Women’s Position, Birth Order, and Child Nutritional Status in Ethiopia
Hilde Bras, Wageningen University & Research
Jornt Mandemakers, Utrecht University
Womens 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. Childrens 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. Mothers educational level and spousal age gap were used asindicators for womens position. A childs 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 mothers 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 mothers 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.
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Presented in Session 1179: Health, Wellbeing, and Morbidity