Annually, one in every seven babies worldwide is born with a low birth weight, while a quarter of children under the age of 5 years (equivalent to 165 million) experience poor growth in height. This severe burden of under-nutrition contributes to child mortality, and later in life to poor educational attainment and adult ill-health.

Since under-nutrition is closely associated with poverty, promoting economic growth is widely seen by policy makers as the key solution. Yet many countries that have substantially increased their gross domestic product (GD), such as India, still experience high rates of child under-nutrition. Simply increasing GDP is no panacea: the kind of economic growth experienced by low- and middle-income countries is closely associated with transformations of the food system. Food may become more widely available, but the composition of the diet changes radically, as new processed foods are imported and replace healthier traditional diets. The consequences include rapid increases in obesity and related diseases, such as diabetes and heart disease.

So, where else can policy makers find opportunities to reduce child under-nutrition? Globally, those most responsible for infants and young children are, overwhelmingly, women. Many individual studies have shown that promoting women’s autonomy not only benefits women themselves, but can also help reduce child under-nutrition.

We can assess women’s agency relative to that of men using markers of “gender inequality“. This can be done at the level of the family, or the local community, but there are also country-level indices, that assess women’s health, literacy and ability to participate in paid work and political life, relative to those of men. Using such an index, we recently investigated how important societal gender inequality is, in explaining global patterns of child under-nutrition.

Our results were very clear: independent of any associations with GDP, the greater the degree of gender inequality in a country, the higher the rates of low birth weight, underweight and stunted children, and child mortality.

There are two important implications of our analysis. First, increases in GDP are often driven by the activities of men in the formal economy, and the resulting wealth often doesn’t reach women, and therefore has limited capacity to benefit child health. On the flip side, GDP completely misses women’s unpaid domestic activities that are especially relevant to child wellbeing. Because these vital activities are unpaid, they are usually considered to be menial, and this contributes directly to women’s persisting low status in society. We urgently need to break this vicious cycle linking gender inequality and adverse public health outcomes.

It is important not to blame women for poor child outcomes but rather, to support women to build their own capacity. On International women’s day, we want to highlight that efforts to improve women’s status represent a win-win situation – for women themselves, for their children, and for society at large. As we increasingly recognise that economic development is harming the natural environment and driving global climate change, promoting gender equality may prove a pathway for human development that is more compatible with sustainable planetary health.

The paper “Associations of gender inequality with child malnutrition and mortality across 96 countries” is published by Global Health, Epidemiology and Genomics  to honor International Women’s Day 2019.

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