Last and least: Findings on intrahousehold undernutrition from participatory research in South Asia

Abstract

In this paper, we analyze intrahousehold mechanisms that rural South Asian women themselves identify as contributing to their inabilities to achieve adequate nutrition. The majority of our female respondents explain that, within their families, they are most likely to eat least and last and to seek lower quality healthcare later, both of which can lead to undernutrition. We consider the explanations that women provide for why they do so. In addition to norm abidance, we highlight two social factors: a partner's heavy alcohol use and intimate partner violence. Women report that these factors adversely impact their own health and food security status and potentially contribute to differential nutritional outcomes within the same household. The emic perspectives presented here show us: (1) many rural South Asian women report shouldering a relatively greater share of food and nutrition insecurity within their households, and (2) taking their perspectives seriously assists in identifying the underlying contributors to intrahousehold differences. These findings indicate the value a gendered perspective on both the drivers of and measurement of undernutrition. Attending to these intrahousehold factors in future quantitative research may provide important insights for understanding drivers of nutritional outcomes.

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“…The lockdown began at the end of March, when monthly rations were almost depleted, and although all impoverished families in HP received two months of advance rations in April, the increased number of mouths to feed caused stress and rationing 1 . In times of household food scarcity, it is typically the women who eat “last and least” (Lentz, Narayanan, and De 2019), and we heard many reports of similar scenarios across field sites. One Nepali woman stated she used to eat at 9 a.m., but since her household had swelled to 12 people, she was too busy cooking for others, so she now ate alone at noon (Sunita, 2 Gokulganga, May 25, 2020).…”

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“…Whether and how women's empowerment impacts health outcomes or nutritional status of women themselves is not adequately addressed, barring a few studies. 3 This is a crucial gap in the literature since there is some evidence that within communities, women may fare far worse than either their male counterparts or their children (FAO, et al, 2017;Lentz et al, 2018;Narayanan et al, 2017a). There is also evidence to suggest that women eat last and least and might prioritize the health of other family members ahead of themselves when resources are constrained (Lentz et al, 2018).…”

“…3 This is a crucial gap in the literature since there is some evidence that within communities, women may fare far worse than either their male counterparts or their children (FAO, et al, 2017;Lentz et al, 2018;Narayanan et al, 2017a). There is also evidence to suggest that women eat last and least and might prioritize the health of other family members ahead of themselves when resources are constrained (Lentz et al, 2018). Given that intergenerational transmission of nutrition is potentially important and there exists a positive relationship between maternal and child nutrition (Black et al, 2013), it is important to understand the drivers of women's own nutritional status.…”