Is Gender Disparity in Child Care Declining in India? A Comparison of two National Family Health Surveys Parveen Nangia (Social Planning Council, Sudbury) Presented at Canadian Population Society 2004 Annual Meetings, Winnipeg, Manitoba June 1-5, 2004

Objectives To assess gender discrimination in child care practices at the state (provincial) level To find out whether this discrimination is declining or not at the national level

Sources of data National Family Health Survey, (NFHS-2) National Family Health Survey, (NFHS-1)

Child Care Practices The indicators of child care practices and outcomes considered for this study are: Immunization of children Duration of breastfeeding Health care for sick children Nutritional status Neonatal, infant, and under-five mortality Educational attainment of children

Selection of Variables Variables selected for different indicators of child care practices/outcomes Immunization of children –Percent of male and female children (12–23 months) who received all vaccinations –Percent of male and female children (12–23 months) who did not receive any vaccination

Selection of Variables Breastfeeding practices –Median duration of breastfeeding for male and female children Health care for sick children –Percent of male and female children under 3 years of age who were suffering from Acute Respiratory Infection (ARI) and were not taken to a health facility or provider –Percent of male and female children under 3 years of age who were suffering from diarrhoea and were not given any treatment for that

Selection of Variables Nutritional status –Percent of male and female children under 3 years of age who are: Underweight (measured by weight for age) Stunted (measured by height for age) Wasted (measured by weight for height) Mortality –During 10 year period preceding the survey, the rates for male and female neonatal mortality, infant mortality, and under-five mortality

Selection of Variables Educational attainment of children –Percent of male and female children (10-14 years) who are literate –Percent of male and female literate children (10-14 years) who completed primary –Percent of male and female children (6-14 years) attending school

Methodology Using the approach adopted by Human Development Report, gender disparity is computed by taking male to female ratios for positive variables of care (e.g. percent of children who received all vaccinations) Female to male ratios computed for negative variables of care (e.g. percent of children not treated for diarrhoea)

Methodology For each indicator of child care a composite index is prepared by taking the average value for all variables in that indicator measured by male/female or female/male ratios as necessary For each indicator, the states are ranked on the basis of the index – higher the rank greater is the discrimination against female children in that particular aspect of child care

Methodology The states are also ranked on the basis of three more indicators: Indicators of social development –Overall level of literacy (age 6+) –Percent of never married women (age 15-19) –Percent of non-scheduled caste/scheduled tribe population Indicators of housing conditions –Percent of households living in pucca or semi-pucca houses (use of durable material in the construction of a house) –Percent of households with piped supply of water –Percent of households with electricity Indicators of female autonomy –Percent of ever married women (15-49) Regularly exposed to mass media Earning in ‘cash’ or ‘cash and kind’ With access to some money to be used as they wish Do not require permission to visit friends and relatives

Methodology For computing the indices of development, relative position of each state is calculated on each variable using the following formula: X - minimum range After ranking each state on every indicator a rank order correlation matrix is computed to assess relationship between level of gender disparity and aspects of social development

Findings - immunization A higher proportion of male children in the country received all vaccinations (43%) compared to female children (41%) The proportion of female children who did not receive any vaccination (15%) is higher than male children (14%) The proportion of children fully vaccinated has gone up by 6 percentage points in NFHS-2 from the NFHS-1 level Gender disparity in immunization coverage for children has declined during this period

Findings - breastfeeding The median duration of breastfeeding for male children in India is approximately two months longer than female children The median duration of breastfeeding had increased slightly between the two surveys Gender disparity in duration of breastfeeding has declined marginally during this period

Findings – health care A much higher proportion of female children (39%) than male children (34%) were not taken to a health facility or provider when they were suffering from Acute Respiratory Infection (ARI) The proportion of female children who were not given any treatment when they suffered from diarrhoea was higher than male children The proportion of children who did not receive any treatment for ARI or diarrhoea has increased from NFHS-1 to NFHS-2 Gender disparity in health care of sick children has declined

Findings – nutritional status A higher proportion of female children in the country are underweight and stunted compared to male children The proportion of male children who are wasted is marginally higher than female children The proportion of undernourished children has declined in the country on all the three measures of nutritional status Gender disparity has declined in terms of ‘wasted’, but increased marginally for underweight and stunted children

Findings - mortality Neonatal mortality is higher for male children (51) compared to female children (45) Infant mortality is also higher for males than females Under-five mortality is higher for females (105) than males (98), reflecting on a greater neglect of female children All the three types of mortality rates have declined in India Gender disparity in mortality, particularly neonatal mortality, has declined between the two surveys

Findings – educational attainment Literacy rate is much higher for male children (87%) than female children (76%) There is no difference in the proportion of male and female children who complete primary schooling A higher proportion of male children (83%) are attending school than female children (74%) Level of literacy and proportion of children attending school has increased substantially between the surveys The gender disparity in educational attainment has also declined during this period

Gender disparity – state level examples At state level, immunization disparity is conspicuous in Assam, where 22% of male and 9% of female children received all vaccinations, and 30% of male and 38% of female children did not receive any vaccination Median duration of breastfeeding in Assam is 36 months for boys and 26 months for girls 56% boys and 62% girls in Assam were not taken to a health facility or provider when they had ARI. Similarly, 35% boys and 42% girls were not treated for diarrhoea

Gender disparity – state level examples In Madhya Pradesh, 53% boys compared to 58% girls are underweight In Uttar Pradesh, 53% boys compared to 58% girls are stunted In Gujarat, 14% boys and 19% girls are wasted In Rajasthan, neonatal mortality is 58 for boys and 50 for girls. This difference is reduced in infant mortality (89 for boys and 87 for girls). The under-five mortality is much higher for girls (135) compared to boys (116), indicating greater neglect of female children

Gender disparity – state level examples In Rajasthan, 90% of boys and 65% of girls age years are literate. Among the literates, 46% boys and 39% girls complete primary education. In Bihar, 71% boys and 54% girls (age 6- 14) attend school In Himachal Pradesh, 99% boys and 97% girls attend school

Correlation Interrelationships between different indices indicate that Index of breastfeeding disparity is positively associated with index of female autonomy. The states which have achieved greater female autonomy have larger disparity in breastfeeding The index of nutritional disparity is negatively associated with the index of social development Mortality disparity is negatively related to health care disparity Indices of social development, housing development (proxy to economic development), and female autonomy are negatively associated with educational disparity

Conclusion There is a strong relationship between female autonomy and social development. Female autonomy is also positively related to the housing (or economic) development Female autonomy reduces the gender gap in educational achievement of children Social development decreases the gender disparity in nutritional status of children Disparity in health care of children is related to their mortality

To sum up Gender disparity in child care persists in India Disparity is declining over the years Disparity is more in the northern states compared to the southern states Greater social development and female autonomy would help in reducing the gender gap in child care