1. Women’s Employment and Child Care and Nutrition in Urban Areas: Examples from Ghana and Guatemala Marie T. Ruel Multi-country Program on Urban Challenges to Food and Nutrition Security IFPRI

2. Urban Women CharacteristicsConsequences for children (and hh) PositiveNegative Higher female education More likely to work, Greater income, control over resource, Better knowledge, practices, caring skills More likely to work, hence less time for child care and household maintenance Greater participation of women in the labor force Greater income, Autonomy, control over resources Less time for child care and household responsibilities, greater use of processed/street foods Higher percentage of female headed hh Less economic, emotional support, need to work Smaller household size Less support for child care and other hh responsibilities Greater availability (and access?) to wider variety of foods Greater dietary diversity, greater micronutrient intake, better nutritional status Use of street foods: risk of contamination; poor choices - risk of chronic diseases; displacement of breast milk

3. Survival, Growth, and Development Dietary Intake Health Care For Children and Women Health Services Healthy Environment Household Food Security Resources and control Human, Economic & Organizational Potential Resources Education Political and Ideological Superstructure Economic Structure

4. Child survival GrowthDevelopment DietHealth Caregiving behaviors Care for women Feeding/breast-feeding Psychosocial care Cognitive stimulation Hygiene practices Home health practices Food preparation and storage Maternal resources for care Knowledge/beliefs/education Health/nutritional status Control over resources Workload/time/social support HH food security Healthy environment Food/economic Resources Food production Income Labor Land assets Health resources Clean water Sanitation Health care avail. Safe environment

5. Objective Use data from 2 case studies (Accra and Guatemala city), examine: –Livelihoods and vulnerability of women in urban areas (working women and women head of households) –Constraints faced by working women in provision of child care and in protecting their children from malnutrition –Patterns of women’s employment and child care use

6. Data used Accra case study of urban livelihoods, poverty, food insecurity and malnutrition (1997) –Participatory Rapid Appraisal (PRA) methods –Representative quantitative survey (n=560) –Observational study of sub-sample (n=22) Guatemala case study (1998-99): –Evaluation of Government Sponsored Community Day Care Program (operational and impact evaluations) –Random sample of hh with children < 7 years of age in the zone where evaluation took place

7. The Accra Case Study Participatory Rapid Appraisals Quantitative representative household survey (n=560) Observational positive deviance study (n=22)

8. The Questions Households headed by women (33%): Are they more vulnerable to poverty and food insecurity? Working women (75%): –How different are they from non-working women? –Does their work affect their child care practices? –Does this in turn increases their children’s nutritional vulnerability?

9. Differences between male- and female-headed households in sociodemographic characteristics Male head Female head (33%) HH size5.24.8 Dependency ratio1.11.5 Years of schooling12.27.5 Income/capita/mo$26.50$16.19 Source of income - Self-employment - Wages - Gifts/transfers 34.4% 50.7% 7.8% 38.1% 18.9% 43.2%

10. Differences between male- and female-headed households in expenditures and food security Male headFemale head Expenditure/capita/mo$48.51$35.48 Food budget share51.560.2* Health budget share4.05.6* Energy intake/aeu2,552.9 (88%)2,781.5 (96%)* Energy from : - street foods - meat and fish 618 183 764* 151 % food insecure11.6%17.4% % vulnerable20.5%37.9%

11. Conclusions Livelihood strategies for both men and women in Accra are predominantly labor based, but sources and levels of income vary There are important differences in expenditure patterns, women more likely to allocate higher % of their budget to food and health Despite lower income, female-hhh more likely to have adequate calorie adequacy, but at what cost? (higher food budget shares increases their vulnerability to shocks)

12. Women’s work and child care and nutrition in Accra 55% of mothers with children < 3 years of age were working full time, 9.5% part time Mothers worked across socioeconomic status levels, education levels, ethnic groups, head of householdship, etc.

13. Working women and child care practices Not workingFull time work (55%) Breastfeed55% Exclusive BF (0-4)20%12%* BF less because work-22% Comp foods right time42%25%* Good hygiene36%25% Mother clean77%68%* Child clean77%67%* Growth monitoring72%59%* Immunization (DPT)75%90%*

14. Nutritional status of children < 3 years of age, by maternal employment 12 18 20 12 18 20

15. Mean HAZ and WHZ by age (0-36 months)

16. Mother’s working patterns and child’s age

17. Early return to work after delivery: source of vulnerability? PRA studies: “When I have to leave my child (to go back to work), my stomach burns me, but I have to work to earn money. Caring for your child is important, but you also have to earn money to provide for your child”

18. Early return to work after delivery: source of vulnerability? Observational study: Mothers of positive deviant children were much less likely to be working when child was < 12 mo of age and still when child was 20-34 mo (Note that children were matched on age)

19. Early return to work after delivery: source of vulnerability? Quantitative survey (sample < 12 mo)  Mothers who returned to work early were not different in any personal or socioeconomic characteristics or financial help from father (same expenditure level suggests they needed to work)  Few care practices were different (only BF less because of work)  Nutritional status was not associated with maternal work in multivariate analysis

20. Bottom Line Maternal employment did not have a marked negative effect on child care practices or nutritional status This is largely due to the fact that mothers adapt their work patterns to the special caring needs of their children This may increase their vulnerability and that of their children and family (taking child to work; strapping them on their back)

21. Guatemala Case Study Evaluation of Program: Hogares Comunitarios (260 pairs: matched beneficiary and controls). Impact on: –Women’s work patterns –Children’s diet –Household expenditure patterns –Older siblings’ schooling Random sample of households with children < 7 years of age in area (n=1363)

25. What type of child care arrangements do women use in Guatemala City? Child care arrangement (37% of women worked) N=491 % Mother42% Relative living in same house3% Relative living elsewhere21% Neighbor/other paid help7% Day care center22% Child stays alone2% Program of Hogares Comunitarios3%

26. How expensive are the different child care alternatives (including supplies, etc.)? Type of arrangementPrice/hourCost/month Mother$0.00 Child stays alone$0.00 Relative living in house$0.06$11.84 Relative living elsewhere$0.12$21.61 Neighbor/other paid help$0.17$35.29 Day care center$0.14$14.09 Program Hogares Comunitarios $0.04$9.10

27. Who are the women who use the Hogares Comunitarios program? CharacteristicsBeneficiaries (n=14) Random sample (n=489) Age25 years31 years Education6 years Single mother43%29% Married/partner57%71% Years living in city1423 No children < 7 y1.31.5 HH size3.45.4 Nuclear family29%37% Value of assets$1469/capita$1350/capita

28. What are the characteristics of their employment? Employment characteristics Beneficiaries (n = 14) Random sample (n=489) Salaried93%53% Informal sector0%39% Factory worker71%21% Days worked/mo19.619 Earnings/month$110$106 Earnings/hour$0.65$0.79 # work benefits42

29. Impact Evaluation: Characteristics of beneficiaries and control mothers Maternal Characteristics Beneficiaries (n=260) Control (n=260) Age (y)28.229.6 % illiterate6.2%10.0% % single moms40.2%44.8% HH size4.25.8 % Nuclear family18.9%37.5% % paying rent73.0%47.1% % living in single room56.8%31.7% % hh members working17.9%23.8%

30. Impact Evaluation: Employment characteristics of beneficiaries and controls Maternal EmploymentBeneficiaries (n=260) Control (n=260) Independent worker7.3%15.1% Factory/industry62.5%46.7% Petty trade, sells in market6.6%12.7% Days worked in past month23.725.3 Salary per month$139$149 % who receives employment benefits 90.9%77.9%

31. Bottom Line Women in Guatemala use a variety of child care arrangements, although a large proportion take the child along Only small proportion benefited from HC program, the cheapest alternative Beneficiaries are more likely to be younger, single, work in factories, receive work benefits; no difference in total earnings, hrs worked, earnings/hour Program seems to be reaching high risk group and filling an important gap

32. Overall Conclusions Urban areas of Ghana and Guatemala do host a high proportion of female-headed households and working women Women in both countries were clearly facing the challenges posed by their dual role as income- earners and principal caretakers In Accra mothers seemed particularly successful at achieving food security and at maintaining good care practices and nutrition while working, but this may have increased their vulnerability In Guatemala the HC program seems to respond to a great need for alternative childcare, but current coverage is extremely low.

33. Programmatic Implications Relative to employment and child care, urban women need support in: –Reliable, safe, flexible, affordable child care arrangements (especially single mothers) –Help with care of very young infants –Facilities at the work place to permit optimal child feeding practices (especially for < 6 mo) –Targeted nutrition and child care education programs