Women's empowerment-related inequalities in complementary feeding practices among children aged 6-23 months in Indonesia: a decomposition analysis

Abstract

Objective: To examine inequalities in complementary feeding among infants aged 6-23 months across three domains of women's empowerment (social independence, attitude towards violence and decision-making) in Indonesia, and identify socioeconomic and demographic factors contributing to these inequalities.

Setting: This study used nationally and provincially representative data from the 2017 Indonesia Demographic and Health Survey, which included all 34 provinces and urban and rural areas.

Participants: Mothers of infants who met the following criteria: aged 6-23 months, last-born child, currently alive and residing with both parents.

Outcomes: Complementary feeding indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD).

Results: Overall, MDD, MMF and MAD were more concentrated among mothers with high empowerment levels. The greatest inequality was observed in MAD when ranked by social independence (Wagstaff Normalised Concentration Index, WCI 0.146; 95% CI 0.106 to 0.185), followed by MDD (WCI 0.144; 95% CI 0.108 to 0.181) and MMF (WCI 0.078; 95% CI 0.035 to 0.122) within the same domain. By decision-making, MMF was more disproportionately distributed (WCI 0.056; 95% CI 0.019 to 0.092) than MDD (WCI 0.048; 95% CI 0.016 to 0.080) and MAD (WCI 0.047; 95% CI 0.011 to 0.083). Evidence for the inequalities by attitude towards violence was statistically significant only for MDD. The main contributing factors to these inequalities were antenatal care, place of delivery, parents' education, fathers' occupation and women's empowerment domains.

Conclusions: This study provides evidence of the women's empowerment-related inequalities in complementary feeding, which were explained by disproportional distributions of mothers' and fathers' characteristics and behaviours. Interventions addressing poor complementary feeding practices should integrate key aspects of women's empowerment-such as enhancing decision-making autonomy, promoting social independence and addressing attitudes towards violence-and should prioritise disadvantaged groups, particularly mothers with limited access to healthcare and low educational attainment.

Keywords: Community child health; Decision Making; Health Equity; Indonesia; Nutrition.

Figure 1

Concentration of minimum dietary diversity, minimum meal frequency and minimum acceptable diet by women’s empowerment domains: attitude towards violence, decision-making and social independence. Long dash line (black): equality line; solid line (blue): complementary feeding indicator. WCI, Wagstaff Normalised Concentration Index.