DEVELOPMENT programmes have often emphasized the importance of a life cycle approach and the interconnectedness of development priorities. Gender and nutrition highlight this interconnection very sharply. But before we look at the complex interlinkages between gender and nutrition, it would be helpful to have a common understanding of empowerment, a notoriously difficult concept to measure. We consider empowerment the expansion of choice and strengthening of voice through the transformation of power relations, so that women and girls have more control over their lives and futures.¹

To demonstrate the close links between gender and nutrition, one need only consider the intergenerational nature of malnutrition, where a child’s nutritional future is linked directly to its mother’s nutritional status. A chronically undernourished or anaemic mother is likely to give birth to an underweight baby, who may be stunted as a child and adolescent and in turn give birth to a malnourished baby. On the other hand, improving nutritional outcomes has a positive impact on educational attainment, cognitive abilities, and even on adult wages/earnings.² An extra year of primary school can boost a girl’s eventual wages by an estimated 20%.³

When women have more decision making powers and access to the right resources, they can prioritise health and nutrition for their children and families. Better-nourished girls are more likely to attend school more regularly, grow up to participate in the economy actively, and be empowered to take decisions in multiple spheres, including parenting.⁴

Global evidence has identified a range of gender-related factors – age of marriage and first birth, maternal short stature, maternal body mass index (BMI) and maternal education – as critical drivers of nutrition outcomes in South Asia. A recent comprehensive review of research on nutrition and family planning also suggests that investing in family planning can contribute to better nutritional outcomes for both mothers and children.⁵ An analysis of India’s National Family Health Survey (NFHS-4, 2015-16) also established that gender related factors could significantly explain almost two-thirds of the observed difference in stunting rates between low and high burden districts. These factors include maternal BMI, mother’s education, age at marriage, and antenatal care.⁶

 

This evidence suggests that investments in girls and women are likely to yield both biological and social pathways to improved childhood nutrition outcomes. India can start a virtuous cycle by simultaneously prioritizing progress on women’s empowerment and nutrition.

India’s policy landscape has a number of schemes and programmes, across ministries, focused on improving the well-being of women and girls. Operating under the ministries of women and child development (MWCD), health and family welfare, human resource development, rural development, agriculture, labour, and micro, small and medium enterprises, these programmes interact with women at different stages in their lives.

 

Programmes and policies that highlight how an expansion of choice, strengthening of voice, and transformation of power relations can help improve health and nutrition outcomes include: Anganwadi centres under the Integrated Child Development Scheme (ICDS) – India’s ICDS programme, initiated in the 1970s and universalized in 2006, provides an opportunity to strengthen both child nutrition and maternal employment through its anganwadi centres (AWCs). Across the country, 1.4 million AWCs function as pre-school daycare centres, providing women a safe and clean environment for their children and reducing the burden of unpaid care work on women. Expanding the center’s hours of operation and investing in more human resources could create an even greater impact bygiving women more time to participate in the economy while being assured about the health and well-being of their children.

A global evidence review has underlined that quality childcare centres can play a crucial role in improving and increasing women’s participation in the labour force and key child development outcomes.⁷ The effects range from an increased probability of mothers working or being employed (5.1% in Mexico, 15 percentage points in Chile, and 25 percentage points in Colombia) and increased hours of work (24 additional hours per month in Mexico, 36 additional hours per month in Brazil, and 36-40 additional hours per month in Ecuador). Quality childcare centres also show improved child nutrition and development outcomes through improved dietary intake (Guatemala), positive impacts on height and weight (Brazil), and improved cognitive skills (Colombia).

 

Women leaders in panchayati raj institutions: The reservation of 33% seats in local governments for women has enabled greater representation and participation of women in the policy process. This provision is also linked with improved nutrition outcomes – evidence highlights that women leaders accord greater priority to development issues⁸ and with more women in political processes, issues like nutrition, health and education stand a better chance of being strengthened. There is also evidence that villages where leadership is reserved for women have a higher availability of public goods – drinking water, schools, health centres and fair price shops.⁹ The experience of Bihar and Kerala shows that women in panchayats play an important role in improving governance at the last mile, including ensuring functionality of AWCs and Village Health and Nutrition Days.¹⁰

In addition, female leadership has a strong influence on the career aspirations and educational attainment of adolescent girls. Research shows that in villages that have female leaders over two election cycles, the gender gap in parents’ aspirations for a son over a daughter closed by 20%, while the gap between adolescent girls’ and boys’ desire to graduate closed by 32%.¹¹

 

Self-help groups under the National Rural Livelihoods Mission (NRLM): India’s NRLM reaches 59.3 million households through self-help groups (SHGs). Several studies highlight the success of SHG models; findings suggest that strong institutional platforms like SHGs empower poor households and women socially as well as economically.¹² They enable women to build their own human, social and financial resources by accessing rights, entitlements and livelihood opportunities, including services from the public and private sector. SHGs have also provided strong platforms to improve the health and nutrition status of women and children.

For instance, Jeevika in Bihar rolled out a comprehensive package of interventions with SHGs, leveraging behaviour change communication, community-level events, reinforcement of messaging by health sub-committees, peer counselling, and convergence with departments of health and social welfare. This approach has led to improvements in many maternal and child nutrition indicators, including breastfeeding and exclusive breastfeeding.¹³

Keeping empowerment at the centre of programmes such as NRLM is critical to realizing its many benefits. The strengthening of women’s federations and exploring the potential of gender resource centres (GRCs) under NRLM can potentially accelerate progress on broader economic and social empowerment outcomes, including access to work, health and nutrition, political participation, and freedom from gender based violence, all of which would have additive benefits for both women’s empowerment and nutrition outcomes.

 

While India has had these strong policy and programme frameworks operating through diverse verticals, the Poshan Abhiyaan launched in March 2018 provides an opportunity for increased collaboration and convergence across platforms that fall under the purview of different ministries. The launch of a Jan Andolan for nutrition, for example, has seen the participation of various ministries, including health and family welfare, rural development, and panchayati raj.¹⁴ Guidelines released by MWCD have also reiterated the need for greater engagement and participation of diverse institutions. Regular reviews are being undertaken under the Poshan Abhiyaan and these reports also highlight the importance of convergence and collaboration with other ministries.¹⁵

 

The examples above, however, have highlighted that the links between gender and nutrition are complex, and women’s empowerment and improved nutritional outcomes are not necessarily linear processes. Data and data analysis are needed to design evidence-based policies and initiatives that will help women take decisions and lead healthy, productive lives. Frequent and regular data, disaggregated by age and sex, can identify areas of progress and challenges, while accompanying analysis can identify how issues should be addressed. MWCD’s recently formed Broad Based Committee for Gender Analysis and Budgeting, with membership across ministries and gender experts, can support the information, evidence, and policy design needs of the Government of India in driving a results-based empowerment agenda. The ministry of statistics and programme implementation (MoSPI) has been leading the way in strengthening data systems and identifying ways of filling data gaps. Some efforts underway include MoSPI’s Sustainable Development Goal 5¹⁶ dashboard, and a time use survey being undertaken by the National Sample Survey Office (NSSO) after a gap of more than 20 years.

Governments across India have recognized the need to keep women at the centre of policymaking. By addressing social norms and continuing to bring greater synergies between various departments and ministries, it will be possible to impact the nutrition- and empowerment-related goals of millions of women and of societies.

 

Footnotes:

1. Bill and Melinda Gates Foundation, ‘A Conceptual Model of Women and Girls’ Empowerment’. https://www.gatesgender-equalitytoolbox.org/wp-content/uploads/Conceptual-Model-of-Empowerment-Final.pdf

2. J.J. Hoddinott et al., ‘The Consequences of Early Childhood Growth Failure over the Life Course’. Discussion Paper 1073, International Food Policy Research Institute, Washington DC, 2011.

3. World Bank, ‘Discriminating Against Women Keeps Countries Poorer’, 2015. https://www.worldbank.org/en/news/opinion/2015/09/10/discriminating-against-women-keeps-countries-poorer

4. R. Oniang’o and E. Mukudi, ‘Nutrition and Gender’, in Nutrition: A Foundation for Development, Geneva, 2002. https://www.unscn.org/files/Publications/Briefs_on_Nutrition/Brief7_EN.pdf

5. R. Naik and R. Smith, ‘Impacts of Family Planning on Nutrition’. Futures Group, Health Policy Project, Washington DC, 2015. https://www.healthpolicyproject.com/pubs/690_FPandnutritionFinal.pdf

6. P. Menon et al., ‘Understanding the Geographical Burden of Stunting in India: A Regression-Decomposition Analysis of District-level Data from 2015-16’, Maternal and Child Nutrition 14(4), 2018.

7. S. Chaturvedi, ‘Global Evidence on the Impact of Centre-based Quality Childcare on Maternal Employment and Early Childhood Development Outcomes’. IWWAGE Working Paper Series, Initiative for What Works to Advance Women and Girls in the Economy, New Delhi, 2019.

8. R. Chattopadhyay and E. Duflo, ‘Women as Policy Makers: Evidence from a India-wide Randomised Policy Experiment’. NBER Working Papers 8615, National Bureau of Economic Research, 2001. https://www.researchgate.net/publication/5196587_Women_as_Policy_Makers_Evidence_from_a_India-Wide_Randomized_Policy_Experiment

9. E. Duflo and P. Topavala, ‘Unappreciated Service: Performance, Perceptions, and Women Leaders in India’, 2004. http://users.nber.org/~rdehejia/!@$devo/Lecture%2009%20Gender/supplemental/Duflo_Unappreciated_Women.pdf

10. A. Gogoi et al., ‘Evaluating Effectiveness of Elected Women Representatives of PRIs in Monitoring Quality of Health Service Provision through Accountability Checklists’, in A. Brahmachari et al., (eds.), Evaluations for Sustainable Development: Experiences and Learning. Astral International Pvt Ltd., 2015.

11. L. Beaman et al., ‘Female Leadership Raises Aspirations and Educational Attainment for Girls: A Policy Experiment in India’, Science 335(6068), 2012.

12. C. Brody et al., ‘Economic Self-Help Group Programs for Improving Women’s Empowerment’. Campbell Systematic Reviews, 2015.

13. A. Noack et al., ‘Improving Nutrition through Livelihoods’. Jeevika Learning Note Series, No 8. http://documents.worldbank. org/curated/en/298391515516507115/122290272_201800120100025/additional/122548-WP-P090764-PUBLIC-India-BRLP-Booklet-p.pdf

14. NITI Aayog, Transforming Nutrition in India: Poshan Abhiyaan – A Progress Report, December 2018. https://niti.gov.in/sites/default/files/2020-02/POSHAN_Abhiyaan_first_progress_report_6_Feb_2019.pdf

15. NITI Aayog, 2018.

16. SDG 5 calls for achieving gender equality and empowering all women and girls. This overarching goal must be remembered in all efforts to ensure success in improving indicators of gender equality.