This month on the Gender-Nutrition Idea Exchange, we continue our series on the interaction of health with the gender-agriculture-nutrition framework. This series is based on a seminar organized by A4NH on Agriculture, Gender, and Health: Tracing the Links on October 20, 2015 which provided three case studies on how gender dynamics in rural livelihoods influence health, and in turn, nutrition. In this interview with A4NH, Kelly Jones, Research Fellow with the Markets, Trade and Institutions Division at IFPRI shares an overview of gender issues in health research and then speaks about her recent research that traces how livelihood shocks increase HIV transmission through transactional sex, especially for women.
Kenyan women farmers in the field. Source: Flickr (Bonnie McClafferty/IFPRI-Images)
A4NH: How does gender influence health in rural communities? What are some of the most important gender-based differences in health?
Kelly Jones (KJ): Gender is an important determinant of several factors that are critical to one’s ability to ensure her own health. Ensuring health requires not only accessing curative care when needed, but also accessing a diet of sufficient quality, basic sanitation, sufficient housing quality, and preventative care. Each of these actions demands some level of access to and control over financial resources, the physical freedom to seek services, and a personal worth that justifies spending on oneself. Across the developing world, many women are disadvantaged in each of these realms, which in turn hampers their ability to ensure their own health.
In South Asian countries, 25-50% of women have no say in the decisions about their own health care. In West Africa, this figure is 30-85% 1. In these settings, accessing skilled maternity care is a significant factor in women’s mortality. Taken together, these suggest that gender-based differences in empowerment can be an issue of life or death.
A4NH: What are the ways in which gender mediates the effect of agriculture on health?
KJ: Some agricultural tasks may pose direct health risks, such as overexertion, exposure to chemical pesticides, interaction with dangerous equipment, or repetitive motion injuries. Gender-based differences in the allocation of agriculture tasks may result in differential exposure to these risks.
More broadly, when agriculture is the primary source of income, the indirect impact of agriculture on the ability to ensure health is substantial. Significant gender differences exist in agricultural profits, due to differential access to cash, credit, technology, agricultural extension, and information networks. Further, gender may be a factor in the intra-household allocation of jointly-produced profits, further impacting the ability to ensure health. Profits from cash cropping are often managed exclusively by men, and when women’s crops become profitable they often become redefined as men’s crops. Preferences for investing in health may differ across genders, suggesting that control of agricultural profits can have serious implications for health outcomes.
Finally, relying on agriculture for livelihoods involves significant risks. Men and women may exercise different risk-coping mechanisms or be impacted differently by household risk-coping in ways that pose various health risks. For example, common responses to severe agricultural shocks include, reducing household food consumption, withdrawing children from school, earlier marriage of dependents, or migration to urban areas – all of which may have differential health implications for men and women (or boys and girls).
A4NH: What are the ways in which gender mediates the effect of health on agriculture?
KJ: Poor health status can impair one’s ability to maximize agricultural production. Social norms may dictate differential abilities of men and women to take rest from normal activities when ill, potentially exacerbating this impact. Poor health of one’s family or other dependents may also reduce the effort one is able to dedicate to cultivation. Expectations that women are caregivers would generate large differences across genders in the impact of household health status on agricultural productivity. Increased family illness may significantly reduce the productivity (and profitability) of women’s plots.
A patient receives an HIV test. Source: Flickr (Arne Hoel / World Bank)
A4NH: Can you tell us about your work studying the impact of agricultural shocks on HIV?
KJ: With co-authors Erick Gong and Marshall Burke, I studied the impact of income shocks on HIV prevalence, focusing on droughts in rural Africa as the indicator of shocks. Examining more than 8,000 villages in 21 countries, we found that villages with one additional drought in the past 10 years have HIV prevalence that is higher by 10%. Among women in high-prevalence countries, the effect is nearly 15%. Droughts are defined relative to the village’s own rainfall history, so this is identifying a true causal effect that is not driven by other unobserved differences across villages. We investigated various risk-coping mechanisms that could explain this relationship. The findings are most consistent with an increase in sexual relationships for financial support, especially between women working in agriculture and men working outside agriculture (who are less impacted by the shock). These findings suggest that gender-specific risk-coping mechanisms can directly link agricultural outcomes to health.
A4NH: How can practitioners incorporate health in their gender, agriculture, and/or nutrition work?
KJ: Many agricultural interventions have the potential to change household behaviors or outcomes along a number of dimensions, including labor allocations, agricultural practices, information seeking, food availability, income, resource-allocation, and decision-making, among others. Each of these has the potential to change the balance of empowerment within the household as well as health outcomes. Indicators of child or adult health could reasonably be added as an additional outcome of interest to many studies. However, impacts are more likely to be observed on first-step behaviors toward health seeking, such as child preventative or curative care, maternity care, use of family planning, use of water filtration, women’s agency in decisions regarding health, etc. Certainly, agricultural interventions with an integrated focus on gender equity will be more likely to improve women’s empowerment and their ability to ensure the health of themselves and their families.
For further reading:
1. Country-specific figures from recent DHS surveys as compiled by online StatCompiler.
This post is part of a blog, the Gender-Nutrition Idea Exchange, maintained by the CRP on Agriculture for Nutrition and Health. To add your comments below, please register with Disqus or log-in using your Facebook, Twitter, or Google accounts. You must be signed-in or registered in order to leave a comment.
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