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The number of children dying across the globe is strongly linked to the level of discrimination against women in the nations where they live, an analysis shows.

Gender inequality is rife in low- and middle-income countries, where women are less educated than men, have poor access to health services and little control over their finances.

Development experts have suspected that discrimination against women impacts child survival (see box below). Now a study published this month (9 March) in the online journal BMC Public Health has for the first time shown a relationship between the two factors.

    Four possible ways that gender inequality contributes to increased child mortality

  • Mothers’ exposure to violence increases the chance of children being born prematurely or with low birth weight.
  • If women do not have access to education, they may be less well equipped to properly feed children and care for their health
  • If women do not have control of household finances, they may be unable to spend money on children’s wellbeing
  • In countries with high gender inequality, women are more likely to suffer from malnutrition, increasing the chances of problems during pregnancy.

“It’s common sense: where women are not treated well, the children die early. Our study confirmed this hypothesis,” says author Anto Rajkumar, a psychiatrist who works for the UK National Health Service.

The study measured discrimination against women using the UN’s Gender Inequality Index (GII), which includes factors such as the percentage of women who get secondary level education, the maternal mortality rate and the adolescent fertility rate. The study compared the GII to child mortality rates in 138 countries including India and Rwanda.

The analysis found that gender inequality, the proportion of immunised one-year-old children and national wealth was linked to over half the differences in neonatal death rates between countries. These three factors also accounted for some 32 per cent of the differences in death rates in children under five.

Further analysis shows that the links between gender inequality and child mortality rates were statistically significant after taking into consideration the effects of the countries’ GDP (gross domestic product) and child immunisation coverage.

Statistical analysis shows that the Gender Inequality Index (GII) and child mortality rates are correlated. Higher GII values correspond to greater gender inequality. Chart reproduced with permission of the authors.

The impact of gender inequality goes beyond the women, explains public health researcher Ethel Brinda, another of the study's authors, who is based at Aarhus University in Denmark.

For example, when women lack control over household finances they are less able to provide their children with healthcare and immunisations. The neglect of female children in favour of sons is also common, says Brinda.

But there are limitations to the study. For one thing, it does not prove that gender discrimination actually causes child mortality because this type of broad analysis doesn’t allow for such a focused finding.

“It’s a study between populations rather than within a population,” explains Rajkumar. To demonstrate a causal link researchers would need to look at connections between inequality and child mortality within a population, he adds.

Furthermore, just one year’s worth of GII data — from 2008 — was available at the time of the study. The team plans to rerun the analysis with GII data that has since become available to strengthen their conclusions.

But the study’s finding are “extremely plausible”, says Katherine Fritz, director of global health at the International Center for Research on Women in the United States.

There is lots of data within countries that shows links between gender inequality and poor health outcomes for children, she says. This study shows that relationship at a global level, making the link “more concrete”, she adds.

The findings strengthen the case for governments to better integrate social services such as support for gender violence within their healthcare systems, says Fritz.

Rajkumar adds that global strategies to tackle child mortality such as the development goals must “go beyond just medical interventions” and integrate gender inequality in their activities.

Link to full paper in BMC Public Health


BMC Public Health doi:10.1186/s12889-015-1449-3 (2015)