Women and Hunger

World Hunger Education Service

Good nutrition is important for all people in order to reach the full potential of their growth and economic success. Poor nutrition, however, has a larger negative impact on women than on men. This is because it impacts not only their own health, but also the health of their children. The children of malnourished women are more likely to have poorer mental and physical development, higher rates of disease and infection, and are more likely to die in childhood (Ransom & Elder, 2003).

Biologically, women are more likely to be malnourished, especially if they’re menstruating, pregnant, or lactating. In these cases, women have greater micronutrient requirements, and adequate protein energy intake is even more important (FAO, 2012). When they are pregnant or lactating, they need to consume more calories to support the development of their babies and the production of breast milk (FAO, 2012).

Women and girls represent 60% of all undernourished people in the world.
The United Nations (UN) estimates that 70% of the 1.3 billion people in poverty worldwide are women (IWPR).
At least 120 million women in developing countries are underweight. In some regions, more women are underweight than not; for example, 60% of women are underweight in South Asia (Ransom & Elder, 2003).

Babies born to a malnourished mother are much more likely to have low birth weights (LBW). LBW is one of the strongest predictors of whether a child will die before his or her fifth birthday (UNICEF, 2014).

In 2013, 22 million infants were born with LBW, which was 16 percent of all babies born that year

Conversely, there is also growing concern in all countries about the rise in obesity rates –obesity being a form of malnutrition. Obesity in women also increases risk for labor complications and poor child health (Delisle, 2008).

Poverty is a main driver of malnutrition. In countries where there is not equality (particularly large disparities in economic equality) between women and men, there is a higher percentage of women among the poor and hungry (Delisle, 2008). There is a strong and consistent relationship between gender inequality and hunger (DeSchutter, 2013). The Food and Agriculture Organization (FAO) recognizes gender inequality as both a cause of and an effect of hunger and malnutrition (FAO, 2012).

I. Women’s Malnutrition: A Serious Problem

A. Protein energy malnutrition (PEM)

Adults in developing countries can also suffer from PEM, with women disproportionately impacted compared with men, particularly in South Asian countries (WFP 2013). There are five major causes of adult malnutrition: insufficient food, infections, mal-absorption of nutrients, malignancies (such as cancer) and eating disorders.

Pregnant women have an increased demand for nutrients by the developing fetus and those who are already undernourished can fall even further behind in their nutritional status with insufficient food intake. Not enough weight gain during pregnancy can lead to increased risk for complications including maternal morbidity and mortality, neonatal mortality and low infant birth weight. It also becomes harder for a malnourished woman to provide adequate amounts of breast milk, which can lead to malnourished infants.

Prevention of adult malnutrition is complex because the underlying causes are numerous and there are no single, inexpensive or universal strategies that can be applied to prevent it.

B. Micronutrient malnutrition

Iron Deficiency and Anemia

During pregnancy, the amount of blood in the mother’s body greatly increases in order to support the developing baby. If the mother does not consume enough iron during this time, it is very easy for her to become anemic. Anemia in pregnancy increases the risk of the mother’s death during and after birth. Children born to iron-deficient mothers are more likely to have impaired physical and mental development and to have inadequate immune systems.

Anemia affects about 43-50% of women of reproductive age in less developed countries (Ransom & Elder, 2003).
Anemia is estimated to contribute to at least 20% of maternal deaths worldwide. • Pregnant women have the highest prevalence of anemia worldwide at 41.8%.
Africa has the highest burden of anemia in pregnant women, at 57.1%, followed by South and Southeast Asia at 48.2%. South and Southeast Asia have a higher burden in terms of number of pregnant women with anemia. (de Benoist, McLean, Egli, Cogswell, 2008)
Iron deficiency has been shown to be a key predictor of pica in pregnant women; pica is the craving and consumption of non-food material such as dirt and paper.

Vitamin A Deficiency

Vitamin A is a nutrient that is required for proper cell growth. It has a critical role in the formation of the heart, lungs, kidneys and other organs in the baby. Vitamin A is crucial in vision, and night blindness is a symptom of severe vitamin A deficiency. Poor vision can become permanent in prolonged deficiency. Vitamin A is found in animal food products such as dairy, eggs and meats. It also comes from dark leafy green vegetables and orange and yellow vegetables.

The World Health Organization (WHO) estimates that 250–500 million children are blind because of vitamin A deficiency. Half of these children will die within a year of vision loss.
Many infants become vitamin A deficient because their mother is deficient and cannot adequately supply enough vitamin A in her breast milk.
The WHO estimates that 19.1 million pregnant women are vitamin A deficient, and half experience vision loss as a result of vitamin A deficiency.
It is estimated that 10 to 20 percent of pregnant women in lower-income countries are vitamin A deficient (Bailey, West Jr., and Black, 2015).

C. Resource Use and Malnutrition

To what extent women have the ability to choose how to use resources in order to achieve a desired outcome impacts the family. In many parts of the developing world, women do not have access to resources, nor the freedom to make choices about how resources are used in their households. When women have more access to resources and their ability to decide how to use them, maternal nutrition improves, child health improves and there is overall economic growth at a countrywide level (World Bank, 2012).

Unequal labor division and food allocation

In many parts of the developing world, women are responsible for performing a large portion of unpaid domestic work. Much of this is difficult physical labor. They may walk many miles every day to gather firewood and obtain water. This energy expenditure increases their daily caloric need. They are responsible for a majority of the labor involved in obtaining, preparing and serving food to their families.

In sub-Saharan Africa it is estimated that women perform anywhere from 60% to 80% of the labor involved in producing, procuring and preparing food for household consumption (Ransom and Elder, 2003).

Female-headed households are particularly vulnerable. They often lack access to resources needed to improve their food security. These resources include land, financial services and training in livelihood skills. Despite the role of women in food preparation, in some cultures women are still expected to eat last. This means they have less access to highly nutritional foods such as leafy greens and animal products. Addressing inequalities in food consumption within the family is a key factor in successful nutrition programs and policies. Improving household access to food is not enough if it is distributed unequally amongst members.

Malnutrition has a huge economic cost to countries. Malnourished individuals contribute less to the workforce, and increased maternal and child mortality drive up health care costs.

In Asia, malnutrition may account for as much as a 10% reduction in total gross domestic product (Ransom and Elder, 2003).

II. Vulnerability in crises and disasters

In severe crises, particularly those in which families are separated or displaced, the consequences on the health and nutrition of women and their children can be dire. Access to an inadequate diet while fleeing war or while in a refugee camp worsens deficiencies a woman already has. Pregnant or lactating women are extremely vulnerable in these situations. They lack access to proper nutrition advice and medical care. Stress can cause preterm deliveries, which is much more likely to take place without a skilled assistant or in a sanitary environment.

Women are more vulnerable socially and economically to malnutrition.

56% of maternal and child deaths take place in fragile settings. Fragile settings are regions affected by violent conflict or natural disasters.

The Mother’s Index Score is a composite ranking of several maternal health and women’s empowerment indices.

Of the 28 countries that have ranked in the bottom 10 since 2000, all but four have a recent history of armed conflict.
Nearly two-thirds (18 of 28) experience continual natural disasters (Save The Children, 2014).

Women and children suffer most in crises

Divorce rates have been shown to rise during food shortages. This leaves women and children to fend for themselves. In cultures where divorced women are shunned in society, this is particularly bad.
Food shortages are shown to lead to daughters being married off sooner so there are fewer mouths to feed. Females who are married before reaching adulthood are more likely to end their education early, to become pregnant while malnourished, to die during childbirth, and to give birth to babies with poor health (Save The Children, 2014).
Differences in control of economic resources between men and women, such as landholding and access to credit, hinder the ability of women to cope with rising food prices. They also lack legal protection to claim the resources they do have the rights to (FAO, IFAD, & WFP, 2015).

Exclusive breastfeeding for six months after birth is widely recognized as the best for baby’s and mother’s health. When a mother is malnourished, her lactation may decrease. If her breast milk is insufficient, she will begin complementary feeding before six months, which is associated with stunting, disease, and other health complications in the baby. Women are also more likely to sacrifice their own food consumption in order to feed their children more. Increased incidence of sexual assault—a common symptom of crises—leads to unintended pregnancies. Becoming pregnant while malnourished has severe consequences on the health of a woman. This is especially true if she is young or if she has been pregnant recently before (Save The Children, 2014).

III. Practical solutions for reducing women’s malnutrition

There are a number of actions that governments, business and communities can take to help reduce malnutrition in women and girls. Some of these actions are:

A. Women’s own role in ending malnutrition

Despite the numerous challenges and vulnerabilities that women face in achieving adequate nutrition, they are also in a unique position to improve their own and their family’s nutrition and health if provided the proper resources and opportunities.

B. Increasing access to family planning

Pregnancy and lactation places a huge demand on the health and nutrition of a woman. Because of this, access to family planning methods is a key way to improve the nutrition of women. With family planning methods, a woman can ensure that she is properly nourished before becoming pregnant. This greatly improves the chances of safely delivering a healthy baby. She is also able to space pregnancies so that she is able to breastfeed her baby for the recommended two years, with complementary feeding added at six months.

C. Investing in women to end malnutrition

In developing countries, 79% of economically active women are farmers.
Women are 43% of the agricultural workforce.
Female farmers have access to fewer resources than male farmers. If they had the same access, it is estimated that there would be 100 to 150 million fewer hungry people in the world (Save The Children, 2014).
Studies have consistently found that when women have more control over household income, the health and nutrition of children improves.

D. Increasing access to education for girls and women

Increased female education is a well-documented route to improving nutrition for women, girls and the family. In one large, cross-country study, it was found that 43% of improvements in nutrition over a 25-year period were attributable to increased women’s education (DeSchutter, 2013).

Some of the most important steps that can be taken to improve women’s nutritional status are improving their access to and freedom to use resources; and providing access to educational opportunities and family planning. Appropriate nutrition policies and programs, including food security are key, along with protection and promotion of good health and care practices through education to women.

Primary Author: Kathryn Merckel, PhD student, International Nutrition, Cornell University,

Date published: February 22 2016

References

Bailey, R. L., West Jr., K. P., & Black, R. E. 2015. The Epidemiology of Global Micronutrient Deficiencies. Annals of Nutrition and Metabolism, 66(2), 22–33. doi:10.1159/000371618 Available online: https://www.karger.com/Article/Pdf/371618

de Benoist, B., McLean, E., Egli, I., & Cogswell, M. 2008. Worldwide Prevalence of Anaemia 1993-2005: WHO Global Database on Anaemia. Geneva, World Health Organization. Available online: http://apps.who.int/iris/bitstream/10665/43894/1/9789241596657_eng.pdf

Delisle, H. F. 2008. Poverty: The Double Burden of Malnutrition in Mothers and the Intergenerational Impact. Annals of the New York Academy of Sciences, 1136(1), 172–184. doi:10.1196/annals.1425.026 Available online: http://onlinelibrary.wiley.com/doi/10.1196/annals.1425.026/epdf

DeSchutter, O. 2013. Gender equality and food security: Women’s empowerment as a tool against hunger. Manila, Philippines. FAO. (2012). Gender and nutrition. Available online: http://www.fao.org/docrep/012/al184e/al184e00.pdf FAO, IFAD, & WFP. (2015).

FAO, IFAD and WFP. 2015. The State of Food Insecurity in the World: Meeting the 2015 international hunger targets: taking stock of uneven progress. Rome: FAO. doi:I4646E/1/05.15 Available online: http://www.fao.org/3/a-i4646e.pdf

Ransom, E.I, & Elder, L.K. 2013. Nutrition of Women and Adolescent Girls: Why It Matters. Population Reference Bureau. Available online: http://www.prb.org/Publications/Articles/2003/NutritionofWomenandAdolescentGirlsWhyItMatters.aspx. Accessed 5 December 2015.

Save The Children. 2014. State of the World’s Mothers 2014: Saving Mothers and Children in Humanitarian Crises. Available online: http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SOWM_2014.PDF

UNICEF. 2014. Low Birthweight: Current Status and Progress. 2014 Low Birth Weight Statistical Table, (NFHS 2005-2006), Analyzed by UNICEF HQ June 2008. The UNICEF low birthrate data website is http://data.unicef.org/nutrition/low-birthweight.html

United Nations World Food Programme (WFP). Rome, Italy. Hunger stats, 2013. Available online: https://www.wfp.org/hunger/stats.

World Bank. 2012. Promoting women’s agency. World Development Report, 150–192. Available online: https://openknowledge.worldbank.org/handle/10986/4391

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