Women’s Autonomy and Child Nutrition in India Wiji Arulampalam Anjor Bhaskar Nisha Srivastava

ESRC Funded Project Partners Wiji Arulampalam, University of Warwick Anjor Bhaskar, Nisha Srivastava, University of Allahabad Duration 1 st April 2010 – 31 st March 2011

Aim To study the relationship between women’s autonomy and child nutrition

Data Characteristics Data from the 3 rd round of the NFHS Anthropometric data (Z scores) for children. Age Group 0-5 years These are born to mothers Data for 29 states

Motivation- Importance of Child Nutrition Evidence: nine months during pregnancy and two years after birth offer a window of opportunity for the child’s physical and mental development, which if lost, leads to permanent and irreversible damage. Therefore: Proper nutrition is important for the proper physical and mental development of a child Lack of proper nutrition contributes ▫ towards nearly 50% of child mortality ▫ susceptibility to diseases ▫ inability to develop to full mental and physical and therefore economic potential

Measures of child nutrition The most common and widely accepted measures of child nutrition are anthropometric z-score measures (WHO 2006 multi-country study) ▫ Height-For-Age (HAZ) ▫ Weight-For-Height (WHZ) ▫ Weight-For-Age (WAZ) Z-score deviation more than 2 std deviations ▫ HAZ: stunted (chronically undernourished) ▫ WHZ: wasted (acutely undernourished) ▫ WAZ: underweight (comprehensively undernourished)

India has one of the highest rates of undernutrition India’s children under 3 (NFHS 3): ▫ underweight: 48% ▫ stunted: 42% are stunted and ▫ wasted: 19% are wasted much higher than most countries of the world including countries which have a much lower per capita income Million children under five in India are Stunted. This is 31.2% of the developing world total (195.1 Million) India also has 42% of the developing world’s Underweight children under five(total 129 million) More than one-third of the developing world’s wasted children under five live in India (Source: United Nations, Tracking Progress on Child and Maternal Nutrition, 2009)

Improvements over time ??? Not changed much over the past two decades.

Lot of studies on trends and determinants of child nutrition Previous Literature Several developing countries: (i) Smith & Haddad (2000); (ii) Ray (2004) Indian studies looking at the persistence of the problem: (i) Shiv Kumar (2007); (ii) Onis et al (2000); (iii) Radhakrishna et al (2006); (iv) Barooah (2002); (v) Ray (2004); (vi) Bassole (2007).

What have they found? Important determinants identified are: Maternal characteristics: mother’s age at child birth, birth interval, education and nutritional status Household characteristics: religion, ethnicity, rural/urban, socio-economic status Public infrastructure: availability of water, electricity and health services Mother’s autonomy: measured as mother’s education, mother’s employment status, some measure of mother’s decision making power.

Actions based on those studies Essential Interventions been identified by Coalition for Sustainable Nutrition The ICDS has been running since 1975

Still…. Yet, the ‘South Asian Enigma’ persists

Possible Explanation… Great deal of consensus regarding the practices which need to be adopted to ensure proper child nutrition. Most are low cost and affordable for all. Yet, their adoption does not take place. Part of the reason: the woman, the primary care-giver to the child, does not have the autonomy to go out and learn about these practices nor to make decisions regarding adoption of these practices. (Smith and Haddad, 2000) It is this hypothesis that we wish to verify through this study.

What is women’s autonomy ??? General definition: “…the capacity to obtain information and make decisions about one’s private concerns and those of one’s intimates,” (Dyson and Moore 1983)...the ability to influence and control one’s personal environment,” (Safilios-Rothschild 1982). “..the extent to which women exert control over their own lives within the families in which they live, at a given point in time.” (Jejeebhoy 2000) Our definition – the freedom and ability to participate in decisions and actions.

Literature on role of women’s autonomy in child nutrition (2) Very few studies have explored this relationship in detail Studies have linked child survival, violence against women to indicators of women’s decision making power: Desai and Johnson (2005); Prakasam (xx); Ghuman (2003); WHO (2003); Jejeebhoy (1998). Child nutrition and characteristics of the mother or household: Education of the mother (Desai and Alva, 1998; Reed et al 1996; Frost et al 2005; Glewwe 1999), women’s decision making (Desai and Johnson 2005); Women’s work (Ukwuani and Suchindran 2003); Economic status of the household (Case et al 2001). Very rarely has the link between women’s autonomy and nutritional status of children been examined in the Indian context. (Dancer and Rammohan 2009 for Nepal; Brunson et al 2009 for Kenya)

Lacunae These studies look at individual aspects of women’s autonomy such as Education, Decision Making, Employment etc. They use single level logistic regression to determine how it affects probability of child being malnourished

Our approach We look at Five dimensions of Women’s autonomy through five separate questions Emotional Autonomy- through view on wife beating Decision Making Autonomy- through actual participation in household decisions Economic Autonomy- through access to money for own use Physical Autonomy- mobility in community Sexual Autonomy- View on refusing sex to husband

20-30% women say wife beating is justified in different circumstances

40-50% women are not involved in making household decisions

50-70% women are not allowed to go out of their house alone

10-20% women say it is NOT justified to refuse sex to the husband even if he has STD, has other women or if she is Tired/not in mood

57% women do not have money for their own use

Components of Women’s Autonomy (1) Construction of our Measure of Autonomy: will use information on various family/mother specific characteristics and responses to the following questions: Emotional Autonomy Is wife beating justified in the following cases: a) If she goes out without telling him b) If she argues with him c) If she argues with him d) If she refuses to have sex with him e) If she burns the food f) If she is unfaithful g) Is disrespectful towards in-laws Responses: 0). No ; 1). Yes; 8) Don’t Know

Dummy Variables for measuring Emotional Autonomy Emotional Autonomy wifebeatargue0: Wife beating NOT justifed if she argue with him wifebeatargue8: Dont Know whether Wife Beating Justified if she argues with him wifebeatsex0: Wife Beating NOT justified if she refuses to have sex with him wifebeatsex8: Don't Know whether wife beating justified if she refuses to have sex with him wifebeatinlaws0: Wife beating NOT JUSTIFIED if she is disrespectful to her in-laws wifebeatinlaws8: DONT KNOW whether wife beating is justified if she is disrespectful to in laws wifebeatout0: Wife beating NOT justifed if she goes out without telling him wifebeatout8:Dont Know whether Wife Beating Justified if she goes out without telling him wifebeatneglect0: Wife beating NOT justifed if she neglects the children wifebeatneglect8: Dont Know whether Wife Beating Justified if neglects the children wifebeatburn0: Wife beating NOT justifed if she burns the food wifebeatburn8: Dont Know whether Wife Beating Justified if burns the food wifebeatunfaithful0: Wife beating NOT justifed if he suspects her of being unfaithful wifebeatunfaithful8: Dont Know whether Wife Beating Justified if he suspects her of being unfaithful Reference: Women who say that Wife beating IS JUSTIFIED in each case

Components of Women’s Autonomy (2) Decision Making Autonomy Who has the final say in the following household decision: a). On own health care b). Making large household purchases c). Making small purchases for meeting daily needs d). Visits to relatives and friends e). Deciding what to do with money husband earns Responses: 1). Respondent Alone; 2). Respondent and Husband/Partner; 3). Respondent and Other Person; 4) Husband/Partner Alone; 5). Someone Else; 6). Other; 7). Husband/Partner has no earnings

Dummy Variables for measuring Decision Making Autonomy finalsayhealth1: Respondent alone has the final say on own health care finalsayhealth2: Respondent decides together with husband on own health care finalsayhealth5: Somebody Else decides about Respondents Health Care finalsayhealth6: Who decides about own health care- OTHER finalsayhealthmis: Who decides about own health care- Missing observation finalsaylpurchase1: Respondent alone has the final say on Large household Purchases finalsaylpurchase2: Respondent decides together with husband on Large household Purchases finalsaylpurchase5: Somebody Else decides about Large household Purchases finalsaylpurchase6: Who decides about own Large household Purchases- OTHER finalsaylpurchasemis: Who decides about Large household Purchases- Missing observation finalsayspurchase1: Respondent alone has the final say on Small household Purchases for daily needs finalsayspurchase2: Respondent decides together with husband on Small household Purchases for daily finalsayspurchase5: Somebody Else decides about Small household Purchases for daily needs finalsayspurchase6: Who decides about own household Purchases for daily needs- OTHER finalsayspurchasemis: Who decides about household Purchases for daily needs- Missing observation finalsayvisits1: Respondent alone has the final say on visits to family or relatives finalsayvisits2: Respondent decides together with husband on visits to family or relatives finalsayvisits5: Somebody Else decides about visits to family or relatives finalsayvisits6: Who decides about visits to family or relatives- OTHER finalsayvisitsmis: Who decides about visits to family or relatives- Missing observation finalsayspending1: Respondent alone has the final say on spending money husband earns finalsayspending2: Respondent decides together with husband on spending money husband earns finalsayspending5: Somebody Else decides about spending money husband earns finalsayspending6: Who decides about spending money husband earns- OTHER finalsayspending7: Who decides about spending money husband Earns-He Has None finalsayspendingmis: Who decides about spending money husband earns- Missing observation Reference: Husband decides alone Who decides on large household purchases Who decides on visits to relatives Who decides on small hh purchases Who decides on own health care Who decides on spending money husband earns

Components of Women’s Autonomy (3) Economic Autonomy Do you have any money for your own use Responses: 0) No; 1) Yes Physical Autonomy Are you allowed to go to the following places a). The Market b). Health facility c). Places outside the village/community Responses: 1). Alone; 2). With Someone Else only ; 3). Not at all

Dummy Variables for measuring Economic and Physical Autonomy Economic Autonomy hasmoneyforuse: Women has money for her own use Physical Autonomy allowedtomarket1: Woman is allowed to go to the market alone allowedtomarket2: Allowed to go to the market with someone else only allowedtohealth1: Allowed to go to health facility alone allowedtohealth2: Allowed to go to health facility with someone else only allowedtovillage1: Allowed to go to places outside the village/community alone allowedtovillage2: Allowed to go to places outside the village/community with someone else only Reference: Women who are NOT ALLOWED TO GO AT ALL

Components of Women’s Autonomy (4) Sexual Autonomy Which of the following justify a wife’s decision to not have sex with her husband/partner a). He has STD b). He has other women c). Tired/Not in mood. Responses: 0). No ; 1). Yes; 8) Don’t Know

Dummy Variables for measuring Sexual Autonomy Sexual Autonomy nosexstd1: Husband having STD is a justified reason for not having sex nosexstd8: Dont Know whether husband having STD is a justified reason for not having sex nosexother1: Husband having other women is a JUSTIFIED reason for not having sex nosexother8: Dont know whether husband having other women is a justified reason for not having sex nosexreason1: Being tired/not in mood is justified as a reason for not having sex nosexreason8: DONT KNOW whether being tired/not in mood is a justified reason for not having sex Reference: Women who say that Refusing Sex is NOT JUSTIFIED

Variables constituting women’s autonomy In total 53 dummies for women’s autonomy 14 dummies for emotional autonomy 26 dummies for decision making autonomy 1 for economic autonomy 6 for physical autonomy 6 for sexual autonomy

Other Covariates v511 : age at first marriage [excludes: married gauna not performed] caste1: Woman: schedule caste caste2: Woman: schedule tribe caste3: Woman: OBC castenk: Woman: caste not known hindu muslim Christian: sikh: girl: female child pbrint1: preceding birth interval lt 18 months pbrint2: preceding birth interval months pbrint3: preceding birth interval months educm1: mother has incomplete primary education educm2: mother has complete primary education educm3: mother has incomplete secondary education educm4: mother has complete secondary education educm5: mother has higher education educfmis: Partner has missing education educf1: Partner has incomplete primary education educf2: Partner has complete primary education educf3: Partner has incomplete secondary education educf4: Partner has complete secondary education educf5: Partner has higher education educf8: partner's educ level not known by woman wealthquintile2: v190==poorer wealthquintile3: v190==middle wealthquintile4: v190==richer wealthquintile5: v190==richest Caste Religion Sex Birth Interval Mother’s Education Father’s Education Wealth Age at 1 st Marriage

Variables we did not include bankaccount: Does the respondent have a bank or savings account givenaloan: Have you been given a loan relativeearning1: Respondent Earns MORE than Partner relativeearning2: Respondent Earns Less than partner relativeearning3: Respondent Earns Same As Partner relativeearning4: Partner doesnt bring in Money relativeearning8: Respondent Doesnt Know whether she earns more than partner respondentmoney1: Respondent Alone Decides how to spend the money she earns respondentmoney2: Respondent decides together with husband/partner how to spend the money she earns respondentmoney4: Husband/Partner Decides Alone how to spend money respondent earns respondentmoney5: Someone else decides how to spend money respondent earns

Econometric Methodology This study will use the GLAMM (Generalised Linear Latent and Mixed Models) framework.

Conclusion Look at the role played by woman’s autonomy in children’s nutritional outcomes. Describe the distribution of the Female Autonomy Index across states.