Within-family inequalities in resource allocation can explain the disproportionately high mortality risk faced by older women in India
There are far more men than women in India relative to developed countries. Following seminal work by Amartya Sen (1990, 1992), this fact has been dubbed the missing women phenomenon. Sex-selective abortion and excess female mortality at early ages have been identified as important determinants of missing women and biased sex ratios. Parental preferences for male children carry the blame (Das Gupta 2005). It has recently been argued, however, that in India excess female mortality persists beyond childhood and that close to half of missing women are of post-reproductive age (Anderson-Ray 2010). Unlike the missing girls phenomenon, excess female mortality at older ages has not received much attention and remains a puzzle.
In a recent paper (Calvi 2017), I identify one mechanism – the decline in women's bargaining power at post-reproductive ages – that can account for a considerable fraction of missing women in the 45-79 age group. The decrease in women's bargaining power is reflected in their diminished ability to access household resources. As a result, poverty rates at older ages are significantly higher among women than men. In other words, when compared to women in developed countries, older Indian women die at a disproportionately higher rate than men exactly at those ages when they are disproportionately poorer than men.
Women’s empowerment, mortality risk, and age
Intra-household bargaining power and its changes are difficult to measure and often unobservable. To overcome this limitation, I proceed in two steps.
- First, I link changes in women’s intra-household bargaining power to changes in their health and mortality risk by using amendments to the Indian inheritance law as a natural experiment. I focus on the Hindu Succession Act amendments that equalised women’s inheritance rights to those of men in several Indian states between 1976 and 2005. By granting women the right to inherit their natal family property, these reforms strengthened their bargaining power in their marital families. Using data from the National Family Health Survey and the NSS Morbidity and Health Care Survey, I show that women’s exposure to these reforms improves their nutritional outcomes (measured by body mass index and anaemia), reduces their likelihood to suffer from a variety of ailments, and lowers their risk of death.
- Next, I examine whether older women are missing in India because their bargaining power weakens at post-reproductive ages. Based on a household model with efficient bargaining and using expenditure data from the NSS Consumer Expenditure Survey, I estimate women’s bargaining power and investigate its determinants.1 Consistent with previous literature, I measure women’s power as the fraction of household’s total resources consumed by women (Browning et al. 2013, Dunbar et al. 2013). I find that during women's core reproductive ages, the allocation of resources between women and men is symmetric. By contrast, women's resources relative to those of men decline steadily at post-reproductive ages, when women receive as little as 65% of the resources that men receive.
Excess female poverty and mortality
One question remains: Why do intra-household bargaining and resource allocation matter for women’s health and mortality risk? Because they affect their likelihood of being poor.2
I use the model estimates of how resources are allocated within households to compute poverty rates (the fraction of individuals living below the poverty line) that are adjusted for unequal sharing of household resources. These are different from standard poverty measures, which by construction ignore intra-household inequality. My poverty analysis (based on World Bank poverty lines) unveils some interesting features.
- When intra-household gender asymmetries are accounted for, female poverty rates are higher at all ages. Conversely, almost no difference can be detected when an equal distribution of resources is assumed.
- While male poverty is roughly constant over age, the relationship between female poverty and age is clearly U-shaped. Importantly, the gap between female and male poverty rates widens dramatically after age 45, indicating that female poverty is particularly high at post-reproductive ages.
By definition, the ratio of female to male poverty rates provides a measure of female poverty relative to that of males. I call this measure the poverty sex ratio. A ratio equal to one indicates no gender asymmetry in poverty, while a ratio larger than one indicates excess female poverty. Figure 1 compares the age distributions of excess female poverty and excess female mortality.
Figure 1 Poverty sex ratio and missing women by age
Note: The graph shows the fraction of female poverty rate to male poverty rate in each age group together with the missing women estimates by age from Anderson-Ray (2010). The underlying gender-age-specific poverty rates are calculated using the US$1.90/day poverty line.
When the unequal allocation of resources within the household is taken into account and the model predictions are used for calculations, the age profile of excess female poverty matches the age distribution of missing women quite well. This match is nearly exact at post-reproductive ages, when the correlation coefficient between excess female mortality and excess female poverty equals 0.96. A simple back-of-the-envelope calculation suggests that up to 73% of missing women at post-reproductive ages can be attributed to the decrease in women's bargaining power over the lifecycle, and to the consequent increase in female poverty at older ages relative to that of males.
As other forces may obviously be playing a role, these magnitudes must be interpreted with caution. Nonetheless, I argue that a potentially sizable reduction in excess female mortality at older ages can be achieved by alleviating the problem of gender asymmetries within the family and the consequent asymmetries in poverty.
Inheritance rights and women’s empowerment
In my paper, I also confirm that exposure to the Hindu Succession Act amendments significantly improves women’s bargaining power inside the family and their ability to access household resources (Roy 2015, Heath-Tan 2016). These reforms were enacted in different states at different times and only applied to Hindu, Buddhist, Sikh, and Jain women who were not married at the time of implementation. A large fraction of Indian women, especially of older ages, is therefore excluded. With a counterfactual policy experiment, I demonstrate that granting universal equal inheritance rights can significantly reduce the number of women living in extreme poverty (by 8%) and the number of excess female deaths at post-reproductive ages (by 19%).
Taken together, these results have some important policy implications:
- As the Indian population is ageing, gender inequality among the elderly needs to be promptly addressed.
- Policies to promote women’s position within their families, such as improving their right to inherit property, can have positive spillovers on their health and well-being.
- Finally, a correct measurement of poverty requires taking into account how resources are allocated among household members. Failure to do so could weaken the efficacy and efficiency of the fight against poverty.
Anderson, S and D Ray (2010), “Missing women: Age and disease”, Review of Economic Studies 77, 1262–1300.
Browning, M, P-A Chiappori and A Lewbel (2013), “Estimating consumption economies of scale, adult equivalence scales, and household bargaining power”, Review of Economic Studies 80, 1267–1303.
Calvi, R (2017), “Why are older women missing in India? The age profile of bargaining power and poverty”, Working Paper.
Chiappori, P-A (1988), “Rational household labor supply”, Econometrica 56, pp. 63–90.
Chiappori, P-A (1992), “Collective labor supply and welfare”, Journal of Political Economy 100, pp. 437– 467.
Dasgupta, M (2005), “Explaining Asia’s “missing women”: A new look at the data”, Population and Development Review 31, 529–535.
Dunbar, G R, A Lewbel and K Pendakur (2013), “Children’s resources in collective households: Identification, estimation, and an application to child poverty in Malawi”, American Economic Review 103, 438–71.
Heath, R and X Tan (2016), “Intrahousehold bargaining, female autonomy, and labour supply: Theory and evidence from India”, Working Paper.
Roy, S (2015), “Empowering women? Inheritance rights, female education and dowry payments in India”, Journal of Development Economics 114, 233-251.
Sen, A (1990), “More than 100 million women are missing”, New York Review of Books: 61–66.
Sen, A (1992), “Missing women”, BMJ 304, 587–588.
 Specifically, I consider a collective household model (e.g. Chiappori 1988, 1992, Browning et al. 2013, Dunbar et al. 2013).
 The World Health Organization lists poverty as one of the major determinants of health and mortality. For instance, Indian women who live in extreme poverty are estimated to face a 2.7 times higher probability of death than those who do not (WHO 1999, 2015).