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« Health and nutrition of children »

Modified on 2015/05/11 15:11 by Sean Zheng Paths: Read in Order Categorized as Chapter 2 - Health
Table II.26

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? Deaths among the children under the age of 1 by sex, deaths among children under the age of 5 by sex and live births by sex.


Children ever born and children surviving by sex of the child and age of the mother.
Civil registration systems.
Population registers.
Household surveys, such as DHS.
Population censuses.

Household surveys, such as MICS.
Population censuses.
Do girls receive the same health care as boys? Children aged 12 to 23 months by sex and type of vaccines received.
Children under the age of 5 with diarrhoea in the past two weeks by sex and type of treatment received.
Children under the age of 5 with a fever in the past two weeks by sex and type of treatment received.
Children under the age of 5 with a cough or breathing difficulties in the past two weeks by sex and type of treatment received.

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










Household income and expenditure surveys, budget surveys and living standards measurement surveys.
Are there sex differences in the nutritional status of children under the age of 5? How do they vary by age? Distribution of children under the age of 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, 2010a; UNICEF, Division of Policy and Practice, 2011). Still, in a number of countries with a strong son preference, mostly located in South and Central Asia, girls appear to be disadvantaged in terms of nutrition and provisions of health, as shown in the paragraphs below. 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 being considered. It is also important to see how sex differences in all those dimensions, as related to health and nutrition vary over time.

      Mortality is higher for boys than for 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 alone, male mortality before the age of 1 is expected to exceed female mortality before the age of 1 by 10 to 30 per cent (United Nations, 1998). However, in countries with a strong preference for sons, the expected excess of male infant deaths may be lower, suggesting 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, Division of Policy and Practice, 2011). In countries with excess female child mortality, sex differences may also be observed with regard to immunization against measles and curative health care, owing to a strong preference for sons (United Nations, 1998). In addition, in those countries, female disadvantage in survival may come from another factor. Parents of a son are more likely to discontinue childbearing or to postpone the next birth. By comparison, parents of a daughter are more likely to have the next birth after a small interval, thereby increasing the risk of death for the older sibling (United Nations, 1998).

      Death rates between the ages of 1 and 5 are a more sensitive test of female disadvantage than infant mortality, because after the age of 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, a considerably lower proportion of girls than boys have received measles immunization (United Nations, 1998; UNICEF, Division of Policy and Practice, 2011). Excess female mortality between the ages of 1 and 5 may also be observed for those countries (United Nations, 1998). However, in most countries in the world and across all regions, measles immunization coverage is similar among boys and girls. Also, sex differentials in overall vaccination are small in most parts of the world and do not clearly favour either sex (UNICEF, Division of Policy and Practice, 2011).

      In a small number of countries in South and 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 well-being of the family. A male advantage in terms of curative health care may be more often found among children of poor and uneducated mothers than among children of wealthy and educated mothers (United Nations, 1998).

      In a few countries, girls between the ages of 2 and 5 are more likely to be underweight than boys of the same age. Most often, sex differences in the nutritional status of children under the age of 5 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 the age of 2. This may be linked to the fact that under the age of 2, the genetic vulnerability of boys to infections may reduce their nutritional status. However, above the age of 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
    • Data on health and nutrition of children refer to:

      (a) Infant deaths by sex and age (in months); deaths among children between the ages of 1 and 5 by sex and age, and live births by sex;

      (b) Children ever born and children surviving by sex of the child and age of the mother;

      (c) Distribution of children under the age of 5 by sex, age, weight and height;

      (d) Children aged 12 to 23 months by sex and type of vaccines received;

      (e) Children under the age of 5 with diarrhoea in the past two weeks by sex and type of treatment received;

      (f) Children under the age of 5 with a fever in the past two weeks by sex and type of treatment received;

      (g) Children under the age of 5 with a cough or breathing difficulties in the past two weeks by sex and type of treatment received;

      (h) Household expenditure on health for each child by sex and age of the child.

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


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

      Household surveys, such as DHS and MICS are used to 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 breathing difficulty. Some living standards surveys are used to collect data on health expenditure for each child in the household.

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

      Health administrative records and immunization coverage surveys can provide data on vaccinations performed by service providers. When this source is used, additional information on the population aged 12 to 23 months (the target population for vaccination) is needed. The target population can be estimated on the basis of data from population censuses, sometimes combined with data from household surveys or civil registration systems.

  • + 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 omission of events, misreporting of the timing of events and 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 the country level, it is important that the observed disadvantage of girls or boys in mortality is assessed at the same time as 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 the age of 5 are disaggregated by age. Under the age of 2, the biological vulnerability of boys to infections may reduce their nutritional status. Above the age of 2, biological factors are less relevant.

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