Page 10 of men -- as dat:.a from higher income countries demonstrate (see table 1). But in poorer countries, life expectancy at b4rth for women and men is about equal, and the natural advantage of women emerges only as income rises (see table 1 and box) (World Bank WDR 1988). Moreover, the ratio of girls to boys up to the age cf four is below .95 in a number of countries, particularly in South Asia (World Bank WDR 1988). This may reflect undercounting of girls in societies where girls are comparatively less valued, but evidence suggests disproportionate mortality for very young girls in India and China (see box) (Chatterjee 1988).

27. Age-specific mortality rates for women in the childbearing years are also sometimes higher than for men, as in India and Ethiopia. In the development world as a whole, millions of "misk ing women" have died prematurely (Sen 1987). Women's health is not well studied, but it appears that maternal deaths account for over one-fourth of all deaths of women in the childbearing ages in many developing countries. About half of all maternal deaths occur in the low-income countries of South Asia and 30 percent in Africa (see box) (WHO 1987). Such gender-related disadvantages tend to diminish as incomes increase: with increased wealth, families treat children of both genders more equally and women's reproductive health improves.

28. Women's disadvantage as measured in health indicators may reflect cultural traditions, such as reserving the best food for men or boys, feeding men or boys first, or devoting more time to the care of boys than to girls when children fall sick (Chatterjee 1988; Pitt and Rosenzweig 1988). Particularly in South Asia, women and girls apparently often suffer poorer nutritional status, especially when the household is short of food (see box) (Schultz 1989; Chen and others 1981; Horowitz 1980; Chatterjee 1988). However, some evidence from Africa and the Near East indicates a similar nutritional status for boys and girls. In the Philippines, for example, family members reportedly spend 23 percent less time in child care for girls than for boys (Evenson and others 1980).

29. Although women usually bear primary responsibility for safeguarding family health and often find health care for others in the family, they may have difficulty obtaining health care for themselves (Herz and Measham 1987; Chatterjee 1988). In some places women need a male relative's permission to seek health care. In some places they can only be treated by female health workers (Kwast 1987). And in some places, clinics report fewer female than male patients (Bevan and others 1988; Ravindran 1986; Chatterjee 1988), although women are more likely tc need health care, particularly during the childbearing years. Most rural women work longer hours than men. The physical strains of housework, fetching water and fuelwood, and agricultural labor, combined with frequent pregnancies and minimal rest and leisure time, exact a toll on women.

30. Less schooling. Substantial evidence shows that women in poorer countries are also at a greater disadvantage in education (as measured by either years of schooling or enrollment rates (see tables 1 and 2). In high-income countries, women attend school about as many years as men and may report higher enrollment rates, at least through secondary school. In Latin America and East Asia, women receive 94 percent and 83 percent, respectively, as much education as men. By contrast, the countries of South and West Asia and Africa invest only about half