Women's empowerment and child nutrition: The role of intrinsic agency.

Rebecca Jones,Stephanie Miedema,Amy Webb Girard,Kathryn M Yount,Usha Ramakrishnan,Regine Haardörfer

doi:10.1016/j.ssmph.2019.100475

Abstract

Women's empowerment is associated with improved child nutrition, and both underpin the achievement of multiple Sustainable Development Goals (SDGs). We examined pathways by which women's empowerment influences child nutritional status. We pooled nationally representative data from Demographic and Health Surveys (2011–2016) collected from married women with children aged 6–24 months in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda (n = 13,780). We operationalized child nutritional status using anemia, height-for-age z-score (HAZ), and weight-for-age z-score (WHZ). We operationalized women's empowerment using a validated measure comprised of three latent domains: social/human assets (“assets”), intrinsic agency (attitudes about intimate partner violence), and instrumental agency (influence in household decision making). We used structural equation models with latent constructs to estimate hypothesized pathways from women's empowerment to child nutritional status with further mediation by maternal body mass index (BMI) and stratification by wealth. Women's empowerment domains were directly and positively associated with maternal BMI (estimate±SE: assets, 0.17 ± 0.03; intrinsic agency, 0.23 ± 0.03; instrumental agency, 0.03 ± 0.01). Maternal BMI was directly and positively associated with child HAZ (0.08 ± 0.04) and child WHZ (0.35 ± 0.03). Assets were indirectly associated with child HAZ and WHZ through intrinsic agency and maternal BMI. In the lowest wealth category, the direct effects from women's empowerment to child nutritional status were significant (assets and instrumental agency were associated with anemia; intrinsic agency associated with HAZ). In the highest wealth category, direct effects from women's empowerment on child nutritional status were significant (intrinsic and instrumental agency associated with WHZ). Improving women's empowerment, especially intrinsic agency, in East Africa could improve child nutrition directly and via improved maternal nutrition. These findings suggest that efforts to realize SDG 5 may have spillover effects on other SDGs. However, strategies to improve nutrition through empowerment approaches may need to also address household resource constraints.

Highlights

In 2015, global leaders pledged to reduce chronic malnutrition in children younger than 5 years by 40 percent before the year 2025 (In ternational Food Policy Research Institute, 2016)
Empowerment of women resulting in more equitable distributions of power within the household may contribute to prioritization of women’s own nutrition and health, which may manifest in improved body mass index (BMI) and micronutrient status (Ramakrishnan, Grant, Goldenberg, Zongrone, & Martorell, 2012; Young, Nguyen, Addo, et al, 2015; Hambidge et al, 2019)
We propose three hypotheses for the crossnational evaluation of pathways of women’s empowerment to child nutritional status in five countries in East Africa

Summary

Introduction

In 2015, global leaders pledged to reduce chronic malnutrition in children younger than 5 years by 40 percent before the year 2025 (In ternational Food Policy Research Institute, 2016). Empowerment of women resulting in more equitable distributions of power within the household may contribute to prioritization of women’s own nutrition and health, which may manifest in improved body mass index (BMI) and micronutrient status (Ramakrishnan, Grant, Goldenberg, Zongrone, & Martorell, 2012; Young, Nguyen, Addo, et al, 2015; Hambidge et al, 2019) This shift could enhance children’s nutrition through direct biological transfer of nutrients in utero and in early infancy (Ackerson & Subramanian, 2008; Mason et al, 2014; Ramakrishnan et al, 2014; Shrimpton & Rokx, 2012; Wu, Imhoff-Kunsch, & Girard, 2012) and improved childcare capabilities throughout childhood (Engle, Menon, & Haddad, 1999; Matare, Mbuya, Pelto, Dickin, & Stoltzfus, 2015; Nuss baum, 2001)

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