Abstract
BackgroundMaternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. However, few studies have investigated this relationship in LMIC.MethodsUsing cross-sectional samples from Demographic and Health Surveys, we investigated the association between maternal employment and overweight (body mass index [BMI] ≥ 25 kg/m2) among women in 38 LMIC (N = 162,768). We categorized mothers as formally employed, informally employed, or non-employed based on 4 indicators: employment status in the last 12 months; aggregate occupation category (skilled, unskilled); type of earnings (cash only, cash and in-kind, in-kind only, unpaid); and seasonality of employment (all year, seasonal/occasional employment). Formally employed women were largely employed year-round in skilled occupations and earned a wage (e.g. professional), whereas informally employed women were often irregularly employed in unskilled occupations and in some cases, were paid in-kind (e.g. domestic work). For within-country analyses, we used adjusted logistic regression models and included an interaction term to assess heterogeneity in the association by maternal education level. We then used meta-analysis and meta-regression to explore differences in the associations pooled across countries.ResultsCompared to non-employed mothers, formally employed mothers had higher odds of overweight (pooled odds ratio [POR] = 1.3; 95% Confidence Interval [CI] 1.2, 1.4) whereas informally employed mothers, compared to non-employed mothers, had lower odds of overweight (POR = 0.72; 95% CI: 0.64, 0.81). In 14 LMIC, the association varied by education. In these countries, the magnitude of the formal employment-overweight association was larger for women with low education (POR = 1.5; 95% CI: 1.1, 1.9) compared to those with high education (POR = 1.2; 95% CI: 1.0, 1.3).ConclusionsFormally employed mothers in LMIC have higher odds of overweight and the association varies by educational attainment in 14 countries. This knowledge highlights the importance of workplace initiatives to reduce the risk of overweight among working women in LMIC.
Highlights
Maternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation
Because we retained interaction terms in select countries (n = 14), we estimated pooled odds ratios (POR), using random effects meta-analysis, separately for the associations between formal and informal employment and overweight for three subgroups: women in countries where the association did not vary education, women with low educational attainment (< primary) in countries where the association varied by education, and women with high educational attainment (≥ primary) in countries where the association varied by education
Being formally employed, compared to nonemployed, was associated with 30% higher odds of maternal overweight when pooling estimates across 38 LMIC (POR = 1.3; 95% Confidence Interval [CI] 1.2, 1.4) (Table 2)
Summary
Maternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. Over the past two decades, there have been vast increases in employment and shifts from part-time to full-time work among women in low- and middleincome countries (LMIC) [1, 2]. These increases are paralleled by increases in the prevalence of overweight and a changing nutritional landscape, characterized by shifts in diet (e.g. increases in consumption of processed foods) and physical activity (e.g. decreases in energy expenditure) [3,4,5,6,7,8,9]. Key limitations of these studies include using a dichotomous indicator of employment and only reporting regional-level trends
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