Potential impact of eradicating malaria on gender inequality within agricultural households in sub-Saharan Africa

Impact of time poverty on productivity of women farmers

Peterman et al. reviewed the literature on gender inequalities in agricultural productivity for sub-Saharan Africa, finding a 25% difference in the productivity of female and male farmers⁴⁸. A separate report focused on six countries comprising more than 40% of the population in sub-Saharan Africa and found that, on average, the difference in agricultural productivity between women and men ranged from 66% in Niger to 23% in Tanzania, accounting for differences in geographic factors and plot size⁴⁷.

Agricultural inputs. Research shows that women farmers in sub-Saharan Africa often experience greater challenges in gaining access to agricultural inputs (e.g., land, labor, fertilizer, seeds, information) compared to men, leading to lower levels of productivity^49–69. Women are often required to farm land that they do not own, such as land belonging to their husband or male relatives⁵¹. They face disincentives to invest in improving this land, which can affect the value of their harvests^51,70. However, the threat of fallow land being appropriated by the community incentivizes women to continually cultivate the land, which leads to a deterioration in soil fertility⁷¹. Women farmers also often experience challenges in accessing information regarding methods to increase their productivity, due to a lack of access to agricultural extension workers or illiteracy. A study in Burkina Faso found that access to female agricultural extension workers was critical for increasing the productivity of women farmers⁷².

In 2011, the Food and Agriculture Organization published an influential report titled The State of Food and Agriculture 2010–2011: Women in Agriculture: Closing the Gender Gap for Development, which highlighted the importance of addressing gender inequities to increase the productivity of women farmers. To create incentives for women to make investments that increase agricultural productivity, protective policies for women’s land rights are needed⁷³. In Ethiopia, the introduction of joint land registration gave women the formal right to the land that they farm^74,75. This policy led to increased investments in the productivity of land farmed by women⁷⁴. Organizations are developing initiatives that focus on providing credit and agricultural inputs to women; self-help groups developed by women are increasing access to financial services and technologies to help increase productivity⁷⁶.

Time poverty. Increasing the access and use of agricultural inputs by women farmers is not, in and of itself, sufficient to increase agricultural productivity. A common expectation in agricultural households is that women will devote more time for caregiving than men⁷⁷. This is problematic given that an extensive body of research has found that the amount of time that women devote to childcare and other household responsibilities negatively impacts their agricultural productivity⁵⁴. Expectations that women are responsible for household activities is an important example of the broader norms that prevent women from achieving the levels of agricultural productivity reached by men when provided access to similar levels of agricultural inputs^54,78–83. Gyasi refers to women’s diverse household activities as a “zero sum game” in which the more time women devote to a new activity within the household, the less time they have available for other commitments^77,84,85.

de Schutter notes that women can become trapped in a “care economy” that leads to a vicious cycle in which time poverty prevents women from achieving economic independence:

Although the issue of time poverty among women in sub-Saharan Africa is clear, the policy options to address the situation are limited. A 2006 World Bank report highlighted the need for investments in infrastructure targeted at reducing the time necessary for household tasks rather than infrastructure focused on income-generating activities:

Bold statements were also made in 2010 by high-level government officials regarding the need for labor-saving technologies and infrastructure in rural areas to reduce the amount of time women devote to domestic activities^84,86, which would, in turn, enable women to experience the benefits of the economic opportunities that are created by agricultural growth⁷³. A 2014 World Bank report recommended measures to reduce the gender gap between women and men⁴⁷. de Schutter states that:

A 2015 study in the Western Democratic Republic of Congo (DRC) used a survey of 2,931 agricultural households to examine how the amount of time women farmers devote to household activities affects their agricultural productivity. On average, the productivity of women farmers was 26% less than men. The study found that women who manage agricultural plots spend 1 hour and 52 minutes more on household activities than male plot managers each day⁸⁷. In addition, women must devote more time to childcare while they are farming than men, and while the presence of young children in a household does not affect the productivity of men, young children are associated with lower productivity among women farmers. These gender inequalities in agricultural productivity may have a significant impact on the agricultural sector in the DRC, given that more than 70% of economically active women in the DRC work in agriculture⁵². The Africa Gender Innovation Lab is piloting alternative means of providing childcare services in the Kongo Central region and examining whether the provision of these services affects the productivity of women farmers⁸⁷.

Household activities can be divided into two components—non-childcare-related activities and childcare-related activities. In the next section, we focus on childcare-related household activities (specifically, illness care for children) and highlight the need to examine how reducing the time women devote to providing care for sick children (especially children sick with malaria) could reduce gender inequalities in agricultural productivity.

Gender inequalities in caregiving time for malaria cases

Women provide the majority of care for household malaria cases; a study in Ghana found that women provide care in 83% of malaria cases⁸⁸. The time that women in agricultural households devote to malaria-associated childcare could be an important factor contributing to lower productivity among female farmers. In this section, we provide a brief review of the most relevant literature examining the amount of time women dedicate to malaria-associated caregiving. We also use a model to quantitatively estimate the total number of days a woman might devote to caregiving for malaria cases in children.

Approximately 93% of malaria cases throughout the world occur in sub-Saharan Africa³⁷. The intensity of malaria transmission in rural Africa is often significantly higher than in urban and peri-urban areas.

Within agricultural households in rural sub-Saharan Africa, approximately 50% to 75% of all malaria cases are in children under the age of 16, with morbidity rates among the highest in the world³⁶. A study of the age distribution of cases of Plasmodium falciparum malaria in sub-Saharan Africa found that approximately 48% of cases were among children under the age of five years; however, there was wide variation across communities based on malaria transmission intensity³⁶. They estimated less variability in children of school age—somewhere between 20 and 40% of cases³⁶.

A large number of studies in the 1990s and 2000s examined the number of caregiving days provided for each malaria case within agricultural households^{8–18,89–99}. Most estimates for caregiving days necessary per malaria case for households in sub-Saharan Africa ranged from one to six days.

The number of caregiving days provided for each malaria case often depends on the time of year, as the opportunity cost of time will be higher when labor is most needed for agricultural activities. A study in Burkina Faso found that the number of caregiving days provided per malaria case was lower during the rainy season than during the dry season, potentially due to the higher opportunity cost of lost work days¹⁸. The requirement of women to provide caregiving would have a greater impact on income during times when labor is greatly needed for cultivating crops⁴⁴.

Quantifying inequalities in caregiving days provided by women and men. Although numerous studies have attempted to estimate the number of caregiving days required per malaria case in children, no study has estimated the total number of caregiving days provided by adults for all children throughout their childhood. To develop these estimates, we consider a hypothetical agricultural household in an area of intense malaria transmission with two adults and three children. This estimate of five people per household is consistent with average household sizes across much of Africa¹⁰⁰.

We defined children as individuals under the age of 16. Children can be divided into two groups—those aged five and under (young children) and those aged six to 15 (older children). Among the 324 million individuals living in agricultural households in malarious regions of sub-Saharan Africa, approximately 52.7 million are under five years of age⁴⁵.

To illustrate the potential impact of malaria elimination on women’s caregiving responsibilities, we estimate the total number of caregiving days needed per household for malaria cases among children aged 15 and under. We explore nine scenarios for this hypothetical agricultural household. Each scenario includes four parameter values: annual number of malaria cases for young children, caregiving days per case in young children, annual number of malaria cases for older children, and caregiving days per case for older children.

Given that we are estimating the number of malaria cases experienced by children in an agricultural household in an area of intense malaria transmission, we assume that the annual number of malaria cases for young children ranges from one to two. For older children, we assume that the annual number of malaria cases ranges from 0.5 to 1.5. Based on these assumptions, and assuming three young children in a household during one year, the maximum number of cases that that household would experience in that year is six.

While an estimated six malaria cases per household per year may appear high based on national malaria case data, it is consistent with sub-national studies conducted in rural communities. A survey of households in Kasangulu, a rural town in Kongo Central province in the DRC, found that 31.7% of households reported six or more malaria cases over a 12-month period¹⁰¹. In 2017, the DRC (a country with an estimated total population of 84 million that year), experienced an estimated 25 million malaria cases¹⁰². However, these estimates are based on passive case detection and likely underestimate the actual number of malaria cases experienced in the country. A 2014 study found that only 34% of the total number of malaria cases in sub-Saharan Africa identified with active case detection would have been recorded with passive case detection³⁶.

We assume that the number of caregiving days provided by adults ranged from three to five for young children, and from two to four for older children. These ranges are consistent with reviews of the relevant literature⁴⁴. Further, we estimate that women provide care in 80% of cases involving younger children and 70% of cases involving older children. These assumptions are consistent with the finding that women provided care for 83% of malaria cases in Ghana⁸⁸ and findings from the World Development Report on Gender Equality and Development¹⁰³.

Figure 1 summarizes the parameter values and the resulting estimates of gender inequalities in caregiving days for the nine scenarios. Each set of three scenarios (i.e., 1 to 3, 4 to 6, and 7 to 9) have the same parameter values for the number of malaria cases per child for the two age groups but different parameter values for the number of caregiving days per case.

Figure 1. Inequalities in caregiving days provided by women versus men for malaria cases experienced by an agricultural household..

Software used for figure constructions: Adobe Illustrator CC 2020.

Based on the parameter values we used to develop our estimates, adults in an agricultural household devote a total of approximately 2.5 to 11 months to providing care for malaria cases for three children throughout their childhood (age 15 and under). The inequalities in caregiving time between women and men ranged from approximately 1.5 months to 6 months.

The estimates above suggest that eliminating malaria would significantly reduce the amount of time women must devote to childcare and homemaking; but, how does this compare to previously proposed policies aimed at reducing this time burden among women? Barwell¹⁰⁴ used survey data from five villages in sub-Saharan Africa to track the time women spent walking to retrieve water and wood, both essential resources required daily. They estimated the potential time savings for women by improving access to these resources. Improved access meant that a potable water source was accessible within a six-minute walk, consistent with Tanzania’s policy at the time that households should be within 40 meters of a water source. By comparing the time women actually devoted to retrieving water with the time they would spend on this activity if a water source were within a six-minute (i.e., 400 meters) walk, the study quantified the potential time savings of improved water access. For the rural village in Kaya, Burkina Faso, such an innovation would reduce water-retrieving time among women by 125 hours each year. For wood, Barwell considered the potential impact of woodlot creation within a 30-minute walk of households. He found that this policy would reduce the annual time required for wood retrieval by 119 hours per year in that same village.

How do these estimated time savings of 125 hours for water and 119 hours for wood compare to the potential reduction in caregiving time for malaria cases associated with malaria elimination? Assuming that the intensity of malaria transmission in Kaya, Burkina Faso corresponds to the malaria burden depicted in scenario five in Figure 1, eliminating malaria would reduce the number of days women provide malaria-associated childcare (assuming three children) by 135 days throughout the 15 years of childhood. Assigning scenario five for Kaya is a conservative assumption given that the malaria burden in young children in West Africa is generally higher than the burden in East and Southern Africa³⁶. A survey of Kaya in 2010 found that the size of the average household was 6.5 and that malaria was the leading cause of death¹⁰⁵. If we assume that each caregiving day represents eight hours of malaria-associated childcare, a conservative assumption, then a woman devotes a total of 1,080 hours providing malaria-associated childcare for three children throughout their childhood. If we assume that all three of these children progress from birth to age 15 over a 20-year period, the average annual reduction in time devoted to malaria-associated caregiving over that period is 54 hours per year. This estimate of 54 hours per year, over a 20-year period, represents approximately 43% (54 hours is 43% of 125 hours) of their time, which could be saved by improving water access in a village like Kaya. Similarly, the estimate represents 45% (54 hours is 45% of 119 hours) of the total time that would be saved by improving access to wood in Kaya.