BRAC initiative towards promoting gender and social equity in health: a longitudinal study of child growth in Matlab, Bangladesh Masuma Khatun 1, *, Hans Stenlund 2 and Agneta Ho ¨rnell 3 1 Family Medicine, Department of Public Health and Clinical Medicine, Umea ˚ University, SE-901 85 Umea ˚, Sweden: 2 Epidemiology, Department of Public Health and Clinical Medicine, Umea ˚ University, Umea ˚, Sweden: 3 Department of Food and Nutrition, Umea ˚ University, Umea ˚ , Sweden Submitted 23 October 2003: Accepted 1 July 2004 Abstract Objective: To explore the effect of BRAC (formerly Bangladesh Rural Advancement Committee) initiatives towards promoting gender and social equity in health among children of poor mothers who are BRAC members. Design: A cohort of 576 children from the prospective study of a BRAC – International Centre for Diarrhoeal Disease Research, Bangladesh joint research project was analysed. Data were collected three times during 1995 – 1996 with approximately 4-month intervals. Stunting, defined as height-for-age below minus two standard deviations from the reference median, was the outcome health measure. The study children were stratified into three groups according to their mother’s social and BRAC membership status: poor and BRAC member (BM), poor non-member (TG) and non- poor non-member (NTG). Setting: Matlab, rural area of Bangladesh. Subjects: Children aged 6–72 months. Results: The overall prevalence of stunting was 76%; the highest prevalence was found among TG (84.6%) children and no significant difference was observed between BM and NTG children (67.3% and 69.4%, respectively). In all groups, a significantly larger proportion of girls was stunted compared with boys in the first round. Group-level analysis showed that stunting decreased among all children except BM boys at the end of third round, with the largest decline among BM girls. In contrast, stunting prevalence increased among BM boys. A similar trend was found in the individual-level analysis, where a larger proportion of BM girls recovered from stunting compared with other groups and no recovery was observed among BM boys. At the end of the third round, the nutritional status of BM girls was almost equal to that of the BM boys, while gender inequity remained large among TG and NTG children. Conclusion: The BRAC initiative appeared to contribute to a significant equity gain in health for girls, as well as to decreased differences in ill health between the poor and the non-poor. Keywords Gender Social equity Stunting Longitudinal study Development intervention Embankment Matlab The term gender refers to societies’ perceptions of and expectations on the social and cultural roles, values and behaviours of men and boys, girls and women, in contrast to the term sex, which refers to the biological differences between male and female 1 . Thus, gender is a social construction of the biological sex and therefore varies across cultures. Gender is also a key social stratifier through which the distribution of power, privileges and resources is systematically discriminated between men and women, which in turn affects their exposure to different health risks. The term ‘gender and social equity in health’ implies that health inequalities are arising from the unfair distribution of resources and benefits and not from the biological differences between sexes 2 . By social custom, rural women in Bangladesh are discriminated against in almost every aspect of their lives: privileges and resources are distributed enormously unequally between men and women, and poor women are the most disadvantaged of all 3 . For instance, the adult literacy rate among females is 29% compared with 52% among males 4 . Like in most other societies, women in Bangladesh are the principal caregivers during the most crucial periods of children’s development. However, caring practices, vital to children’s nutritional well-being, q The Authors 2004 *Corresponding author: Email masuma.khatun@fammed.umu.se Public Health Nutrition: 7(8), 1071–1079 DOI: 10.1079/PHN2004652 https://doi.org/10.1079/PHN2004652 Published online by Cambridge University Press