This paper questions some of the basic assumptions underlying the World Declaration and Plan of Action for Nutrition produced by the World Health Organization (WHO) and the UN Food and Agriculture Organization (FAO) at their International Conference on Nutrition in Rome in 1992. The Declaration expressed the determination of all member states and the European Community, as well as more than 150 other governmental and nongovernmental organizations, to eliminate hunger and substantially reduce malnutrition. It pointed to poverty and the lack of education as fundamental causes of hunger and malnutrition, with social, economic, and gender disparities, along with wars and natural calamities, as major contributors to the problem.

The signers of the Declaration pledged, among other things, to substantially reduce undernutrition, especially among children, women, and the aged, by improving household food security and caring for the socioeconomically deprived and nutritionally vulnerable. Meeting the health and nutrition needs of the family, particularly mothers, infants, and young children, has been fundamental to this work.

Although gender and age biases in intrahousehold allocation of resources had been revealed by many earlier studies the authors had questions about the methodologies used for poverty, income, and food consumption measurement, and undertook an in-depth review of sex differences in the food consumption and nutrition literature of the past ten years. In particularly, they reviewed conclusions about boy-girl differentiation in household food allocation and about gender and income.

The Study
The study reviewed 168 publications (including 18 previous FCND discussion papers) from 1977 to study date (September 1996), using the FAO/WHO gendered conceptual framework. This framework considers as basic factors the differences in male/female poverty rates; differences in male/female control over resources such as land; the legal, political, and ideological structures that may reinforce gender asymmetries; and gender differences in access to education, culture, and information. Intermediate factors in the framework are women's control of income as it relates to household food security; quantitative and qualitative differences in child-care time given to boys and girls; and child gender differences in access to health care. Immediate factors are dietary intake by age and sex; sex differences in psychosocial security; and sex differences in morbidity. The framework is topped by consideration of anthropometric measurement of sex differences in child nutrition and survival, leading, finally, to results in terms of adult development—gender differentials in ability to earn income and to learn. Since the literature suggests that intrahousehold differences in income, household structure, food consumption, and nutrition are location-specific, the evidence is organized by region— Latin America, Sub-Saharan Africa, South Asia, and the Philippines. In each case, careful and critical consideration is given to commonly used food measurement methodologies.

...policymakers must understand intrahousehold allocation patterns so that policies and programs have the desired impact...and policies need to recognize the crucial role women play both as gatekeepers to household food security and nutrition and as major contributors to the household economy.

Findings
Despite the assumptions in the 1992 Rome declaration that household gender bias is a widespread nutritional and health problem for women in the developing world, the authors found only scarce evidence of pro-male bias in consumption. The strongest and most consistent evidence for this is was from India. Here, the literature suggests, the bias against females is attributable to the dowry system, which requires families to pay bridegrooms to marry their daughters. Indeed, the evidence indicates that discrimination against females is greater in higher-income families than among the poor. Conversely, studies in Sub-Saharan Africa, where the culture requires bridegrooms to pay a bride price, indicate that daughters are slightly more nutritionally favored than sons. Overall differences outside India are slight, and apparent favori-tism toward adult males is explained by greater energy expenditures required for male agricultural workers and by the failure of researchers to account for children's snacking outside the home.

Similarly, household studies on access to health care showed not much gender difference in most regions. Again, the evidence of anti-female bias was strongest in South Asia—India, Bangladesh, Pakistan, and Nepal. Health care access has been less studied than food consumption, and the authors note a methodological problem in that poorer families are less likely to admit illness unless the individual is too sick to work.

Turning to anthropometric studies, the authors found significant methodological problems, particularly a near universal tendency to understate the ages of female children. However, once again, the review showed that in South Asia, females have worse anthropometric scores than males, while in Africa, girls are consistently better-off than boys. Yet again, it is the Indian subcontinent where mortality rates are consistently higher for girls than boys, resulting in a surplus of males in the adult population—950–970 females for every 1,000 males.

Given the evidence against widespread anti-female discrimination in nutrition and health care allocations, the authors seek to explain the persistence of this belief. They speculate that this can be attributed to publication bias. Studies that show evidence of bias, they suggest, are more likely to be published, while those that show negative results often are filed and forgotten.

Finally, considering the issue of women and poverty in less developed countries, the authors find problems with the way poverty is defined. However, the data do indicate, they say, that women are overrepresented in poor households, although this overrepresentation is not striking.

Policy Implications
The authors recommend that food and nutrition programs in South Asia need to pay special attention to boy-girl discrimination. The peculiar family economic rationale for such discrimination (the dowry question is implied here) needs to be acknowledged in program design. For example, well-intended school meals programs for girls may have the result of girls being denied food at home. Real understanding of intrahousehold food allocation patterns is a prerequisite for successful policy intervention. They urge a two-pronged strategy. For the short run, policymakers must understand intrahousehold allocation patterns so that policies and programs have the desired impact. For the longer term, policies need to recognize the crucial role women play both as gatekeepers to household food security and nutrition and as major contributors to the household economy.