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Food utilization

Modified on 2013/05/23 16:51 by Haoyi Chen Paths: Read in Order Categorized as Chapter 2 - Food security
From gender issues to gender statistics on food utilization: illustrative examples

Policy-relevant questions Data needed Sources of data
Do mothers apply recommended feeding practices for their children? Does the socio-economic background of the mothers / caretakers have an impact of the type of feeding practices? Are there differences in feeding practices based on the sex of the child/infant?

Are there gender-based differences in nutritional status of children under 5? How do they vary by age?
Distribution of feeding practices by sex and age of children and socio-economic characteristics of the mothers/caretakers (education, occupation, etc.)

Distribution of children under 5 by sex, age, weight and height
Household surveys such as DHS and MICS

How pervasive is female malnutrition? Is malnutrition higher among specific groups of women? Which ones?

What type of malnutrition do women have? How many pregnant women are affected by micronutrient deficiencies (eg., iron deficiency anaemia and vitamin A deficiency)?
Distribution of adult (or reproductive-aged) non pregnant women by weight and height, further disaggregated by socio-economic characteristics

Distribution of reproductive aged women by haemoglobin concentration, retinol concentration and pregnancy status.

Distribution of children by birth weight
Household surveys such as DHS and MICS

Health administrative records

  • + Gender issues
    • Malnutrition is a human right issue and a problem that affects women and men throughout their life-cycle, with tremendous negative economic and intergenerational effects. Adequate nutrition and food security require more than access to food. Food utilization, incorporating a variety of contextual and behavioural issues, such as food storage, processing, and preparation; infant and young child feeding practices; access to safe water and sanitation; and hygiene practices, also have an impact on nutritional status (FAO, 2002). Most often, women are in charge with performing activities related to those issues, therefore they have a key role in achieving nutrition security and food security for their family members. However, such a key role is often played by women in a context of limited and gender-discriminated access to productive resources or other opportunities. Women may also experience throughout their lives gender discrimination in access to food, overburden due to gender roles in household work, and additional challenges due to their reproductive role.

      As children, in some parts of the world, girls are discriminated against in access to health care and food (see also the subsection on “Health and nutrition of children”, in Chapter 2). In some countries, mostly located in South-Central Asia, girls between ages 2 and 5 are more likely to be underweight than boys of the same age. Most often, sex differences in nutritional status of children under five are very small and within the bounds of sampling fluctuation. In some countries, girls appear not to be disadvantaged, especially when mothers are more educated. However, age can play an important role. In general boys are more likely than girls to be underweight under age 2. This may be linked to the fact that below age 2, the genetic vulnerability of boys to infections may reduce their nutritional status. However, above age 2, when the biological difference is no longer relevant, girls are more likely than boys to be underweight in a few countries, suggesting a gender-based disadvantage in nutrition (United Nations, 1998).

      Females continue experiencing disadvantages also during the adolescence and mature age. Most women are exposed to the stress of having to combine multiple reproductive and productive roles. Beside the reproductive responsibility, the social and economic roles of women within and outside the household often result in very heavy workload and time constraints (United Nations, 2010). In poor contexts, this overburden may lead to irregular meals, exhaustion, and sickness. In addition, in situations of food insecurity, mothers tend to reduce their own consumption in order to maintain children’s intake at acceptable levels (United Nations ACC/SCN, 1992).

      Women’s malnutrition contributes to and perpetuates growth and developmental failure in the future generations. Inter-generational impacts of women’s malnutrition include increased risk of infant mortality, pre-term delivery, low birth weight, and reduced cognitive development in children. Empirical evidence has also demonstrated the vicious cycle of malnutrition between generations: small and malnourished mothers (i.e., low anthropometric measures and anaemia) are more likely to have low birth weight children. Low weight at birth facilitates children’s growth failure and this leads back to small adults. (UNICEF and WHO, 2004)

      Micronutrient disorders, another manifestation of malnutrition, are a particular threat to the health of children under 5 years and pregnant women. For instance, Iron Deficiency Anaemia (IDA), which is one of the most common nutritional disorders, contributes to over 100,000 maternal and almost 600,000 peri-natal deaths each year; it also results in reduced energy levels, which affect productivity and earning power (Kothari and Noureddine, 2010). Little progress has been made in reducing anaemia, especially in African countries. For example, among the eleven countries for which consecutive DHS surveys measured anaemia in pregnant women, eight countries showed no measurable change or an increase in anaemia prevalence (Kothari and Noureddine, 2010). Beside iron deficiency, Vitamin A and iodine deficiencies are among the most micronutrient disorders. Pregnant women are particularly vulnerable to Vitamin A Deficiency (VAD), especially during the last trimester of pregnancy when the demand of the foetus and mother is highest.

      At the other end of the malnutrition spectrum is overweight, a well-known phenomenon in developed countries which is also increasing in developing world, especially in the urban population. Over-nutrition is a result of diets that are characterized by energy-dense, nutrient poor foods that are high in fat, sugar and salt. It is a major contributor to heart disease, stroke, diabetes and cancer. While information on sex differences in balanced nutrition are rarely available, data on prevalence of obesity show that sex differences vary across and within countries (WHO, 2009).

  • + Data needed
    • Food utilization is captured through: (a) data on context and behaviours; and (b) data on individual nutritional status.

      (a) Data on context and behaviours related to food utilization

      Infant and young children feeding practices by sex and age of children and background information on mothers/caretakers. Data are combined to derive a series of indicators regarding breastfeeding, child dietary diversity and optimal diet (WHO, 2008; WHO, 2010a; WHO, 2010b).

      Source of main drinking water; distance from dwelling (space/time); sex and age of the water collector; treatment/preparation of unimproved drinking water; access to improved sanitation.

      (b) Data on individual nutritional status (i.e. anthropometrics, and main micronutrient deficiencies)

      Age, sex, weight, height, oedema, and MUAC (Mid-Upper Arm Circumference) of children from 0 to 59 months (or from 6 to 59 months). Age, weight and height are combined to compute weight-for-height, height-for-age, and weight-for-age measures of malnutrition.

      Height and weight of non pregnant adult women or non pregnant women in reproductive age (15-49). While height alone can be used to report on the stature of women, height and weight can be combined in the Body Mass Index (BMI)3

      Weight of children at birth is a summary measure of a range of problems including long-term maternal malnutrition, illness, fatigue, and poor pregnancy health care 4. It is a reasonable proxy indicator of mother’s nutritional status.

      Haemoglobin concentration in blood of pregnant women and in non pregnant adult/reproductive aged women.

      Retinol concentration in blood of pregnant women, non pregnant adult/reproductive aged women and children less than 5 years of age. Alternatively, clinical signs of day/night blindness can be used as proxy for Vitamin A Deficiency (VAD).

      Additional breakdowns, such as area of residence, educational attainment of the women, and wealth status of the household should be taken into account for all data above.


      3The BMI is equal to the weight in kilograms divided by the square of the height in metres. A woman with a BMI below 18.5 kg/m2 is considered Chronically Energy Deficient (CED). Official cut-offs for BMI for women and men, as well as other methodological information can be found at: http://apps.who.int/bmi/.

      4Low birth weight is defined as less than 2,500 gr. However, it has become evident that the cut-off value of 2,500 grams may not be appropriate for all settings (UNICEF, WHO, 2004).

  • + Examples of indicators derived from gender statistics on food utilization:
    • Prevalence of stunted/wasted/underweight children under 5, by sex

      Prevalence of adult non pregnant women or women in reproductive aged who are mildly/moderately/severely undernourished or overweight

      Prevalence of low weight children at birth

      Prevalence of iron deficiency anaemia in reproductive aged women and children under 5 by sex

  • + Sources of data
    • Household Surveys such as DHS and MICS collect data on feeding practices, hygiene behaviour, and nutritional status of children and women. In particular:

      - DHS surveys have included child anthropometry since Round I (1984-1989), and adult female anthropometry from Round II (1989-1993), and have more recently included biomarkers, such as anaemia/iron deficiency, Vitamin A deficiency, and iodine deficiency. Infant and young feeding practices, access to water and sanitation and hygienic behaviours are also collected.

      - MICS surveys included child anthropometrics since the first round (MICS 1). MICS monitor iodine consumption at the household level, Vitamin A supplementation for children under 5, infant, young child feeding practices, access to water and sanitation and hygienic behaviours.

      Living Standard Measurement Study (LSMS) surveys do not usually collect weight and height data, although in a few countries an anthropometric module for children is included.

      In the recent years, WFP Comprehensive Food Security and Vulnerability Assessments (CFSVAs) have included more often women’s and children’s anthropometrics. Yet, only in very few countries the sample size is large enough to achieve the necessary quality for the national and sub-national estimates. Infant and young child feeding practices are collected in some recent CFSVAs. Access to safe water and sanitation and hygienic behaviours are frequently collected.

      Administrative health sources may also be considered for data on nutritional status of children at birth. However, in countries from the less developed regions, only a small fraction of newborns are delivered in health facilities and their characteristics are not necessarily representative for all the newborns. The estimates obtained can be severely affected by the under coverage as well as by the quality of the administrative records.

  • + Conceptual and measurement issues
    • Empirical findings on women’s and children’s nutrition should be evaluated using a holistic approach. In fact, individual malnutrition can be the consequence of household food insecurity, sickness, or poor sanitation/caring practices; or it can derive from the combined effect of those factors. In addition, the analysis should take into account as much as possible intra-household dynamics: for instance, lack of food at the household level does not necessarily result into children’s malnutrition, especially if children are protected against infections and mothers diminish their food intake to preserve children’s consumption.

      Sex differentials in nutrition may be clearer when data on weight and height of girls and boys under 5 are disaggregated by age. Under age 2, the biological vulnerability of boys to infections may reduce their nutritional status. Above age 2, the biological factors are less relevant.

      Women’s BMI is generally measured either on adult non pregnant women (18 years old or more) or reproductive-aged women (15-49). Any comparison should carefully reflect on the reference population and compare the same age groups. Along the same line, nutritional status of young girls (i.e., below 18 years of age) should be measured using the BMI-for-age.

      Weight is not to be taken in case of oedema and pregnancy because they introduce a bias in the weight value. For this reason, and for the high measurement costs, some surveys measure nutrition through the Mid Upper Arm Circumference (MUAC).

      Age patterns in height of adult women over age 20 (the height of an adult women is considered stable after age 20) can be used to assess improvements or deteriorations in nutritional status along cohorts of women. Increases in height over generations are historically linked to health transition, in particular with the control of infectious diseases, as well as with improving nutrition. Normally, the average height of adult women is increasing from one generation to another. However, in some countries, negative trends in the height of adult women over age 20 from older cohorts to the younger cohorts have been observed (Garenne, 2011). These negative trends along cohorts are indicative of deterioration in the overall nutritional status of women. Similar analysis can be done for cohorts of men, although anthropometric data on men are less often available.

      Data on storage, food preparation and processing are rarely available and international standards have not been set so far.

Note: A first draft of this section was prepared by the Food and Agriculture Organization of the United Nations FAO, Statistics Division.

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