Let the Little Boys Die II – WHO cares?

It’s not just the World Bank which believes that the health of baby boys matters less than girls. Here’s the World Health Organisation:

  • “While women and men share many similar health challenges, the differences are such that the health of women deserves particular attention.”
  • “Every year some nine million children under five years, including 4.3 million girls [48% of the total], die from conditions that are largely preventable and treatable… Globally, girls are not more likely to die under the age of five years than boys are. In fact, girls may have a certain advantage.”
  • “The health and development of… children is a prime concern for all societies. The health and wellbeing of young girls is of particular concern because of their future reproductive roles and the clear intergenerational effects that poor maternal health has on the health and development prospects of their children.”

So… boys die more than girls, and are sicker. The overwhelming majority of these deaths (95+%) could be prevented easily and cheaply. But the health a boy is worth less than that of a girl, because mothers will go on to play a greater role in the lives of their children than fathers.

I still think this is a morally repugnant argument, especially when WHO (like the Bank) can find no evidence of sexual discrimination in child or healthcare. There’s “no overall systematic bias against either boys or girls” in access to immunization, for example. Furthermore, “boys are more likely to suffer from severe malnutrition (stunting) than girls are.”

But let’s explore WHO’s instrumentalist approach a little further. It’s widely accepted, of course, that more educated women have healthier families. Their own health as children presumably has an impact on their ability to stay in school and learn, and thus on the role they’ll play as mothers.

But causation runs the other way, as well. As children become healthier, families tend to choose to have fewer children, and to invest more in them. This has a huge impact on the health of women and on the lives they lead. The health of all children has instrumental benefit, therefore.  If anything, parents may be especially sensitive to male infant mortality, given the preference of many to have at least one son.

Also, as wealth is the most important determinant of health, men’s role as breadwinners – they make up 60% of the global workforce – cannot be totally ignored. There may be greater return on investment in the health of a young girl (although I haven’t seen research proving this), but a boy’s expected lifetime earnings, and the impact these will have on his children, remain important.

What is galling is how threadbare the evidence base is – even after years of ‘mainstreaming’ gender into health. The WHO has run an awful lot of gender workshops in recent years, but its network on Gender, Women, and Health (interesting name), displays remarkably little curiosity as to why women are healthier than men. The anodyne verdict –“probably due to a combination of… genetic and behavioural facts” – is backed up with just four references to the academic literature.

In its research into men and boys, it simply indulges in the usual lazy speculation about men’s risk-taking and failure to take care of themselves, before turning attention to strategies to “encourage men to take responsibility for advocating agendas of gender equality, including policy initiatives for women’s rights.”

“What gets measured gets done,” says WHO’s Director-General, Margaret Chan, explaining why she commissioned a report to “gather a baseline of data about the health of women and girls throughout the life-course, in different parts of the world, and in different groups within countries.”

Perhaps it’s time for her to do the same for the other – sicker – sex.

Let the Little Boys Die – Reaction to the 2012 World Development Report

The 2012 World Development Report has a stat that the World Bank is mighty proud of. I’ll let Bank President, Robert Zoellick tell the story:

Imagine if a city of almost four million people disappeared every year. A Los Angeles, Johannesburg, Yokohama. It would be hard to miss.

 Yet it goes largely unnoticed that almost four million girls and women “go missing” each year in developing countries.

It’s a shocking statistic. For comparison, AIDS and TB each kill around 1.7 million people a year – malaria a million. So why are so many women missing? What’s happening to them? And what does the Bank want to do about it?

Burrow into the report and the total drops a bit – to 3.882 million. A third of the ‘missing’ are from China, 30% from Sub-Saharan Africa, and 22% from India. The two big rising powers and the countries of the world’s poorest region clearly have some questions to answer.

The initial analysis follows a well-trodden path. According to the Bank, the largest group, 37%, are ‘missing at birth’. This is largely a problem for China and India (95% of missing baby girls). Many parents in these countries want sons rather than daughters, and are prepared to use ultrasound and abortion to make sure they get them.

It’s when we move onto infant mortality that the WDR gets into trouble. 617,000 of the missing (16% of the total) are girls who die before the age of 5, it reports. These girls die in much larger numbers than their brothers because they are neglected by their parents and are starved of healthcare by the prejudiced societies into which they have the misfortune to be born. Right?

Well no, not at all, as it happens.