Invisible Women

Catherine Bertini

Abstract: Women are ubiquitous and critical to the nutritional well-being of their families, yet they are often invisible to policy-makers, public of½cials, community leaders, and researchers. Effecting signi½cant decreases in the number of hungry poor people, as well as the improvement of nutritional and economic outcomes, requires policy in addition to operational and research priorities that are directed at the needs of

women and girls. Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021

Food is grown to be consumed: by livestock, ½sh, even vehicles. But of course, the primary consumer of food is humankind. And the primary providers of food as meals–in virtually all of the developing world and much of the developed world–are wom - en. As I remarked in my plenary address to the Fourth World Conference on Women in September 1995 in Beijing, China:

CATHERINE BERTINI, a Fellow of Women eat last. In almost every society in the world, the American Academy since 2003, women gather the food, prepare the food, serve the is Professor of Public Administra- food. Yet most of the time, women eat last. A woman tion and International Affairs at the feeds her husband, then her children, and ½nally–with Maxwell School of Citizenship and whatever is left–she feeds herself. Even pregnant Public Affairs at Syracuse Universi- women and breast feeding women often eat last when, ty. She is the 2003 World Food Prize of all times, they should eat ½rst.1 Laureate. She formerly served as Assistant Secretary, Food and Con- Should you be tempted to assume such practices sumer Services at the U.S. Depart- are no longer the norm, consider the ½ndings out- ment of Agriculture and Executive lined in the Institute for Developmental Studies’ Director of the United Nations bridge World Food Programme. She is a 2014 report Gender and Food Security: Towards Distinguished Fellow, The Chicago Gender-Just Food and Nutrition Security: “Even during Council on Global Affairs, for whom pregnancy, ‘special care is not always taken to ensure she chaired the task forces that au- women receive enough food.’”2 thored the publications Renewing Twenty years after the Fourth World Conference American Leadership in the Fight Against on Women, it is not just the household pecking order Global Hunger and Poverty(with Dan for food consumption that is a concern, but also the Glickman, 2009) and Girls Grow: A Vital Force in Rural Economies (2011). invisibility of women when it comes to policy-making She has also written for Foreign Af- at every level: from the household, to the community, fairs, The Washington Times, USA To- to the private sector, to research, to local, regional, day, and The Wall Street Journal. and national governments.

© 2015 by Catherine Bertini doi:10.1162/DAED_a_00351 24 Women are the key human ingredient to from these chronic diseases will reach $35 Catherine adequate diets for families. As such, their trillion by 2030.7The report also points out Bertini voices should be sought after, listened to, that adults who were undernourished as and acted upon. children earn 20 percent less in income than those who were not.8 Adequate nutrition depends on a well- Malnutrition is costly in other ways, too: balanced diet. For those who can afford al- 4–9 percent of most countries’ gdp is most no food–the 795 million people who, spent on medical costs related to over- according to the Food and Agriculture Or- weight or obesity.9 ganization (fao) of the United Nations, There are many reasons behind these are chronically undernourished–the strug- trends, including increased consumption 3 of overly processed foods that add sugars gle to obtain any food is a daily challenge. Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021 For the rest of the world, including the very and salts in place of nutrients, overcon- poor, eating the “right” balance of foods is sumption of food generally, and lack of di- key. In fact, the word malnutrition has taken etary variety (most commonly manifested on an expanded meaning. Its use no longer as too few fruits and vegetables and too connotes only those who have too little to much starch). Some of these factors stem eat, but also those who consume too much from poverty. In order to maximize the or lack dietary balance. In other words, an amount of food she has available to feed her obese person is also “malnourished.” family, a poor mother might buy cheaper Obesity is growing in virtually every re- foods that are higher in starch: potatoes, gion in the world. It has fast become a ma- rice, and flour-based breads. In the United jor source of the world’s most widespread States, cheaper foods may also mean large diseases, commonly called noncommuni- bottles of sugary drinks. It seldom means cable diseases (ncds), including high blood more fruits and vegetables. pressure, diabetes, heart disease, asthma, Fruits and vegetables are not only more liver disease, and sleep disorders. ncds are expensive than processed foods, they are now the leading cause of human death in also less readily available to consumers. the world.4 Their perishability causes huge shifts in There are now almost as many people availability and cost in countries where re- worldwide who are obese (600 million) as frigeration technology is minimal. For a few are chronically undernourished (795 mil- weeks, the market is swamped with a cer- lion).5 It won’t be many years until those tain vegetable or fruit, causing the price to numbers intersect; obesity rates are dra- drop; later, availability is scarce and the matically rising while undernourishment price is high. In the United States, the Sup- rates are gradually decreasing, even as the plemental Nutrition Assistance Program global population increases. Some of the (snap; formerly known as food stamps) most dramatic growth in obesity rates is allocation is distributed once monthly for among children under ½ve years of age. For all recipients, leaving smaller stores no rea- instance, between 2000 and 2013, the preva - son to stock perishables past the predict - lence of overweight in children under ½ve in able once-monthly period of major food Southern Africa rose from 1 to 19 percent.6 purchases. The Chicago Council on Global Affairs report Healthy Food for a Healthy World: Back to the pregnant woman: while cul- Leveraging Agriculture and Food to Improve ture and society, not to mention household Global Nutritionpredicts that the decline in priorities, should ensure that she has enough global productivity due to illness and death of the right foods to eat, she still too often

144 (4) Fall 2015 25 Invisible does not. Developed countries like the trition during this period–which comes Women United States are taking action to address from her mother–she will be stunted in this discrepancy: for example, the United some way, and she can never make up the States created the Special Supplemental loss in later years. A person who goes hun- Nutrition Program for Women, Infants, gry for months at age twenty-½ve or ½fty and Children (wic) in 1974, under the Nixon can recoup losses; a one-year-old child administration, to support the nutritional who goes hungry for months cannot. In needs of poor pregnant mothers and their fact, for a child who had been stunted, sig- infants and toddlers through distribution ni½cant weight gain later in life, even later of speci½c foods and nutrition education. in childhood, often results in obesity. The It is commonly considered the most effec- lack of physical and/or intellectual capac- tive national nutrition program. ity caused by a lack of food and nutrition in Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021 During my term at the United States De- early childhood impacts a person’s eco- partment of Agriculture (usda) in the early nomic well-being for life. And if a stunted 1990s, we created a special food package young woman becomes pregnant while she for breastfeeding mothers in the wic pro- still has an inadequate diet, she will give gram. After all, until then the government birth to a child who, if he survives, will be encouraged women to breastfeed but only stunted himself. Thus, malnutrition per- gave poor women infant formula. unicef’s petuates the cycle of poverty. data on incidence of breastfeeding con- The recent International Food Policy Re- ½rmed that the U.S. rates for low-income search Institute (ifpri) report Women’s Em - women began to increase (although still powerment and Nutrition tells us that nearly not at high enough levels) following im- half (43 percent) of the decreases in chil- plementation of the program. (Clayton dren underweight between 1970 and 1995 Yeutter, then–Secretary of the usda un- have been due to the empowerment of wom- der President George H.W. Bush, recog- en, as measured through improvements in nized the program’s importance; he cut women’s education.12 For example, the the ribbon on the ½rst wic clinic in 1974.) HelenKeller International Program in Bur - The World Health Organization (who) kina Faso found that educating women in has concluded that “Exclusive breastfeeding farming households via women extension –de½ned as the practice of only giving an agents led to increased dietary diversity infant breast milk for the ½rst six months and decreased wasting, anemia, and diar- of life–has the single largest potential im- rhea among the women and their children. pact on child mortality of any preventive intervention.”10 A multiyear, multicoun- The nutrition-based cycle of poverty is try who study proved that infant growth most prevalent in rural areas of the devel- outcomes are similar whether the mother oping world. Urban poverty is a growing is from Norway or Ghana–from a rich or scourge in many parts of the world, but the poor country–as long as the mother re- poorest and hungriest people are still those ceives adequate nutrition herself.11 whose major source of income is cultivating food. They may be subsistence farmers or The most critical period in the develop- they may work for extremely low wages on ment of a human is from her time in utero other farms. A high percentage of these until age two (some experts say age ½ve). farmers are women. The fao estimates that This is the period when she grows physi- women make up 43 percent of all agricul- cally and intellectually, when her cells are ture laborers in developing countries, in- multiplying fastest. Without adequate nu- cluding at least 50 percent in sub-Saharan

26 Dædalus, the Journal ofthe American Academy of Arts & Sciences Africa.13 This ½gure undercounts the mil- agricultural advice offered by most coun- Catherine lions who work for no pay as part of their tries’ extension workers are offered by men Bertini household and familial responsibilities. to men. Women’s and men’s agricultural jobs Once a farm becomes slightly more suc- vary in different communities, different cessful, it might mechanize a function. This climates, and different regions. Often, men mechanized function then often shifts to are responsible for the large cash crops like the male purview, even if it was earlier con- tobacco, maize, and wheat. Women may sidered a “female” role. weed or help plant these crops, but they may also be primarily responsible for in- Muhammad Yunus, founder of the mi- digenous crops like cassava or millet. In cro½nance organization Grameen Bank, livestock, men care for the larger animals; which launched in Bangladesh and now Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021 women typically manage milking and care operates in many countries around the for smaller animals. world, has spoken openly about differences And in almost all cultures in which wo - in resource use across genders. The ifpri men and men work in agriculture, the man’s and other experts have validated Yunus’s workday starts and ½nishes in the ½eld. But ½ndings that resources that enter a house- the woman’s job starts when the babies cry hold and are controlled by women are and need food before dawn, when the cow highly likely to be spent on the needs of the needs to be milked, when breakfast is household and all of its members. Men, by cooked, when the children are dressed to contrast, are more likely to use ½nances go to school, and it continues after a full under their control for nonhousehold re- day in the ½eld when she fetches water and lated matters.16 ½rewood and food for the evening meal, Stunningly, an extra $10 in the hands of a and cooks the meal, milks the cow, and tends woman will add the same nutritional ben - to her children and husband. e½t for the household as an additional $110 Yet women and men do not have the same given to a man.17 access to agricultural inputs–to seeds and fertilizer, land, and extension services. The So far in this paper, women are every- fao estimates that if they did, women’s where. The adequate nutrition of mothers agricultural production would increase is essential to ensuring that their children 10–20 percent.14The cgiar(Consultative are well-nourished and growing. From pre - Group for International Agricultural Re- dawn to past sundown, their lives are crit- search) Research Program on Water, Land ical to the functioning of the household and and Ecosystems notes, in Water-Smart Agri- to obtaining and allocating resources to culture in East Africa, that “increasing the re- support it. Yet when policy-makers or grant- sources that women control has been shown makers look at community needs, the dearth to improve the nutritional, health, and ed- of women in leadership or spokes person ucational outcomes of their children.”15 roles prevents them from learning what is The ifpri, who is without peer in its re- really required to best support the com- search and writing about gender and agri- munity. culture, has argued that educated farmers So feedback comes from men, and it pre- are more productive than noneducated dictably centers on what the men need. farmers; women are illiterate at higher When I was Executive Director of the Unit- rates than men; and women are more likely ed Nations World Food Programme, I once to follow the successful farming practices visited an area in rural Angola where the of other women than those of men. Yet the ½elds had recently been demined following

144 (4) Fall 2015 27 Invisible a truce in the civil war. The farmers told us • Educate girls. The latest data from the Women that they could not work in the ½elds be- Unit ed Nations Millennium Develop- cause they did not have any implements. ment Goal (mdg) project show that the “What do you need?” we asked; “Hoes,” goal of universal primary education has they answered. There were perhaps one mostly been met.18 But those data mea - hundred hoes–implements with long poles sure “enrollment” and not attendance, and rectangular metal spades–stacked up participation, progress, or the quality of against a fence. “What is wrong with education received. The data also show these?” I asked. “They are male hoes,” they that the biggest gender gap comes in the answered. transition from primary to secondary Did you know that in Angola, hoes are school. Further, there are still less girls gender differentiated? I did not, and clearly than boys in schools. Yet when girls are Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021 the well-meaning ngo who ordered the educated, they have fewer children than hoes did not either. Why? The ngo had their uneducated sisters, maternal mor - not talked to the women. In that region of tality declines, their children see better Angola, women were the only people who nutritional and general health outcomes tilled the ½elds, but they did not use the long- (and are also more likely to attend poled hoes. Women’s hoes, it turned out, school), the women are more productive had shorter wooden handles and shovel- farmers, and their economic opportuni- like spades at the end. Unlike the “male” ties and lifelong earnings increase. hoes that were used from a standing posi- • Start research with women’s needs. The most tion, women had to squat to use the “fe- wonderful new seed, capable of growing male” hoe, a preferred technique because drought- and pest-resistant crops at vol- women worked most of the day with babies umes multiple times greater than in the strapped to their backs, and squatting put past, could be useless if the taste and less stress on the back than leaning over, cooking time are not palatable to the weighed down by a child. lives of the cooks: the women. Include For me, this story became a metaphor for them in the process. the importance of always speaking with the people who know what their needs are, • Enhance women’s health support. A mother’s and that those who do not speci½cally seek health is directly related to that of her out women in order to understand their children. Health care centers, research, needs may waste their entire contribution and education all can make her stronger. to the good they seek to accomplish. • Support breastfeeding. One model of sup- It also reminds me that women are gen- port is that employed by the American erally not in community leadership roles and advocacy group 1000 Days. They pro- are too often politically invisible. In fact, it mote the idea that the days between con- may be their “job” not to speak up; anyway, ception and a child’s second birthday are they are busy in the home and the ½elds all the most critical days in a human’s life. day and night. While women are the font Another effort is the unicef/whoBaby- of life for the family, they are not ½rst call Friendly Hospital Initiative (bfhi), a for community knowledge, though they twenty-four-year-old campaign to make should be. every hospital “baby friendly” so that women giving birth receive the in for - For women to be seen and heard, and for mation and support they need to ex - societies to bene½t from their knowledge, clusively breastfeed their infants. skills, and perspectives, we must:

28 Dædalus, the Journal ofthe American Academy of Arts & Sciences • Improve women’s literacy. Even if more girls • Consider societal gender roles in all develop- Catherine are in school now, most of their mothers ment thinking. The established roles of Bertini were not schooled. Training girls to wom en and men in a given community teach their mothers how to read and or arena of society are critical consider- count is a viable contribution. ations in development work. Talk to both the women and the men, and design • Create agricultural extension programs that programs to reach the stated objective in both include women and reach women. a manner that is sensitive to distinct gen- • Expand microbanking loans and insurance der norms and needs. to more poor women, who have been Visible women can change the world. shown to dedicate resources to their household more effectively than men. Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021

• Create legal rights for women to own and in- herit land, and promote those rights so wom en know what is available to them.

endnotes 1 Catherine Bertini, “Statement at the United Nations Fourth World Conference on Women,” Beijing, China, September 6, 1995. 2 Alyson Brody, Alexandra Spieldoch, and Georgina Aboud, Gender and Food Security: Towards Gender-Just Food and Nutrition Security, bridge Overview Report (Brighton, United Kingdom: Institute of Development Studies, 2014), 22. 3 Food and Agriculture Organization of the United Nations, The State of Food Insecurity in the World 2015: Meeting the 2015 International Hunger Targets (Rome: Food and Agriculture Organi - zation of the United Nations, 2015), 4. 4 World Health Organization, Global Status Report on Noncommunicable Diseases 2010 (Geneva: World Health Organization, 2011), 28. 5 World Health Organization, “Obesity and Overweight,” Fact Sheet No. 311 (updated January 2015), http://www.who.int/mediacentre/factsheets/fs311/en/. 6 World Health Organization, Global Nutrition Targets 2025: Childhood Overweight Policy Brief, who/nmh/nhd/14.6 (Geneva: World Health Organization, 2014), 1, http://apps.who.int/ iris/bitstream/10665/149021/2/WHO_NMH_NHD_14.6_eng.pdf?ua=1. 7 Andrew D. Jones, Healthy Food for a Healthy World: Leveraging Agriculture and Food to Improve Global Nutrition (Chicago: The Chicago Council on Global Affairs, 2015), 13. 8 Ibid. 9 Ibid., 1. 10 World Health Organization/unicef, Global Nutrition Targets 2025: Breastfeeding Policy Brief, who/nmh/nhd/14.7 (Geneva: World Health Organization, 2014), 1. 11 World Health Organization Multicentre Growth Reference Study Group and Mercedes de Onis, “Assessment of Differences in Linear Growth among Populations in the who Multi- centre Growth Reference Study,” Acta Pædiatrica 95 (S450) (2006): 56–65. 12 Mara van den Bold, Agnes R. Quisumbing, and Stuart Gillespie, Women’s Empowerment and Nu- trition: An Evidence Review, ifpri Discussion Paper 01294 (Washington, D.C.: International Food Policy Research Institute, 2013), 7.

144 (4) Fall 2015 29 Invisible 13 Food and Agriculture Organization of the United Nations, The State of Food and Agriculture Women 2010–11: Women in Agriculture (Rome: Food and Agriculture Organization of the United Nations, 2011), 22. 14 Ibid, 5. 15 Alan Nicol, Simon Langan, Michael Victor, and Julian Gonsalves, eds., Water-Smart Agriculture in East Africa (Colombo, Sri Lanka: cgiar Research Program on Water, Land and Ecosystems, 2015), 261. 16 Agnes R. Quisumbing, ed., Household Decisions, Gender, and Development: A Synthesis of Recent Re- search (Washington, D.C.: International Food Policy Research Institute, 2003). 17 John Hoddinott and Lawrence Haddad, “Does Female Income Share Influence Household Ex- penditures? Evidence from Côte D’Ivoire,” Oxford Bulletin of Economics and Statistics 57 (1) (1995): 77–96. Downloaded from http://direct.mit.edu/daed/article-pdf/144/4/24/1830649/daed_a_00351.pdf by guest on 25 September 2021 18 United Nations, The Millennium Development Goals Report 2014 (New York: United Nations, 2014), 4.

30 Dædalus, the Journal ofthe American Academy of Arts & Sciences