Discussion The study has attempted to identify the poor of the Matete Zone, using three convergent approaches--expenditure, calorie consumption, and proportion of expenditure for food. The caloric norm per person of 2,200 calories per day provides the lowest poverty estimate of about 44%. The two other norms would place the proportion of poor households at about 60%. Even if the data corresponding to each indicator had weaknesses, the fact that these are consistent with one another makes the results worthy of confidence (13). Among the poor, the widows are in the lowest economic bracket. Interviews to obtain family histories of widows resulted in a deeper understanding of the consequences of death in the family, especially of the breadwinner. Based on the experience from this study, several larger poverty studies have been initiated in former Zaire. Apart from problems in the use of 'poverty-lines' to identify the poor (14), there are inherent but unavoidable difficulties with the methodology used. There are biases that arise both from the respondents and the interviewers. There can be memory lapses on the part of respondents regarding expenditure or deliberate efforts to misinform the interviewer. The poor live from day to day and cannot easily make a budget of their expenses for a month or even a week. Measuring tools used for food are local ones, not necessarily calibrated. These have to be converted into kilograms. Although exchanges through barter are not common in urban areas, there are several non-monetized transactions as produce from kitchen gardens. Efforts have been made during the field work to account for these items, but these are at best estimates. When compounded with the inherent difficulties mentioned earlier, the figures in the tables must be considered reasonable approximations. The need for longitudinal databases, as maintained by the ICDDR,B: Centre for Health and Population Research in Matlab or periodic cross-sectional surveys as the National Sample Survey in India, can only be stressed for scientific studies to understand the linkages between mortality and poverty. Lack of mother's education, malnutrition, low socioeconomic status, and some of the variables associated with poverty have been documented as being related to higher mortality levels in Matlab (15,16). Studies of death in varied cultural settings also need to be made to understand the linkages between poverty and death in the family. In Kinshasa, widows from patrilinear families are at greater risk of poverty after the death of their spouses than those from matrilinear families. In South Asia, the traditional role of the eldest male child at the death of parents as well as other issues, such as lack of security in old age, the dowry system, and the low status of women, foster the so-called ‘son preference.' In poverty situations, it has been documented in the Matlab area that both nutrition and healthcare could be reserved for boys rather than girls (17). Sex-selective abortion has now also made its appearance in India, with science being able to detect the sex of the unborn child. The relationship between poverty and death in the family must also be viewed from the point of view of fertility. The poor have large families, and hence a certain type of wisdom would insist that having fewer children and better reproductive health is the answer. However, at the microlevel, the view of the world is somewhat different. There are a few, if any, social security schemes for the poor in much of the developing world. Life insurance policies are also practically nonexistent in the rural areas where most of the poor live. In urban areas, even in the fortunate cases of pension schemes, widows are faced with the ever-decreasing value of their pensions, given the high inflation rates that exist in most developing countries. With this background, the widows who were interviewed clearly placed great reliance regarding their economic security on their immediate family members, including elder children. Children at an early age are compelled to work to support the family in many countries of the developing world. Safety nets and transfers are effected through relatives. Schematically, one can consider the linkages between death in the family and poverty as in the two boxes below. The first box contains variables associated with death in the family, and the second one has some variables associated with poverty. The inevitable passage from one box to the next can be avoided through appropriate safety nets/transfers. The role of governments in providing health and social services to the poor has been absent from our considerations. In the DRC, most effective social services are now provided by nongovernment organizations. The informal sector has increased enormously. Even before the tragic events of 1991 when soldiers went on the rampage as indicated in the introduction, this sector provided employment for many, especially women. It has been estimated that the per-capita GDP rises from US$ 150 to US$ 250 if the informal sector is taken into account (18). The role of a government, no matter how poor, should be to assist in facilitating this sector, and examples exist in several parts of the world. Education and empowerment of women through employment have been shown to be key areas through which the mortality-poverty trap can be avoided, and awareness at the micro-level of the need for control of family size can be increased. In the case of the breadwinner's death, the burden--resulting from the lack of safety nets--falls on widows, often unprepared to take the breadwinners' role. To enable governments of poor countries to provide safety nets, they must be relieved of the heavy debt burdens that their countries face. The so-called 20-20 compact for human development remains a vague goal (3). Apart from the need to achieve effective internal security, accountability, and political stability, governments in developing countries will have to show greater social awareness and managerial skills in the use of scarce resources, if they are to overcome a certain donor resistance.
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