From gender issues to gender statistics on food utilization: illustrative examples
Sources of data
Do mothers apply recommended feeding practices for their children? Does the socioeconomic background of mothers/caretakers have an impact of the type of feeding practices used? Are there differences in feeding practices based on the sex of the child/infant?
Distribution of feeding practices by sex and age of children and socioeconomic characteristics of mothers/caretakers (education, occupation, etc.).
Household surveys, such as DHS and MICS.
|Are there gender-based differences in the nutritional status of children under 5 years of age? How do they vary by age?||Distribution of children under 5 years of age by sex, age, weight and height.|
How pervasive is female malnutrition? Is malnutrition higher among specific groups of women and, if so, which ones?
Distribution of non-pregnant adult/reproductive-aged women by weight and height further disaggregated by socioeconomic characteristics.
Household surveys, such as DHS and MICS.
|What type of malnutrition do women have? How many pregnant women are affected by micronutrient deficiencies (e.g., iron deficiency anaemia and vitamin A deficiency)?|
Distribution of reproductive-aged women by haemoglobin concentration, retinol concentration and pregnancy status.
Distribution of children by birthweight.
244. Malnutrition is a human rights issue and a problem that affects women and men throughout their lifecycle, 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 of 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 owing to gender roles in household work and additional challenges owing to their reproductive role.
245. As children, in some parts of the world, girls are subject to discrimination in access to health care and food (see also the subsection entitled "Health and nutrition of children" in the section entitled "Health" below). In some countries, mostly located in South and Central Asia, girls between 2 and 5 years of age are more likely to be underweight than boys of the same age. Most often, sex differences in the nutritional status of children under 5 years of age 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 below the age of 2. This may be linked to the fact that below 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).
246. Females continue experiencing disadvantages during adolescence and maturity. 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 a very heavy workload and time constraints (United Nations, 2010; United Nations, Administrative Committee on Coordination, Subcommittee on Nutrition, 1992). 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 their children's intake at acceptable levels.
247. Women's malnutrition contributes to and perpetuates growth and developmental failure in future generations. Intergenerational impacts of women's malnutrition include increased risk of infant mortality, preterm delivery, low birthweight 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-birthweight children. Low weight at birth facilitates children's growth failure and this leads back to small adults (UNICEF and WHO, 2004).
248. Micronutrient disorders, another manifestation of malnutrition, are a particular threat to the health of children under 5 years of age and pregnant women. For instance, iron deficiency anaemia, which is one of the most common nutritional disorders, contributes to over 100,000 maternal and almost 600,000 perinatal deaths each year; it also results in reduced energy levels, which affect productivity and earning power (Kothari and Abderrahim, 2010). Little progress has been made in reducing anaemia, especially in African countries. For example, among the 11 countries for which consecutive DHS surveys measured anaemia in pregnant women, eight showed no measurable change or an increase in anaemia prevalence (Kothari and Abderrahim, 2010). Besides iron deficiency, vitamin A and iodine deficiencies are among the most common micronutrient disorders. Pregnant women are particularly vulnerable to vitamin A deficiency, especially during the last trimester of pregnancy, when the demand of the foetus and mother is highest.
249. At the other end of the malnutrition spectrum is obesity, a well-known phenomenon in developed countries that is also increasing in the developing world, especially among the urban population. Overnutrition 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 the prevalence of obesity show that sex differences vary across and within countries (WHO, 2009).
250. Food utilization is captured through:
a) Data on context and behaviours, such as:
(i) Infant and young child 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, 2010a, 2010b);
(ii) Source of main drinking water, distance from dwelling (space/time), sex and age of the water collector, treatment/preparation of unimproved drinking water and access to improved sanitation;
b) Data on individual nutritional status (i.e., anthropometrics and main micronutrient deficiencies), such as:
(i) Age, sex, weight, height, oedema and 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;
(ii) Height and weight of non-pregnant adult / reproductive-aged women. 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). 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. Official BMI cut-offs for women and men, as well as other methodological information, can be found at http://apps.who.int/bmi/.5
(iii) Weight of children at birth. This is a summary measure of a range of problems including long-term maternal malnutrition, illness, fatigue and poor pregnancy health care6. Low birthweight is defined as less than 2,500 grams. However, it has become evident that the cut-off value of 2,500 grams may not be appropriate for all settings (UNICEF and WHO, 2004). It is a reasonable proxy indicator of the mother's nutritional status;
(iv)Haemoglobin concentration in blood of pregnant women and non-pregnant adult/reproductive-aged women;
(v) Retinol concentration in blood of pregnant women, non-pregnant adult/reproductive-aged women and children under 5 years of age. Alternatively, clinical signs of day/night blindness can be used as a proxy for vitamin A deficiency.
251. Additional breakdowns, such as area of residence, educational attainment of women and wealth status of the household, should be taken into account for all the data above.
Sources of data
252. Household surveys, such as DHS and MICS, are used to collect data on feeding practices, hygiene behaviour and nutritional status of children and women. In particular:
a) DHS surveys have included child anthropometry since Round I (1984-1989) and adult female anthropometry since Round II (1989-1993). More recently, they have included biomarkers, such as anaemia/iron deficiency, vitamin A deficiency and iodine deficiency. Data on infant and young child feeding practices, access to water and sanitation, and hygienic behaviours are also collected.
b) MICS surveys have included child anthropometry since the first round (MICS 1). MICS surveys monitor iodine consumption at the household level, vitamin A supplementation for children under 5 years of age, infant and young child feeding practices, access to water and sanitation, and hygienic behaviours.
253. LSMS surveys are not usually used to collect weight and height data, although in a few countries an anthropometric module for children is included.
254. In recent years, WFP CFSVA surveys have more often included women's and children's anthropometry. Yet, only in a very few countries is the sample size large enough to achieve the necessary quality for national and subnational estimates. Data on infant and young child feeding practices have been collected in some recent CFSVA Surveys. Data on access to safe water and sanitation, and hygienic behaviours are frequently collected.
255. Health administrative records may also be considered as a source of data on the nutritional status of children at birth. However, in countries in the less developed regions, only a small fraction of newborns are delivered in health facilities and the characteristics of these newborns are not necessarily representative of all newborns. The estimates obtained can be severely affected by the undercoverage and quality of administrative records.
Conceptual and measurement issues
256. Empirical findings on women's and children's nutrition should be evaluated using a holistic approach. Indeed, individual malnutrition can be the consequence of household food insecurity, sickness or poor sanitation/caring practices, or a combination of all three. In addition, analyses should take into account, as much as possible, intrahousehold dynamics: for instance, lack of food at the household level does not necessarily result in children's malnutrition, especially if children are protected against infections and mothers diminish their food intake to preserve their children's consumption.
257. Sex differentials in nutrition may be clearer when data on weight and height of girls and boys under 5 years of age 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.
258. Women's BMI is generally measured on either non-pregnant adult women (women of age 18 years and above) or non-pregnant reproductive-aged women (women aged 15 to 49). Any comparison should carefully reflect on the reference population and compare the same age groups. Along the same lines, the nutritional status of young girls (i.e., below 18 years of age) should be measured using BMI-for-age.
259. Weight is not to be measured in the case of oedema and pregnancy, because this introduces a bias in the weight value. For this reason, and owing to high measurement costs, some surveys measure nutrition through mid-upper arm circumference.
260. Age patterns in the height of adult women over the age of 20 (the height of an adult women is considered stable after the age of 20) can be used to assess improvements or deteriorations in nutritional status among cohorts of women. Increases in height over generations are historically linked to health transitions, in particular the control of infectious diseases and improving nutrition. Normally, the average height of adult women increases from one generation to the next. However, in some countries, negative trends in the height of adult women over the age of 20 from older cohorts to younger cohorts have been observed (Garenne, 2011). Such negative trends among cohorts are indicative of a deterioration in the overall nutritional status of women. Similar analyses can be conducted for cohorts of men, although anthropometric data on men are less often available.
261. Data on food storage, preparation and processing are rarely available and international standards have not been established thus far.
5 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. Official BMI cut‐offs for women and men, as well as other methodological information, can be found at http://apps.who.int/bmi/.
6 Low birthweight is defined as less than 2,500 grams. However, it has become evident that the cut‐off value of 2,500 grams may not be appropriate for all settings (UNICEF and WHO, 2004).