Summary of "Some Statistical Investigations to Assess Gender Bias and Nutritional Deficiency in the States of Uttar Pradesh and Uttranchal" – a Study conducted by Institute of Applied Statistics and Development Studies, Lucknow.

Introduction

Inequities, driven by overwhelming poverty, affect both male and female in the developing world. Yet cultural traditions, scant economic resources and limited opportunities marginalize females. Males have better access to health care, nutrition and education. Gender bias is reinforced throughout as men retain economic and political power. Women’s health issues have traditionally been ignored in patriarchal systems such as our own.

2. It is well known that in all countries men fare better than women on most socio-economic indicators, although the degree of disparity may vary. The situation in India is no different. Gender bias is particularly pronounced in some of the northern states. The most glaring evidence of gender bias in India is the low sex ratio, 927 females per 1000 males as per 2001 census. Given natural biological advantage, similar nutrition and health care should result in a higher proportion of females to males. India’s adverse sex ratio reflects the relative neglect of women’s health and their social subordination. Many Indian women go through life in a state of nutritional stress, have little control over their own fertility and reproductive health, and face violence insides and outside the family.

3. In many households across the country, boys generally enjoy preference over girls in the matter of nutrition, education, health care, etc. This situation is more prevalent in the northern states and as a result, mortality and morbidity rates among females are higher and clinical forms of protein calorie malnutrition are more prevalent in girls than in boys. It is generally believed that, with respect to health care and nutritional inputs, girls, at least from poor households, suffer relative neglect and that women in general, get an inequitable share of the food available to the family. It is a well known fact that the nutritional status of a child is strongly related to maternal nutritional status i.e. the girl who is under nourished in her pre-adolescent age is likely to give birth to a undernourished child and this leads to higher prevalence of adult non-communicable diseases such as diabetes, hypertension and coronary heart disease according to the theory of Fetal origin of adult disease.

4. Clearly, there is a need for examining several issues of nutritional significance in the light of gender difference for effective planning. The present study aimed to know the gender bias and nutritional deficiency in the state of Uttar Pradesh and Uttranchal.

Objective

5. The present study was initiated with the following objectives:

• To measure the extent of gender inequality in dietary intakes in intra-house hold food consumption according to age groups with respect to percentage shortfall from Recommended Dietary Allowance (RDA).
• To investigate possible relationship between percentage shortfall of RDA and Protein Energy Malnutrition (PEM) and micronutrient deficiencies.

Methodology

6. Secondary data was used for the study. National Nutrition Monitoring Bureau (NNMB) and Institute of Applied Statistics and Development Studies (IASDS) (NNMB-IASDS) have jointly conducted Nutritional Profiles of Indians (NPI) study in each of the 63 districts (as per 1991 census) of Uttar Pradesh (UP) and Uttaranchal and, as a part of this; extensive surveys were conducted in all the districts. The surveys included investigating dietary intakes by 24 hour recall method of all the individuals of the selected 6300 households. The data were available on individual dietary intakes, nutritional status and nutritional deficiency disorders of more than 25,000 individuals of all age groups spread across all the 63 districts. After the reorganization, the erstwhile State of Uttar Pradesh was divided into Uttar Pradesh comprising 55 districts, while the hill part was named as Uttaranchal comprising 9 districts, which also included Haridwar. Total number of districts has now changed in both the States.

7. To evaluate gender-wise intra-household disparities according to the age-group, five broad age groups were considered viz. 1-5, 6-10, 11-17, 18-39 and 40-59. The particular choice of these age groups assumes homogeneity within each age group, the first one being pre-school going, the second being childhood, the third as adolescent, fourth as teenage and young, and the last as middle aged groups. For a given age group, only those households have been included in the analysis which have in the household at least one male and a female of this age group.

8. At the first stage, the data was arranged according to the present objectives. The districts were distributed according to the census 2001, constituting the States of Uttar Pradesh and Uttaranchal. In the NNMB-IASDS study, a total of 400 Households (HHs) from 20 randomly selected villages from each district were selected to identify individuals belonging to the focused group. The dietary intake of all the individuals was assessed from 100 HHs by taking every 4th selected household. Out of these total 100 HHs, only those HHs were selected for the present analysis which had at least one male and one female of the targeted age-group. This exercise was repeated for all the 63 districts. Next, the analysis was carried out according to the specified age-groups.

9. The daily intake of different foods and nutrients are computed per Consumption Unit. The calorie requirements of a reference man aged 20-39 years, weighing 60 kg, doing sedentary work is taken as one Consumption Unit and the calorie coefficients for all the other individuals in the HH are calculated proportionately on the basis of energy requirements according to age, sex, physiological status and activity pattern.

10. The extent to which there is a shortfall from RDA was analyzed. The average daily intake of various foods in terms of Consumption Unit (CU) was computed separately for males and females. For this, both mean and median intakes were taken as the average. The average intake of foodstuffs and nutrients for males and females were compared with RDA. The relationships between of percentage short fall of RDA with Protein Energy Malnutrition (PEM) and nutritional deficiency disorders were worked out.

11. To explore possible relationship between percentage shortfall of RDA and (i) Protein Energy Malnutrition (PEM) and (ii) micronutrient deficiencies. For PEM, the best measure to assess current level of malnutrition in children (non adults) is weight for age indicator. Both types of malnutrition, severe underweight (z<-3 standard deviation) and moderately underweight (z<-2 standard deviation, but >= -3 standard deviation) are studied for these relationships. Extent of malnutrition is measured on the standardized z-scores, where z is given by z = (weight of child for given age – median weight of same age)/standard deviation. Median weight refers to the median of weights of children of same age from some standard (reference) population. For adult population (18 years or more), PEM is measured on body mass index (BMI) scores, where BMI= (weight/height2 metres). BMI scores of, 16 indicates sever malnutrition, while values between 16 and, 18.5 are categorized as moderate malnutrition.

12. For micronutrient deficiencies, prevalence of Bitot’s Spot has been taken as the indicator for Vitamin A deficiency. This indicator was assessed clinically in the survey by a team of trained social scientists/nutritionists. No assessment of Vitamin A deficiency using biomedical methods through blood samples was done in the survey.

Study Results

13. To evaluate gender-wise intra-household disparities according to the age-group, six broad age groups were considered viz. 1-5, 6-10, 11-17, 18-39 and 40-59. An analysis comparing per Consumption Unit intakes, as percentage of RDA is more focused and meaningful. Therefore this was attempted in the study. The analysis brings out gender inequality in respect of certain food items in most age groups, though, in some cases, the inequality is in favour of females. Age group wise findings are given in the following paras. Few relevant tables are given in the annexures.

Age Group 1-5 years

14. The frequency distributions of different foodstuffs are quite different and skewed in population from 1-5 years. While most foodstuffs have no consumption percentage around or below 25, green leafy vegetables, other vegetables and fruits have very high percentages. Some evidence of gender inequality is noticed in the consumption of vegetables and fruits. While higher percentage of females was consuming cereals in both the States, higher differential in consumption of cereals was observed in Uttar Pradesh. However, statistically these were non-significantly different.

15. Most children have protein rich dietary intakes (more than half of them have consumption exceeding RDA) They also have somewhat satisfactory level of energy and fat through their diets But most of the children suffer from nutrient deficiencies and have extremely low availability of vitamin A, iron, riboflavin and vitamin C. Gender-wise; some evidence of inequality is noticed in vitamin A only. However, statistically these were non-significantly different.

Age Group 6-10

16. The frequency distributions of different foodstuffs are quite different and skewed for the age group 6-10 years also. While most foodstuffs have no consumption percentage around or below 25, pulses and milk & milk products in Uttar Pradesh, and green leafy vegetables, other vegetables and fruits have very high percentages of no consumption as in case of 1-5 years age group. Also the consumption levels were statistically non-significantly different in males and females.

17. The majority of 6-10 years children suffer from nutrient deficiencies. While these children have protein rich dietary intakes (more than 60% of them have consumption exceeding RDA), they also have somewhat satisfactory level of energy, calcium and fat through their diets. However, these children have extremely low availability of vitamin A, iron, riboflavin and vitamin C. There is no evidence of any inequality in the nutrient intakes of children. In most of the cases, the consumption levels in the boys and girls in both the states are statistically non-significant, except in case of iron and thiamin in Uttar Pradesh. Here, a very small segment of the population have consumption less that 60% of Recommended Dietary Allowance.

Age Group 11-17

18. It is seen that for the age group 11-17 years there is some evidence of gender inequality in the consumption of fats & oils and higher percentage of females has been consuming vegetable in both the States. However, in Uttar Pradesh , the differences were also statistically significant in case of green leafy vegetables (in favour of boys) and other vegetables (in favour of girls). In Uttaranchal, the consumption of milk and milk products and sugar and jaggery was significantly higher for girls than boys.

19. Most 11-17 years children suffer from nutrient deficiencies. While these children have protein rich dietary intakes (more than 40% of them have consumptions exceeding Recommended Dietary Allowance), they also have somewhat satisfactory level of energy, fat, calcium and vitamin C through their diets. However, these children have extremely low availability of vitamin A, iron and riboflavin. Almost whole adolescent population has intakes of vitamin A and riboflavin below Recommended Dietary Allowance.

Age Group 18-39

20. For the age group 18-39 years also, higher percentages of males were consuming pulses greater than Recommended Dietary Allowance in both the States. Females of both the States had higher mean consumption levels of vegetable and the differences were also statistically significant. The gender differential (in favour of females) in Uttaranchal for the consumption of milk & milk products was also statistically significant. Female domination in consumption of fats & oils was also visible through median values and also values of consumption in excess of Recommended Dietary Allowance in both the States.

21. The majority of population of 18-39 years suffers from nutrient deficiencies. While these persons have protein rich dietary intakes, they also have somewhat satisfactory level of energy, calcium and fat through their diets. However, these persons have extremely low availability of vitamin A, iron, riboflavin and vitamin C. Almost whole population has intakes of vitamin A and riboflavin below Recommended Dietary Allowance.

Age Group 40-59

22. For the age 40-59 years, the mean percentages of Recommended Dietary Allowance for males green leafy vegetable was higher in both the States and the means differed significantly in Uttar Pradesh. Females of both the State had higher mean consumption levels of vegetables, milk & milk products and fats & oils and the differences were also statistically significant.

23. The majority of population of 40-59 years suffers from nutrient deficiencies. While these persons have protein rich dietary intakes, they also have somewhat satisfactory levels of energy, calcium and fat through their diets. However, these persons have extremely low availability of vitamin A, iron, riboflavin and vitamin C. Almost whole population has intakes of vitamin A and riboflavin below RDA.

24. While exploring possible relationships between percentage shortfall of Recommended Dietary Allowance and (i) PEM and (ii) micronutrient (Vitamin A) deficiencies, it was observed that coefficients of the fitted regressions were very small and R-square was also small in many cases. Small regression coefficients even though significant do not reveal much. In spite of these, one cannot conclude no relationship between PEM and shortfall of Recommended Dietary Allowance of nutrients. There is some evidence of a relationship between z scores and protein, energy, fat and riboflavin. Further, there was some indication that consumption of fruits, green leafy vegetables and milk & milk products had some effect in preventing vitamin A deficiency (presence of Bitot’s spot) as individuals without any symptom of Bitot’s Spot had higher intakes of these items.

25. It has been observed that most foodstuff have no consumption percentage around or below 25 RDA. Some evidence of gender inequality is noticed in the age group1-6 and 6-10 years, but these are not statistically significant. However, gender inequality in the age group 11-17, 18-39 and 40-59 years found significant in consumption of green leafy vegetables, milk & milk products and fat & oil respectively.

Limitations of the study

26. Choice of appropriate variables for fitting different regressions was an extremely difficult task. There was also the problem of choosing appropriate range (cut-off) of shortfall of Recommended Dietary Allowance for these micronutrients. Lots of exploratory trials runs were made with a number of choices of independent variables as well as with a number of cut-offs of shortfall of Recommended Dietary Allowance, and finally, it was decided to choose important micronutrients as independent variables. Nevertheless, some important fitted regressions have been reported to have some first hand idea about the complexities as well as voluminous amount of effort needed. Sample size seems to be major constraint towards exploring such relationships, particularly with appropriate cut-offs of shortfall of Recommended Dietary Allowance.

(The copy of the research study is available in the Library of the MOS&PI.)

Annexure-1

Frequency Distribution (%) of percent Recommended Dietary Allowance for children of

Age –group 1-5 years

Annexure-2

Frequency Distribution (%) of percent Recommended Dietary Allowance for children of

Age –group 6-11 years

Annexure-3

Frequency Distribution (%) of percent Recommended Dietary Allowance for children in the

11-17 age –group.

Annexure-4

Frequency Distribution (%) of percent Recommended Dietary Allowance for persons in the

18-39 age –group.

Annexure-5

Frequency Distribution (%) of percent Recommended Dietary Allowance for persons in the

40-59 age –group.

(This summary has been prepared by Shri Inder Jeet Singh, Director, CSO, PSSU, MOS&PI, New Delhi.)