This is a study of the effects of gender stratification in Egypt upon medical treatment of boys and girls. Mortality of children in Egypt has declined rapidly in recent years, but a female disadvantage in post-neonatal and early childhood mortality persists, probably the result of the differential amount and type of medical care that boys and girls receive. Previous research has identified women's status as an important determinant of demographic outcomes and gender differentials in medical treatment; however, the conceptualization and measurement of women's status vary widely. This study adapts a bargaining approach to explain the probability that boys and girls receive medical treatment at the onset of an illness episode. Bargaining theory, based on the assumption that men and women within a household have different gender preferences, posits that the inability of adult women to implement their preferences prevents sick daughters from receiving equitable medical treatment. Of interest in this study are the intra-household and community-level aspects of gender stratification that determine a woman's realized autonomy (actual mobility and decision-making authority), gender preferences (long-term and short-term costs and benefits of sons and daughters), and beliefs regarding the health risks of boys and girls. The objectives of this study are, therefore: 1) to identify the extent to which a gender bias in the allocation of medical care to boys and girls exists, 2) to measure exogenous aspects of gender stratification among adults within the household and community, 3) to examine the ways in which gender stratification among adults influences treatment choices for sick boys and girls, and 4) to assess the degree to which child survival interventions can offset unequal allocations of medical care to boys and girls. Data sources will include: 1) in-depth interviews and case histories of child illness episodes collected over seven months from men and women in a random sample of two rural vi llages and two urban neighborhoods in Minia, Egypt, 2) a population-based survey, and 3) community-level data sources such as area maps of the distribution of health facilities. Indices of women's autonomy, gender preferences, and health beliefs will be developed from the responses to survey questions. Ordinary least squares regression will be used to assess the effects of the exogenous intra-household and community-level indicators on the intermediate indices. Logit regression based on maximum likelihood will be used to assess the effects of service availability on treatment choices of parents in the presence of the other determinants. The potential endogeneity of the intermediate dimensions of women's autonomy, gender preferences, and health beliefs will be tested. Evidence of endogeneity will require the use of instrumental variables and two stage regression to derive unbiased estimates of coefficients in the final model. Because treatment outcomes of children in the same household and community are likely to be correlated, generalized estimation techniques will be used to correct for correlated errors and group-wise heteroskedasticity. The direct and indirect effects of selected underlying individual-level and community-level variables on the outcome will be assessed using path analysis. Clarification of the mechanisms by which gender inequality is transferred from one generation to the next will enhance the development of policies that benefit adult women and young girls directly. The results of this study will also clarify the degree to which public health interventions can be tailored to diminish persistent inequalities in health care provision to children.
