IFPRI Report
Volume 19, Number 2
June 1997
Measuring the Effects of Care on Children's Nutrition
The concept that care—the time and attention paid to children—affects their health and nutrition is not new in the nutrition field. But care practices vary widely among different cultures in developing countries, making it difficult to measure quantitatively the relationship between care, food availability, and nutritional status. Care and Nutrition: Concepts and Measurement, a new IFPRI occasional paper by Patrice L. Engle, Purnima Menon, and Lawrence Haddad, summarizes issues related to care and suggests strategies for mea- surement that can be applied in many cultures. It extends a model of care and child health developed by the United Nations Children's Fund, by defining the resources a caregiver needs to offer appropriate care and by arguing that a child's own characteristics play a role in the kind of care he or she receives.A child's behavior is found to be a key element in the quality of care received. For example, a passive child will elicit less response from the caregiver than a demanding one. Caregivers may expend less effort to feed a child who refuses food or is difficult to feed. A positive relationship between caregiver and child leads to increased intake of food by the child.
In examining the resources that caregivers draw on to meet the physical, mental, and social needs of the growing child, the authors consider six factors:
- Education, knowledge, and beliefs. The paper finds that better-educated caregivers are more likely to take advantage of, say, available community health programs and to seek help if a child is ill.
- Physical health and nutritional status. If a caregiver is undernourished or ill, he or she is likely to spend less time on child care.
- Mental health and level of stress and self-confidence. Although depression and stress have been linked to poor caregiving in developed countries, measures need to be developed that are tailored to developing countries.
- Autonomy and control of resources. When women control household resources, they tend to allocate a larger share to children.
- Workload and availability of time. Whether a mother's working outside the home is good or bad for young children may depend on the quality of replacement caregivers and the amount of income earned.
- Family and community social support. With the increased entry of women into the labor force, the major form of social support needed is provision of competent alternative caregivers. Institutional child care is rarely available in developing countries, and child care comes at a high social cost if older girls are kept out of school to care for young children.
The authors look at two care practices in detail: complementary feeding and psychosocial care. Feeding practices that can affect nutrition include adapting the foods offered to a child's abilities (offering finger food, for example) and responding to a child's cues (perhaps offering more food or a different food).
Psychosocial care—the provision of affection and attention to the child— includes physical, visual, and verbal interactions between caregiver and child. Practices depend on cultural norms. For example, when asked to attract an infant's attention, Native American women gazed at the child, while Euro-American women spoke to the child. The purpose of the action, however, was the same.
Although much remains to be learned about the role of care and how to measure it, a better understanding of these issues offers policymakers the tools to design improved interventions for child nutrition and health. (ISBN 0-89629-334-3)
