India has a major child malnutrition problem. The Rapid Survey on Children (2012-13) found that about 4 in 10 children are stunted. On average, children who are stunted do less well in school, earn less, and die sooner than children who are not.
There are many causes of child stunting. Addressing poverty and improving education would help, but development is not the only factor. Research shows that poor sanitation spreads diseases that sap children’s energy and stunts their growth. Also, the health of a child’s mother matters critically for whether or not the child is stunted.
The first two years of life are the most important time for a child’s physical and cognitive growth. During this time, she depends heavily on her mother for nutrition. As a growing foetus, she gets all her food from her mother’s bloodstream, and after birth, is ideally breastfed for at least six months.
Unfortunately, research shows that many Indian women start pregnancy underweight and gain little weight during pregnancy. This leads to low birth weight babies, high rates of neonatal mortality, and less successful breastfeeding. Women’s undernourishment contributes substantially to India’s unacceptably high rates of child stunting.
Why are Indian women so malnourished? Here, too, poverty and sanitation play a role. But a recent survey that I conducted with a team of economics and sociology researchers suggests that widespread discrimination against women in their own homes likely plays an important role too.
Social Attitudes Research for India (SARI) is a new phone survey that seeks to interview representative samples of 18-65-year-olds. Recently, we interviewed 1,270 adults in Delhi and 1,470 adults in Uttar Pradesh. One of the things SARI measures is discrimination against women. In India, girls are less likely to survive infancy than boys, and if they do, parents invest less in their education. Women are far less likely to work outside the home and have their own bank accounts than men. Many report little decision-making power over their own lives. One aspect of discrimination against women that matters for health is whether women eat less or worse quality food than men. In order to measure discrimination in women’s food intake, SARI used a question that was previously tested and used by the India Human Development Survey (2011): “When your family eats lunch or dinner, do the women usually eat with the men? Or do the women usually eat first? Or do the men usually eat first?” Answers to these questions have implications for nutrition because in households with a limited food budget, or where there is no refrigerator to store leftover food, the person who eats last very often gets less or lower quality food than people who eat before her. The IHDS 2011 survey interviewed married women aged 15-49 and found that one in five women in Delhi and half of the women in Uttar Pradesh said they ate after men did. When we decided to include the same question in the SARI survey five years later, we found even higher numbers. One in three adults in Delhi, and six in ten adults in U.P. said they lived in households where men eat first. Why are these numbers even higher than what the IHDS found in 2011?
Part of the reason is that SARI and the IHDS asked different people. The IHDS asked only women, while SARI asked both women and men. The graph shows the SARI results for this question broken up by sex. In U.P. (but not in Delhi) men were significantly more likely to say that they eat first. We do not know why men in U.P. reported more often than women that women eat last. Studies of discrimination in other contexts suggest that where discrimination is severe, it is often easier to get people to admit to engaging in acts of discrimination than to experiencing it. Nor do we know for sure why even among women, the SARI figures are higher than the IHDS figures. It may have to do with how respondents react to a phone survey versus a face-to-face survey. The women surveyors who conducted IHDS interviews may have been seen by respondents as progressive women having jobs and moving around without their family members. For a respondent in a conservative household, it may be easier to admit discrimination to a stranger on the phone than to a progressive woman sitting in front of her.
What can be done about it
No matter what the exact figures, it is clear that the practice of making women eat last is widespread in Delhi and U.P., and that it has important implications for a child’s health. What is unclear is how to address the problem.
While the government cannot force people to give women an equal share of food, it could do a lot more to promote gender equality. It could publicise and condemn this practice. It could also more aggressively pursue policies to address discrimination against women in other domains. Encouraging girls’ education, discouraging dowry, supporting marriage choice, and encouraging female labour force participation would all give women more power to challenge this damaging practice. Diane Coffey is a visiting researcher at the Indian Statistical Institute, Delhi. This is the last of a four-part series on prejudice. The first, second and third parts, with Amit Thorat, appeared on December 29 and December 30, 2016, and January 2, 2017.