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

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.

Keywords: East Africa; Maternal and child health; Nutritional status; Women's empowerment.

Fig. 1

Conceptual tested path models from Women's empowerment to Children's nutritional status.

Fig. 2

Diagram of direct and indirect standardized path coefficients from Women's empowerment to Children's nutritional status (N = 13,780). Note. ^a Model fit statistics: df = 78; CFI = 0.995; TLI: 0.993; RMSEA: 0.004 (0.001,0.006). ^b Significant paths based upon 95% confidence intervals. ^c All nonsignificant paths were dropped for simplicity. ^d Anemia model excludes Kenya (n = 4918). ^e Abbreviations: HAZ, height-for-age z-score; WHZ, weight-for-age z-score. df, degrees of freedom; CFI, comparative fit index; TLI, tucker lewis index; RMSEA, root-mean square error of approximation.

Fig. 3

Diagram of direct and indirect standardized path coefficients from Women's empowerment to Children's nutritional status mediated by Women's BMI (N = 13,780). Note. ^a Model fit statistics: df = 88; CFI = 0.994; TLI: 0.991; RMSEA: 0.004 (0.002,0.006). ^b Significant paths based upon 95% confidence intervals. ^c All nonsignificant paths were dropped for simplicity. ^d Anemia model excludes Kenya (n = 4918). ^e Abbreviations: BMI, body mass index; HAZ, height-for-age z-score; WHZ, weight-for-age z-score. df, degrees of freedom; CFI, comparative fit index; TLI, tucker lewis index; RMSEA, root-mean square error of approximation.

Fig. 4

Diagram of direct and indirect standardized path coefficients from Women's empowerment to Children's nutritional status mediated by Women's BMI, by wealth groups (N = 13,780). A. Low. B. Middle. C. High. Note. ^a Model fit statistics: df = 288; CFI = 0.990; TLI: 0.988; RMSEA: 0.008 (0.006,0.009). ^b Significant paths based upon 95% confidence intervals. ^c All nonsignificant paths were dropped for simplicity. ^c Anemia model excludes Kenya (n = 4918). ^d Wealth categories based on Demographic and Health Survey household wealth index. ^e Abbreviations: BMI, body mass index; HAZ, height-for-age z-score; WHZ, weight-for-age z-score. df, degrees of freedom; CFI, comparative fit index; TLI, tucker lewis index; RMSEA, root-mean square error of approximation.