of changing labor market conditions or designing development policies to improve individual well‐being or to empower women.     

Development and health: The need for integrated approaches in South Africa

The impact of development policies on health are outlined within the context of epidemiological and demographic transition. Macroeconomic policies have a major impact on the nutritional status of the population; agricultural policy and particularly changing patterns of land use have in the past resulted in forced resettlement with concomitant health effects, while the development of new irrigation schemes has increased the risk of vector‐borne disease. Industrial and energy policies increase the risk of the population for a range of environmental and occupational pollutants. Several adverse health impacts associated with urbanisation include poverty‐related disease (measles, nutritional diseases); all forms of trauma (from motor vehicle accidents to interpersonal violence); behaviour injurious to health (associated with tobacco, alcohol and sugar consumption); and sexually transmitted diseases. Aids could well become a major impediment to all aspects of future development. The article concludes by recommending greater interaction between epidemiologists and economists so as to ensure that an integrated approach to development will result in enhancement of the health of people.     

Are Determinants of Rural and Urban Food Security and Nutritional Status Different? Some Insights from Mozambique

Undernutrition of children 0–60 months old in Mozambique is much higher in rural than in urban areas. Food security is about the same, although substantial regional differences exist. Given these outcomes, we hypothesized that the determinants of food security and nutritional status in rural and urban areas of Mozambique would differ as well. Yet we find that the determinants of food insecurity and malnutrition, and the magnitudes of their effects, are very nearly the same, although some differentiation in determinants of undernutrition does begin to appear among children 24–60 months old. The difference in observed outcomes appears primarily due to differences in the levels of critical determinants rather than in the nature of the determinants themselves.     

An Analysis of Childhood Malnutrition in Rural India: Role of Gender,Income and Other Household Characteristics

There are controversies regarding the role of individual and household characteristics in childhood nutritional status measured by anthropometric indicators. Using a nutrition index based on weight-for-age of children in rural India, the paper re-examines this issue. Ordered probit estimates of nutritional status suggest female literacy improves the nutritional status of boys at the cost of girls while higher per capita current income improves that of both boys and girls, though the impact is higher for boys; however, effect of income is not robust when we use instruments of longer-run income. But more income and literacy give more ways to discriminate between boys and girls.     

Contract Farming in Mozambique: Implications for Gender Inequalities Within and Across Rural Households

This paper analyses the implications of contract farming for gender inequalities in rural Mozambique. Contract farming is often considered one of the major tools of agribusiness development. It broadly includes those arrangements under which producers commit to providing cash crop to a buyer firm. This paper exploits a panel dataset (2002–2005) collected by the Mozambican Ministry of Agriculture among a nationally representative sample of rural households to explore contracts’ implications for gender equality both across and within households. We look at both the participation of female‐headed households in contracts and the impact of establishing a contract on a set of intra‐household women empowerment indicators. Concerning the first, our results confirm a (small though significant) effect of selection out of contracts of households where a woman is the household’s head. With regard to the second, we expect contrasting effects to be at work: on the one hand, increased income may relax budget constraints improving women’s living conditions, and on the other, we may expect a shift in favour of men of the control over the household’s assets. We find different results according to the indicator used; after controlling for selection bias, we find no effect on control over land but a negative effect on women’s access to extension services.     

The effect of family planning exposure on fertility choices and reproductive health care in rural Pakistan

This paper investigates whether family planning exposure mainly through the Lady Health Worker Program has had any effect on women’s fertility choices and use of reproductive health care service in rural Pakistan, using the 2013 Pakistan Demographic and Health Survey (PDHS). Exploiting variations in the program intensity across regions, we conduct instrumental variables (IV) estimation on the impact of family planning exposure on women’s fertility preferences and reproductive behaviors. Our analysis shows that even in the presence of strong son preferences in Pakistan, increasing family planning exposure reduces women’s incentive to have additional children. Moreover, family planning exposure is associated with more antenatal care visits, more deliveries performed by skilled professionals, and a greater chance of delivery at the health center. Finally, we examine the heterogeneity in the effect on fertility preference by age group and education level, and find that the effect is mainly significant for the educated and young women.     

Do home gardens improve the nutrition of rural pre-schoolers in Lesotho?

In this study, the contribution of household gardens to the nutritional status of pre-schoolers in Lesotho was investigated. The anthropometric status of children under five years of age was measured in five randomly selected villages in five districts of Lesotho during November and December 1999. In each district, the nutritional status of an average of 538 children was assessed. Production from household gardens was investigated to determine whether households had access to vegetables throughout the year. Despite a significant association between the presence of home gardens and lower incidences of wasting and underweight, the nutritional status of children in households with or without home gardens in sampled areas is poor. Some 49 per cent of children from households with food gardens were stunted, 29 per cent were underweight, and 24 per cent showed wasting. Many households do not produce enough vegetables rich in vitamin A to meet both their consumption and nutritional needs. Recommendations include intensified production of a wider mix of crops that include starchy crops, vitamin A-rich vegetables and fruit trees to ensure a significant impact on children's nutritional status.     

Impact of Childcare and Eldercare on Off‐farm Activities in Rural China

Using individual data collected in rural China and adopting Heckman's two‐step function, we examined the impact of childcare and eldercare on laborers' off‐farm activities. Our study finds that having school‐aged children has a negative impact on rural laborers' migration decisions and a positive impact on their decision to work in the local off‐farm employment market. As grandparents can help to take care of young children, the impact of preschoolers is insignificant. Having elderly family to care for decreases the income earned by female members of the family. Although both men and women are actively engaged in off‐farm employment today in rural China, this study shows that women are still the primary care providers for both children and the elderly. Therefore, reforming public school enrollment and high school/college entrance examination systems so that migrant children can stay with their parents, this will help rural laborers to migrate to cities. The present study also calls for more public services for preschoolers and the elderly in rural China.     

EXPLORING THE IMPORTANCE OF EXCESS FEMALE MORTALITY AND DISCRIMINATION IN “NATALITY” IN EXPLAINING THE “LOWNESS” OF THE SEX RATIO IN INDIA

The beginning of the present century has been marked by a shift in attention from “excess” female mortality to discrimination in natality in explaining the “lowness” of the sex ratio or proportion of women in India's population. Such a shift in focus seemingly suggests that discrimination in intra‐family allocation of resources has reduced substantially in India. In this context, an attempt has been made to decompose the observed lowness of the sex ratio in India vis‐à‐vis that of the stable population into that attributable to: (1) age structure difference, (2) excess female mortality, and (3) abnormalities in sex ratios at birth in India. Estimated contributions by each factor suggest that, as late as 2001, excess female mortality or the lowness of the relative survival advantage of women is the single most important determinant of “missing” women in India. The results also point to the importance of age structure difference, which accounts for a little more than 17% of the lowness of the sex ratio in India in 2001.     

Finding the Benefits: Estimating the Impact of The South African Child Support Grant

This paper estimates the impact of the South African Child Support Grant (CSG) on child health, nutrition and education. Data from the 2008 South African National Income Dynamics Study are used to estimate the impact of the CSG on six different outcomes measuring child well‐being. We find a positive treatment effect of the CSG on children's height‐for‐age, progress through the school system, as well as household expenditure on food items using a continuous treatment estimator developed by Hirano and Imbens. Robustness analysis using the inverse probability weighting approach by Flores and Mitnik is also implemented. Although these estimates provide some evidence of a positive impact resulting from the CSG, they are not conclusive in showing that the cash transfers are spent mainly on improving the lives of beneficiary children, as the treatment effects are quite small.     

Migration and development in Mozambique: poverty,inequality and survival

Migration is many Mozambicans' preferred employment option (and sometimes last resort). Rural southern Mozambique, short of resources and traditionally less productive agriculturally than other regions of Mozambique, is now more developed and better off than other rural areas. An inter-regional analysis of the South, Centre and North of Mozambique demonstrates developmental differences largely attributable to labour migration (mainly to South Africa) and remittances. However, although migrant worker households, usually deficit agricultural producers largely dependent on migrant remittances, are often better off than non-migrant ones, many are still vulnerable to poverty. Migration has changed significantly over the last 15 years, with the eclipsing of mine migration and the increasing scarcity of jobs available to young Mozambicans. Despite the overall positive economic impact of migrant labour in southern Mozambique, as remittances decrease because earnings are lower and mechanisms for transfer are limited, its benefit may diminish.     

Bringing home the bacon? Regional nutrition,stature, and gender in the industrial revolution1

The impact of changing diet and resultant nutrition on living standards over the industrial revolution has been much debated, yet existing data have enabled only general trends to be identified. We use data from Eden's survey of parishes in 1795 and the Rural Queries of 1834 to go beyond average calorie intake, instead focusing on micronutrients and quality of diet. From this we discern regional differences in diet. In 1795 these differences were related to the availability of common land and the nature of women's work. Diet in both periods also maps onto stature. Using five datasets on height, we observe a positive impact of diet in 1795 on men's, women's, and boy's heights. By 1834 the impact is less evident; for men it remained, for women and boys it either no longer existed or became negative. This may indicate the superseding of nutritional factors by environmental ones, but it also hints at the emergence of a different relationship between height and nutrition for women and children compared with men. We speculate that this points to a shift in the intra‐household allocation of resources, but challenge the notion that the emergence of male breadwinning automatically led to universal female disadvantage.     

The impact of microcredit on women's empowerment: evidence from China

The impact of microcredit on women's empowerment remains controversial, as documented in the microfinance literature. While some studies claim that microcredit helps women increase their income earning abilities, leading to greater power to overcome cultural asymmetries, others contend that small loans allocated to women are usually controlled by their spouses, which results in more severe subordination of women and leaves them more vulnerable to the patriarchy system within the household and/or at society level. This paper evaluates the empowerment impact of microcredit on rural women in China. Logistic regression is employed for empirical analysis and data are collected through a rural household survey. The results confirm that microcredit has a significant impact on five dimensions of women's empowerment, ranging from economic security to awareness of social/legal issues.     

The counting approach to multidimensional poverty. The case of four African countries

This paper investigates the levels and evolution of poverty in Malawi, Mozambique, Tanzania and Zimbabwe using the decomposability properties of poverty measures based on a counting approach. We compare poverty measures such as the Alkire and Foster index with alternative poverty indices that are sensitive to inequality. Poverty is estimated using Demographic and Health Surveys for different years for Malawi (2004, 2010 and 2015), for Mozambique (2003 and 2011), Tanzania (2004, 2010 and 2015) and for Zimbabwe (2005, 2010 and 2015). Our findings show that one obtains insightful information when looking at the breadth and inequality components of multidimensional poverty.     

Dynamics of Child Malnutrition in Rural and Small‐Town Ethiopia

Improving the status of malnourished children, and preventing children from becoming malnourished, lies at the heart of several of the Sustainable Development Goals. While many cross‐sectional studies examine correlates of stunting, they largely cannot identify drivers of change in stunting. We use two waves of panel data from Ethiopia and incrementally larger sets of fixed effects to control for time‐variant observable characteristics and time‐invariant unobservable characteristics. After controlling for these potential confounders, our analysis reveals that many factors that are associated with stunting in the cross‐section do not impact stunting dynamics. We also estimate individual fixed‐effects regressions, separately, according to baseline stunting status. We find evidence suggesting that while improved societal conditions drive many children out of a stunted state, certain exogenous factors may lead previously healthy children to become stunted. Overall, policymakers and practitioners would be wise to consult research utilising both cross‐sectional and panel data analyses in order to more effectively target already stunted children as well as vulnerable children who may be at risk of becoming stunted.     

Socioeconomic Determinants of Child Health: Empirical Evidence from Indonesia

This paper characterizes the socioeconomic determinants of child health using height‐for‐age z‐score (HAZ), a long‐run measure of chronic nutritional deficiency. We construct a panel data that follows children between ages 3 and 59 months in 1993 through the 1997 and 2000 waves of the Indonesian Family Life Survey. We use this data to identify the various child‐level, household‐level and community‐level factors that affect children's health. Our findings indicate that household income has a large and statistically significant role in explaining improvements in HAZ. We also find a strong positive association between parental height and HAZ. At the community level, we find that provision of electricity and the availability of paved roads are positively associated with improvements in HAZ. Finally, in comparison to community‐level factors, household‐level characteristics play a large role in explaining the variation in HAZ. These findings suggest that policies that address the demand‐side constraints have greater potential to improve children's health outcomes in the future.     

THE DETERMINANTS OF GRADE ATTAINMENT IN LOW‐INCOME COUNTRIES: EVIDENCE FROM RURAL BANGLADESH

This paper presents an econometric analysis of the effects of child health on school enrollment and grade attainment in Bungladesh. It improves on past studies in a number of ways mainly by incorporating into its analysis the endogenous nature of child health. The results challenge the conclusions found in the literature. First, it finds that in Bangladesh, a child's health and his/her probability of being enrolled in school are at best weakly related. Second, it shows that once enrolled, nutritional deficiencies retard substantially school progress: Underweight children tend to be in lower grades than well‐fed children of the same age. It is estimated that a one standard deviation improvement in weight‐for‐age would be expected to reduce the grades behind by about 0.25 years or about 13.5 percent of the actual years completed. Finally, the estimates suggest that the weight‐for‐age indicator appears as the best predictor of nutritional status.