Last and least: Findings on intrahousehold undernutrition from participatory research in South Asia.Soc Sci Med 2019; 232:316-323SS
We analyze intrahousehold mechanisms that rural South Asian women themselves identify as contributing to their inabilities to achieve adequate nutrition. The majority of our female respondents explain that, within their families, they are most likely to eat least and last and to seek lower quality healthcare later, both of which can lead to undernutrition. We analyze the explanations that women provide for why they do so. In addition to norm abidance, we highlight two social factors: a partner's heavy alcohol use and intimate partner violence. Women report that these factors adversely impact their own health and food security status and potentially contribute to differential nutritional outcomes within the same household. The emic perspectives presented here show us: (1) many rural South Asian women report shouldering a relatively greater share of food and nutrition insecurity within their households, and (2) taking their perspectives seriously assists in identifying the underlying contributors to intrahousehold differences. These findings indicate the value a gendered perspective on both the drivers of and measurement of undernutrition. Attending to these intrahousehold factors in future research may yield important insights for understanding drivers of nutritional outcomes.