by Sen, Amartya
TABLE 4.1: India and Sub-Saharan Africa: Selected Comparisons (1991)
Note: The age cutoff is 15 years for African figures, and 7 years for Indian figures. Note that in India, the 7+ literacy rate is usually higher than the 15+ literacy rate (e.g., the all-India 7+ literacy rate in 1981 was 43.6%, compared with 40.8% for the 15+ literacy rate).
Indeed, India alone accounts for more than half of the combined population of these fifty-two deprived countries. It is not by any means the worst performer on average (in fact, average life expectancy in India is very close to sixty years and according to latest statistics has just risen above it), but there are large regional variations in living conditions within India. Some regions of India (with populations as large as—or larger than—most countries in the world) do as badly as any country in the world. India may do significantly better on average than, say, the worst performers (such as Ethiopia or Zaire, now renamed the Democratic Republic of Congo) in terms of life expectancy and other indicators, but there are large areas within India where life expectancy and other basic living conditions are not very different from those prevailing in these most-deprived countries.30
Adult literacy rate comparisons
Region Population
(millions) Adult literacy rate*
(female/male)
India 846.3 39/64
Rajasthan 44.0 20/55
Bihar 86.4 23/52
Uttar Pradesh 139.1 25/56
Barmer (Rajasthan) 1.4 8/37
Kishanganj (Bihar) 1.0 10/33
Bahraich (Uttar Pradesh) 2.8 11/36
Burkina Faso 10/31
Sierra Leone 4.3 12/35
Benin 4.8 17/35
Sub-Saharan Africa
488.9
40/63
Source: J. Drèze and A. Sen, India: Economic Development and Social Opportunity (Delhi: Oxford University Press, 1995), table 3.1.
Table 4.1 compares the levels of infant mortality and adult literacy in the least-developed regions of sub-Saharan Africa and India.31 The table presents the 1991 estimates of these two variables not only for India and sub-Saharan Africa as a whole (first and last rows), but also for the three worst-performing countries of sub-Saharan Africa, the three worst-performing Indian states, and the worst-performing districts of each of these three states. It is remarkable that there is no country in sub-Saharan Africa—or indeed in the world—where estimated infant mortality rates are as high as in the district of Ganjam in Orissa, or where the adult female literacy rate is as low as in the district of Barmer in Rajasthan. Each of these two districts, incidentally, has a larger population than Botswana or Namibia, and the combined population of the two is larger than that of Sierra Leone, Nicaragua or Ireland. Indeed, even entire states such as Uttar Pradesh (which has a population as large as that of Brazil or Russia) do not do much better than the worst-off among the sub-Saharan countries in terms of these basic indicators of living quality.32
It is interesting that if we take India and sub-Saharan Africa as a whole, we find that the two regions are not very different in terms of either adult literacy or infant mortality. They do differ in terms of life expectancy, though. The expectation of life in India around 1991 was about sixty years, while it was much below that figure in sub-Saharan Africa (averaging about fifty-two years).33 On the other hand, there is considerable evidence that the extent of undernourishment is much greater in India than in sub-Saharan Africa.34
There is thus an interesting pattern of contrast between India and sub-Saharan Africa in terms of the different criteria of (1) mortality and (2) nutrition. The survival advantage in favor of India can be brought out not only by comparisons of life expectancy, but also by contrasts of other mortality statistics. For example, the median age at death in India was about thirty-seven years around 1991; this compares with a weighted average (of median age at death) for sub-Saharan Africa of a mere five years.35 Indeed, in as many as five African countries, the median age at death was observed to be three years or below. Seen in this perspective, the problem of premature mortality is enormously sharper in Africa than in India.
But we get a very different balance of disadvantages if we look at the prevalence of undernourishment in India via-à-vis Africa. Calculations of general undernourishment are much higher in India than in sub-Saharan Africa on the average.36 This is so despite the fact that it is India, rather than sub-Saharan Africa, that is self-sufficient in food. Indian “self-sufficiency” is based on the fulfillment of market demand, which can be, in normal years, easily met by domestically produced supply. But the market demand (based on purchasing power) understates the food needs. Actual undernourishment seems to be much higher in India than in sub-Saharan Africa. Judged in terms of the usual standards of retardation in weight for age, the proportion of undernourished children in Africa is 20 to 40 percent, whereas the proportion of undernourished children in India is a gigantic 40 to 60 percent.37 About half of all Indian children are, it appears, chronically undernourished. While Indians live longer than sub-Saharan Africans, and have a median age at death much higher than Africans have, nevertheless there are many more undernourished children in India than sub-Saharan Africa—not just in absolute terms but also as a proportion of all children.38 If we add to it the fact that gender bias at death is a substantial problem in India, but not so in sub-Saharan Africa, we see a picture that is much less favorable to India than to Africa.39
There are important policy issues related to the nature and complexity of the respective patterns of deprivation in the two most acute regions of poverty in the world. India’s advantage over sub-Saharan Africa in survival relates to a variety of factors that have made Africans especially prone to premature mortality. Since independence, India has been relatively free of the problems of famine and also of large-scale and persistent warfare, which has periodically ravaged a large number of African countries. India’s health services—inadequate as they are—have been less overwhelmed by political and military turmoil. Furthermore, many countries of sub-Saharan Africa have had specific experiences of economic decline—partly related to wars, unrest and political disorder—which make it particularly hard to improve living standards. A comparative assessment of the achievements and failures of the two regions would have to take note of these and other aspects of their respective development experiences.40
One should also note that one problem that India and sub-Saharan Africa have in common is the persistence of endemic illiteracy—a feature that, like low life expectancy, sets South Asia and sub-Saharan Africa apart from most of the rest of the world. As table 4.1 indicates, literacy rates are very similar in the two regions. Both in India and in sub-Saharan Africa, every other adult is illiterate.
The three focal features of deprivation of basic capabilities on which I have concentrated in comparing and contrasting the nature of deprivation in India and in sub-Saharan Africa (viz., premature mortality, undernourishment and illiteracy) do not, of course, provide a comprehensive picture of capability-poverty in these regions. However, they bring out some striking failures and some crucial policy issues that demand immediate attention. I have also not attempted to produce an “aggregate” measure of deprivation, based on “weighting” the different aspects of capability deprivation.41 A constructed aggregate may often be far less interesting for policy analysis than the substantive pattern of diverse performances.
FIGURE 4.2: Female-Male Ratios in Total Population in Selected Communities
Source: Calculated from UN Population Statistics.
GENDER INEQUALITY AND MISSING WOMEN
I turn now to a specific aspect of a general inequality that has drawn much attention lately; this section draws on my article “Missing Women” published in the British Medical Journal in 1992.42 I refer to the terrible phenomenon of excess mortality and artificially lower survival rates of women in many parts of the world. This is a crude and sharply visible aspect of gender inequality, which often manifests itself in more subtle and less gruesome fo
rms. But despite its crudeness, the artificially higher female mortality rates reflect a very important capability deprivation of women.
In Europe and North America, women tend, generally, to outnumber men by substantial numbers. For example, in the United Kingdom, France and the United States, the ratio of women to men exceeds 1.05. The situation is quite different in many countries in the third world, especially in Asia and North Africa, where the female-male ratio can be as low as 0.95 (Egypt), 0.94 (Bangladesh, China, West Asia), 0.93 (India), or even 0.90 (Pakistan). The significance of these differences is of interest in analyzing female-male inequalities across the worlds.43 Figure 4.2 presents this comparative information.
In fact, more boys than girls are born everywhere (typically about 5 percent more). But there is much evidence that women are “hardier” than men and, given symmetrical care, survive better. (Indeed, it appears that even female fetuses have a higher survival rate than do the male fetuses; the proportion of male fetuses in conception is even higher than that in birth.44) It is through the lower mortality rates of females that the high female-male ratio of the “West” comes about. There are also other causes for this preponderance of women. There is some remaining impact of deaths of males in past wars. There has been, in general, a greater incidence of smoking among men and also greater proneness toward violent death. But it seems clear that even when these other effects are taken out, women would tend to outnumber men, given symmetrical care.
The low female-male ratios in countries in Asia and North Africa indicate the influence of social factors. It is easily calculated that if these countries had the female-male ratio that obtains in Europe and the United States, there would have been millions more women in these countries (given the number of men).45 In China alone the number of “missing women,” calculated on the basis of the European or American ratio, would be more than 50 million, and on that basis, for these countries taken together, many more than 100 million women may be seen as “missing.”
It may not, however, be appropriate to use the European or American ratio, not just because of such special features as wartime deaths. Because of lower mortality rates of females in Europe and America, the female-male ratio rises gradually with age. A lower ratio would be expected in Asia or North Africa partly because of the lower general life expectancy and higher fertility rate. One way of dealing with this issue is to take as the basis of comparison not the female-male ratio in Europe or America, but that in sub-Saharan Africa, where there is little female disadvantage in terms of relative mortality rates, but where life expectancy is no higher and fertility rates are no lower (quite the contrary). Taking the sub-Saharan female-male ratio of 1.022 as the benchmark (used in my earlier studies and in those with Jean Drèze) yields an estimate of 44 million missing women in China, 37 million in India, and a total for these countries still in excess of 100 million.46
Another way of dealing with this problem is to calculate what the expected number of females would be had there been no female disadvantage in survival, given the actual life expectancy and the actual fertility rates in these respective countries. It is not easy to calculate that directly, but illuminating estimates have been made by Ansley Coale, through using model population tables based on the historical experience of “Western” countries. This procedure yields 29 million “missing women” in China, 23 million in India, and a total for these countries of around 60 million.47 While these are lower numbers, they too are fiercely large. More recent estimates, based on the use of more scrutinized historical data, have tended to yield rather larger numbers of missing women (about 90 million, as estimated by Stephan Klasen).48
Why are overall mortality rates for females higher than for males in these countries? Consider India, where the age-specific mortality rate for females consistently exceeds that for males until the late thirties. While the excess mortality in the childbearing age may be partly the result of maternal mortality (death during or just after childbirth), obviously no such explanation is possible for female disadvantage in survival in infancy and childhood. Despite occasional distressing accounts of female infanticide in India, that phenomenon, even if present, cannot do anything to explain the magnitude of extra mortality, nor its age distribution. The main culprit would seem to be the comparative neglect of female health and nutrition, especially—but not exclusively—during childhood. There is indeed considerable direct evidence that female children are neglected in terms of health care, hospitalization and even feeding.49
Even though the Indian case has been studied more extensively than others (there are more researchers working on this issue in India than in any other country), similar evidence of relative neglect of the health and nutrition of female children can be found in the other countries as well. In China there is even some evidence that the extent of neglect may have increased sharply in recent years, particularly since the compulsory family restrictions (such as the one-child policy in some parts of the country) were introduced, along with other reforms, around 1979. There are also some new, ominous signs in China, such as a radical increase in the reported ratio of male births to female births—quite out of line with the rest of the world. It can, quite possibly, indicate “hiding” of newborn female children (to avoid the rigors of compulsory family restriction), but it can, no less plausibly, also reflect a higher female infant mortality—whether or not induced (with new births and new deaths both going unreported). However, recently, the brunt of the antifemale bias in family composition seems to be in sex-selective abortion, which has become quite widespread in China with the progress of technology.
CONCLUDING REMARKS
Economists are sometimes criticized for concentrating too much on efficiency and too little on equity. There may be some ground for complaint here, but it must also be noted that inequality has received attention from economists throughout the history of this discipline. Adam Smith, who is often thought of as “the Father of Modern Economics,” was deeply concerned with the gulf between the rich and the poor (more on this later, in chapters 5 and 11). Some of the social scientists and philosophers who are responsible for making inequality such a central subject of public attention (such as Karl Marx, John Stuart Mill, B. S. Rowntree and Hugh Dalton, to take writers belonging to very different general traditions) were, in terms of substantive involvement, devoted economists, no matter what else they might also have been. In recent years, economics of inequality as a subject has flourished, with major leadership coming from such writers as A. B. Atkinson.50 This is not to deny that the focus on efficiency to the exclusion of other considerations is very evident in some works in economics, but economists as a group cannot be accused of neglecting inequality as a subject.
If there is a reason to grumble, it rests more on the relative importance that is attached, in much of economics, to inequality in a very narrow domain, viz., income inequality. This narrowness has the effect of contributing to the neglect of other ways of seeing inequality and equity, which has far-reaching bearing on the making of economic policy. Policy debates have indeed been distorted by overemphasis on income poverty and income inequality, to the neglect of deprivations that relate to other variables, such as unemployment, ill health, lack of education, and social exclusion. Unfortunately, the identification of economic inequality with income inequality is fairly common in economics, and the two are often seen as effectively synonymous. If you tell someone that you are working on economic inequality, it is quite standardly assumed that you are studying income distribution.
To some extent, this implicit identification can be found in the philosophical literature as well. For example, in his interesting and important paper “Equality as a Moral Ideal,” Harry Frankfurt, the distinguished philosopher, provides a closely reasoned and powerful critique of what he calls “economic egalitarianism,” defining it as “the doctrine that there should be no inequalities in the distribution of money.”51
The distinction, however, between income inequality and economic inequality is
important.52 Many of the criticisms of economic egalitarianism as a value or a goal apply much more readily to the narrow concept of income inequality than they do to the broader notions of economic inequality. For example, giving a larger share of income to a person with more needs—say, due to a disability—can be seen as militating against the principle of equalizing incomes, but it does not go against the broader precepts of economic equality, since the greater need for economic resources due to the disability must be taken into account in judging the requirements of economic equality.