gender of the fetus, sometimes aborting female children. Moreover, a small fraction of Indian and Chinese couples practice female infanticide. Additionally, in Mumbai, India, women had to be more seriously ill than men to be taken to a hospital. India, China, and the Middle East, with low female to male ratios, have a bias in nutrition and health care that favours males. Discrimination against women in schools, jobs, and other economic opportunities lies behind the bias against the care of females within the family (Sen 1993: 40-7). 2.9 Sen’s view of food entitlements, the state, and famines Econometric and case study evidence indicates that war and state violence increase nutritional vulnerability.14Relief agencies indicate 20 million deaths from severe malnutrition in 1991 in six African countries—Ethiopia, Liberia, Sudan, Somalia, Angola, and Mozambique—where food trade was disrupted by domestic political conflict. Moreover, while, on the one hand, food deficits contribute to refugee problems, on the other hand, the five million or so refugees annually fleeing civil wars, natural disasters, and political repression (including before 1990, South Africa’s destabilization) added to Africa’s food shortages.15The conventional economic approach examines food (or total) output and its distribution, focusing on agricultural production, poverty rates, and Gini indices of concentration. According to this explanation, famine arises from a decline in food availability (Ravallion 1997: 1207-08). Amartya Sen (1981, 1983b) and Drèze and Sen (1989) criticize this explanation, emphasizing that nutrition depends on society’s system of entitlement. Entitlementrefers to the set of alternative commodity bundles that a person can command in a society using the totality of rights and opportunities that he or she possesses. An entitlement helps people acquire capabilities (like being well nourished). In a market economy, the entitlement limit is based on ownership of factors of production and exchange possibilities (through trade or a shift in production possibilities). For most people, entitlement depends on the ability to find a job, the wage rate, and the prices of commodities bought. In a welfare or socialist economy, entitlement also depends on what families can obtain from the state through the established system of command. A hungry, destitute person will be entitled to something to eat, not by society’s low Gini inequality and a high food output per capita, but by a relief system offering free food. Thus, in 1974, thousands of people died in Bangladesh despite its low inequality, because floods reduced rural employment along with output, and inflation cut rural labourers’ purchasing power. Sen argues that food is ‘purchased’ with political pressure as well as income. Accordingly, one-third of the Indian population goes to bed hungry every night and 14Nafziger et al. (2000); Nafziger and Auvinen (2003).