Women’s Position, Birth Order, and Child Nutritional Status in Ethiopia

Hilde Bras, Wageningen University & Research
Jornt Mandemakers, Utrecht University

Women’s position is seen as key to improved child nutrition. However, in many cultures child nutritional status also varies by gender and birth order because of specific food distribution patterns, care giving practices, and access to formal health care. Whereas female empowerment may be expected to increase household resources for children, it is unclear whether it also compensates the nutrition security of the worst-off children in the household. Does having a more empowered mother straighten sibling inequalities in nutritional status? We base our analysis on a pooled sample of the 2011/12 and 2013/14 waves of the Ethiopian Rural Socioeconomic Survey (ERSS) using 5,966 observations from 4,200 children nested in 2,607 households. Children’s nutritional status was assessed by means of WHO reference population standardized measures for height-for age and weight-for-age. Women’s educational level, her age at childbirth, and spousal age gap were used as indicators for women’s position. A child’s sibling position was defined by gender and birth order. In general, girls do worse than boys both in terms of height-for-age and weight-for-age. Random-effect models show that children with better educated and older mothers had significantly better nutritional outcomes. In a second step household fixed-effect models were estimated to control for all observed and unobserved household characteristics. Results show that the higher the parity, the lower the height-for-age and weight-for-age z–scores of both boys and girls. Analyses including interactions with mother’s education and age show that there is indeed compensation within the sibling set when the mother is better educated; maternal education decreases the boy-advantage and the earlier-born advantage, particularly for girls. Our findings show that mother’s position not only improves children’s nutritional status, which has been found before, but that empowerment also straightens out long-lasting sibling inequalities, particularly ameliorating the health position of later-born girls in households.

Introduction

Women’s position is seen as key to improvedchild nutrition (Asian Development Bank 2013; Unicef 2011; Christiaensen &Alderman 2004; Smith et al. 2002; Sen 1989). However, in many cultures childnutritional status also varies according to gender and birth order because ofspecific food distribution patterns, care giving practices, and access toformal health care (Garenne 2003; Horton 1988; Behrman 1988). Whereas femaleempowerment may be expected to increase household resources for children, it isunclear whether it also compensates the nutrition security of the worst-offchildren in the household (Fledderjohan et al. 2014). Does having a moreempowered mother straighten sibling inequalities in nutritional status?

Data and methods

We base our analysis on the 2011/12 and2013/14 waves of the Ethiopian Rural Socioeconomic Survey (ERSS). We used the 2,486households (out of 5,881 participating households) that had information on atleast one child aged five and younger. Children’s nutritional status wasassessed by means of four WHO reference population standardized measures forchildren aged 6 months until 5 years: height-for age (stunting) (N=4,732),weight-for-age (underweight) (N=5,075), BMI-for-age (N=4,745),and weight-for-height (wasting) (N=4,751). Nutritional status inEthiopia has improved over the last decades (Tesfai, Adugna, & Nagothu2015), in the ERSS data still 41% of under-fives were stunted, 26% underweightand 11% wasted. Mother’s educational level and spousal age gap were used asindicators for women’s position. A child’s position was defined by gender and birthorder (first born versus other parities) andtheir interaction (first born x male). The data wereanalyzed with fixed effects models to control for all observed and unobserved family-specificcharacteristics. We thus focus on within-family (between sibling) differences. Weincluded interactions with maternal characteristics to examine whether siblingdifferences in nutritional status depend on maternal characteristics. Standarderrors were adjusted for clustering of observations in mothers and children.

Findings and interpretations

Preliminary analyses showed that childrenwith better educated mothers had significantly better nutritional outcomes(e.g.: 44% stunted for illiterate mothers compared to 24% for mothers with sometertiary education), no differences were found by spousal age gap. Whileearlier studies on Ethiopia reported earlier-born children and girls to be morenutrition secure (Hadley et al. 2008; Mekonnen et al. 2005; Collin 2006; Vosti& Witcover 1993), the ERSS data, in contrast, reveal that especially girlshad a considerable disadvantage for all four outcomes compared to boys (figure1). Especially firstborn girls fared worse for height-for-age andweight-for-age. Analyses including interactions with mother’s education forheight-for-age and weight-for-age show there is indeed compensation within thesibling set when the mother is better educated; maternal education decreasesthe boy-advantage, and the firstborn-girl disadvantage (figure 2). Our findingsshow that mother’s position not only improves nutritional status in general,which has been found before, but that empowerment also straightens out longlasting sibling inequalities, particularly ameliorating the health position ofgirls in households.

 

 

References

 

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Presented in Session 1179: Health, Wellbeing, and Morbidity