Improving Nutritional Status of Women from Low Income Households’ in Bangladesh: A Rural-Urban Comparison by Afifa Shahrin M.S.S. (Economics), University of Dhaka, 2006 B.S.S. (Economics), University of Dhaka, 2005 RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC POLICY in the School of Public Policy Faculty of Arts and Social Sciences Afifa Shahrin 2012 SIMON FRASER UNIVERSITY Spring 2012 All rights reserved. However, in accordance with the Copyright Act of Canada , this work may be reproduced, without authorization, under the conditions for “Fair Dealing.” Therefore, limited reproduction of this work for the purposes of private study, research, criticism, review and news reporting is likely to be in accordance with the law, particularly if cited appropriately. Approval Name: Afifa Shahrin Degree: M.P.P Title of Capstone : Improving Nutritional Status of Women from Low Income Households’ in Bangladesh: A Rural-Urban Comparison Examining Committee: Chair: Nancy Olewiler Director, School of Public Policy, SFU John Richards Senior Supervisor Professor, School of Public Policy, SFU Royce Koop Assistant Professor, School of Public Policy, SFU Jon Kesselman External Examiner Professor, School of Public Policy, SFU Date Defended/Approved: April 13, 2012 ii Partial Copyright Licence Ethics Statement The author, whose name appears on the title page of this work, has obtained, for the research described in this work, either: a. human research ethics approval from the Simon Fraser University Office of Research Ethics, or b. advance approval of the animal care protocol from the University Animal Care Committee of Simon Fraser University; or has conducted the research c. as a co-investigator, collaborator or research assistant in a research project approved in advance, or d. as a member of a course approved in advance for minimal risk human research, by the Office of Research Ethics. A copy of the approval letter has been filed at the Theses Office of the University Library at the time of submission of this thesis or project. The original application for approval and letter of approval are filed with the relevant offices. Inquiries may be directed to those authorities. Simon Fraser University Library Burnaby, British Columbia, Canada update Spring 2010 Abstract This study analyzes the nutritional status of women from low income households in Bangladesh. The key policy issue is inadequacy of protein and micronutrients in the regular diet of low income women. Women’s poor nutritional condition results in long- term health problems and pregnancy-related disorders that pass from one generation to the next. On the basis of a primary survey on about 800 married women in rural, urban and suburban areas in Bangladesh, this study identified a number of underlying factors related to women’s poor nutritional status. These include illiteracy and low education, poor economic conditions, addiction to tobacco, drinking unclean water, not having nutritional supplements, ineffective services by community health workers, and ongoing food price hikes. This study proposes several short-term, low-cost policy alternatives to address the cited dietary deficiencies of low income women in Bangladesh. Keywords : malnutrition; health; Bangladesh; women; food score; BMI iii Dedication To my mother and Shimon iv Acknowledgements I would like to thank all the people who supported and inspired me during my educational life. I am deeply indebted to John Richards, my is supervisor for all the valuable guidance, inspiration and affection not only during this capstone work but throughout the past two years. I never could reach here if I did not meet Professor Richards. Thanks to J. Rhys Kesselman, for his valuable comments and feedbacks as my external examiner. Thanks to Nancy Olewiler for all her guidance during my journey to the MPP program. Thanks to all people in Dhaka who helped me to undertake such an ambitious survey. Thanks to Karen Lund, coordinator of the nursing college at the International University of Business, Agriculture and Technology (IUBAT) in Dhaka, Alimullah Miyan, Vice-Chancellor of IUBAT, and Narayan Chandra Das from BRAC, Bangladesh for their support. Thanks to all surveyors who worked effectively to collect the data. Thanks to all officials of BRAC and IUBAT who helped me to organize the focus group discussions in Dhaka and Jamalpur. Thanks to Jesse Joice from my thesis group and also to all my classmates. Thanks Arno Kamolika for helping me during the data entry work. Special thanks to Georgia Gulden from the Asian University of Women, Bangladesh and Christine Sommers from OASIS Hospital, Bangladesh for sharing their collected data for my capstone work. Many thanks also to CARE Society, Canada for the award during my co-op term. A special thanks to the Department of Economics, SFU for offering me TA jobs during my MPP program. Last but not least I would like to thank Shuhash Shimon, my husband for all the little discussions during the survey, during the capstone work and most importantly to always be my side in this journey. v Table of Contents Approval .......................................................................................................................... ii Abstract .......................................................................................................................... iii Dedication ...................................................................................................................... iv Acknowledgements ......................................................................................................... v Table of Contents ........................................................................................................... vi List of Tables .................................................................................................................. ix List of Figures.................................................................................................................. x List of Acronyms ............................................................................................................ xii Executive Summary ...................................................................................................... xiii 1. Introduction .......................................................................................................... 1 2. Background .......................................................................................................... 3 3. Methodology ....................................................................................................... 19 3.1. Description of the Sample ..................................................................................... 19 3.2. Sampling technique .............................................................................................. 21 3.3 Questionnaire Design ........................................................................................... 22 3.3.1. Diet recall .................................................................................................... 22 3.3.2. Sources of minerals and vitamins ............................................................... 23 3.3.3. Hygiene and Cleanliness ............................................................................ 23 3.3.4. Smoking and Betel nut chewing .................................................................. 23 3.3.5. Awareness and Education .......................................................................... 23 3.3.6. Assets and Income ..................................................................................... 23 3.3.7. Demographic information ............................................................................ 24 3.3.8. Self-assessed questions ............................................................................. 24 3.3.9. Price Information ......................................................................................... 24 3.4 The survey and its limitations ................................................................................ 24 3.5 Focus group discussions ...................................................................................... 25 3.A. Chapter 3: Tables and Figures ............................................................................ 27 4. Descriptive Statistics ......................................................................................... 33 4.1. Dependent Variables ............................................................................................ 34 4.2. Independent Variables .......................................................................................... 36 4.2.1. Education of woman.................................................................................. 36 4.2.2. Education of husband ............................................................................... 37 4.2.3. Household’s highest level of education ..................................................... 37 4.2.4. Occupation of women ............................................................................... 38 4.2.5. Occupation of husbands ........................................................................... 38 4.2.6. Age of woman ........................................................................................... 39 4.2.7. Structure of family ..................................................................................... 39 4.2.8. Addictions