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Health and nutrition of children

Modified on 2013/05/16 15:10 by Haoyi Chen Paths: Read in Order Categorized as Chapter 2 - Health
From gender issues to gender statistics on health and nutrition of children: illustrative examples

Policy-relevant questions Data needed Sources of data
Does the gap between male and female child mortality suggest that non-biological factors may disadvantage girls? Number of deaths under age 1 by sex; number of deaths under age 5 by sex; number of live births by sex.



Children ever born and children surviving by sex of child and age of mother
Civil registration system
Population registers
Household surveys such as DHS (Demographic and Health Survey)
Population censuses

Household surveys such as MICS (Multiple Indicator Cluster Survey)
Population censuses
Do girls receive the same health care as boys? Number of children aged 12-23 months by sex and type of vaccines received
Children under 5 with diarrhoea in previous two weeks by sex and type of treatment received
Children under 5 with fever in previous two weeks by sex and type of treatment received
Children under 5 with cough or breathing difficulty in previous two weeks by sex and type of treatment received

Household expenditure on health for each child by sex and age of child
Household surveys such as DHS and MICS











Household income and expenditure surveys, budget surveys, living standard measurement surveys
Are there sex differences in nutritional status of children under age 5? How do they vary by age? Distribution of children under 5 by sex, age, weight and height Household surveys such as DHS and MICS

  • + Gender issues
    • In most countries in the world, systematic neglect of girls in terms of nutrition, immunization and curative health care is uncommon (United Nations, 1998; 2010; UNICEF 2011). Still, in a number of countries with strong son preference, mostly located in South-Central Asia, girls appear to be disadvantaged in terms of nutrition and provisions of health, as shown in the paragraphs following. Girls’ disadvantage in terms of health and nutrition should be assessed by taking into account all the dimensions involved – infant mortality, child mortality, nutrition, immunization, and access to curative health care – as well as the overall cultural context of the country or of the population groups considered. It is also important to see how sex-differences on all those dimensions related to health and nutrition vary over time.

      Mortality is higher for boys than girls during the first year of life. Boys have a greater biological vulnerability than girls to most causes of infant death. Based on biological factors only, male mortality before age 1 is expected to exceed female mortality by 10 to 30 per cent (United Nations, 1998). However, in countries with strong preference for sons, the expected excess of male infant deaths may be lower, suggesting a gender-based discrimination against girls.

      Child mortality is usually higher among boys, except in a small number of countries, mostly located in Asia (United Nations, 1998; UNICEF, 2011). In countries with excess female child mortality, sex differences may also be observed with regard to immunization against measles and curative health care, due to a strong preference for sons (United Nations, 1998). In addition, in those countries, female disadvantage in survival may come from another factor. Parents who have a son are more likely to discontinue childbearing or postpone the next birth. By comparison, parents who have a daughter are more likely to have a next birth at a small birth interval, thus increasing the risk of death for the older sibling (United Nations, 1998).

      Death rates between ages one and five are a more sensitive test of female disadvantage than infant mortality, because after age 1 exogenous causes of death rather than biological causes dominate. Still, this is complicated by the fact that boys have a greater susceptibility than girls to death from accidents (United Nations, 1998).

      In a small number of countries in Asia, considerably lower proportions of girls than boys have received measles immunization (United Nations, 1998; UNICEF, 2011). Excess female mortality between ages one and five may also be observed for those countries (United Nations, 1998). However, in most of the countries in the world and across all regions, measles immunization coverage is similar among boys and girls. Also, differentials by sex in overall vaccination are small in most parts of the world, and do not clearly favour either sex (UNICEF, 2011).

      In a small number of countries in South-Central Asia, there are sex differences in curative health care to the disadvantage of girls. These are also countries with excess female child mortality. Curative health care involves expenses and, in the context of scarce family resources, investing in sons may be considered more important for the long term economic wellbeing of the family. A male advantage in terms of curative health care may be more often found among children of poor and uneducated mothers compared to children of wealthy and educated mothers. (United Nations, 1998)

      In a few countries, 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 to be advantaged, 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)

  • + Data needed
    • Infant deaths by sex and age (number of months); deaths between ages 1 and 5 by sex and age; and number of live births by sex

      Children ever born and children surviving by sex of the child and age of the mother

      Distribution of children under 5 by sex, age, weight and height

      Number of children aged 12-23 months by sex and type of vaccines received.

      Children under 5 with diarrhoea in previous two weeks by sex and type of treatment received

      Children under 5 with fever in previous two weeks by sex and type of treatment received

      Children under 5 with cough or breathing difficulty in previous two weeks by sex and type of treatment received

      Household expenditure on health for each child by sex and age of the child



      As far as possible, additional breakdowns should be considered for all the statistics above, such as urban/rural areas, educational attainment of the mother, and wealth status of the household.


  • + Sources of data
    • Civil registration systems with complete coverage are the preferred source of data on deaths under the age of 5 and live births.

      Household surveys such as DHS (Demographic and Health Survey) and MICS (Multiple Indicator Cluster Survey) collect data on births and deaths of children; weight and height of children; immunization; and curative health care for children with diarrhoea, fever, cough or respiratory difficulty. Some living standard surveys collect data on health expenditure for each child in the household.

      Population censuses may collect data on births and deaths in the past 12 or 24 months and data on children ever born and children surviving.

      Health administrative sources and immunization coverage surveys can provide data on vaccinations performed by service providers. When this source is used, additional information on population 12-23 months old (the target population for vaccination) is needed. Target population can be estimated based on data from population censuses, sometimes combined with data from household surveys or civil registration system.


  • + Conceptual and measurement issues
    • Ascertaining sex differentials in infant and child mortality is difficult in countries with less developed statistical systems. Many countries still lack a complete and accurate civil registration system. These also tend to be countries with high child mortality rates. Some sex bias in reporting child deaths and live births may take place. In general, data obtained from censuses and household surveys are subject to recall errors, such as omissions of events, misreporting the timing of events, or age heaping; whereas data obtained from household surveys are affected by sampling errors.

      Estimates of sex-specific mortality based on household surveys may have large standard errors and wide confidence intervals. Therefore some of the differences observed may not be statistically significant. For analysis at country level, it is important that the observed disadvantage of girls or boys in mortality is assessed at the same time with evidence concerning other health aspects such as immunization, health-care practices and nutrition. It is also important to see whether the gap between male and female infant mortality and the gap between male and female child mortality are widening or narrowing.

      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.


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