7 (+1) WAYS TO IMPROVE RESEARCH ON THE IMPACT OF WOMEN’S EMPOWERMENT ON CHILD NUTRITION

Photo: M. Santoso

We all believe in the inherent importance of women’s empowerment, but as a reader of this blog, you also likely believe in the role of women’s empowerment in ensuring good child nutrition. If so, you would probably be as surprised as we were to find out that our systematic review of the literature on this relationship was inconclusive. It definitely made us pause and wonder how that could be.

Yet it seemed to be the case: after reviewing 62 studies and finding 200 unique indicators of women’s empowerment tested in 1316 associations with various child nutrition outcomes, we found that about 83 percent of those associations were neither statistically nor biologically significant. The findings are concerning, since they seem to indicate there is no underlying relationship between women’s empowerment and child nutrition.

During our analysis, however, we also noticed some crucial methodological weaknesses in the available evidence. Below are some suggestions to address these weaknesses before we can conclude that the role of women’s empowerment is unimportant for child nutrition outcomes.

1. Use longitudinal study designs. All 62 studies were observational and cross-sectional, meaning data were collected at one time-point, which allows us to explore associations but not infer causation. To do so, we would need longitudinal (multiple time-point) study design, both observational and interventional (e.g. measure nutrition impacts of gender equity interventions).
2. Examine relevant indicators. Two-thirds (42 out of 62) of the studies were secondary data analyses, which might explain why some analyze indicators that do not have clear pathways of impact towards child nutrition, such as political group membership. Explicitly declaring how researchers expect a women’s empowerment indicator to affect child nutrition would help avoid this problem.
3. Pay attention to pathways. Half (31 out of 62) of the studies controlled for variables that might be a pathway by which women’s empowerment impacts child nutrition, such as care practice score or infant and young child feeding practices. Since controlling for something in a regression means erasing the effect of that variable, it is not surprising these studies find the relationship between women’s empowerment and child nutrition to be statistically insignificant. A more helpful analysis would examine the relationship between women’s empowerment and these pathway variables or analyze how these pathway variables mediate the relationship between women’s empowerment and child nutrition.
   

   Photo: M.Santoso

4. Think about timing. A big proportion (39 out of 62) of the studies tested women’s current empowerment and child stunting. Stunting is an indicator of chronic malnutrition; it might be impacted by women’s decision-making power as to whether she wants to be pregnant in the first place, her workload during pregnancy and breastfeeding, her child’s diet over the years, and so on. Since a woman’s level of empowerment can vary over time, her current empowerment level might not reflect these indicators. This is another reason why we need longitudinal study design and to pay attention to pathways.
5. When choosing indicators, consider pathways and lifecycle. The pathway by which women’s empowerment impacts child nutrition varies throughout her life. For example, when assessing child nutritional status at birth, women’s decision-making power in reproductive decisions and readiness for pregnancy might be especially pertinent. When looking at child nutrition during the breastfeeding period, we should consider analyzing the relationship between gender equity in household tasks allocation, women’s time use, and rate of exclusive breastfeeding. More studies exploring the role of the mother’s physical and mental health on the relationship between various women’s empowerment indicators, childcare practices, and eventually child nutrition are also needed. The figure below offers more proposed pathways.
6. Investigate interaction with household wealth. Women’s empowerment is expected to impact child nutrition through better resource allocation. However, in extremely poor households where there are limited or no resources to be allocated, it is possible that women’s decision-making might have no effect on childcare practices. This is also true in extremely wealthy households where resource allocation is not a contested issue.
7. Diversify populations studied. Only 14 out of 62 studies included data from outside South Asia and sub-Saharan Africa. Since the importance of various indicators of women’s empowerment vary by region, we need more studies looking at this relationship in other regions.

+1    (Also) study men. Only 2 out of the 62 studies considered men’s engagement in childcare as an indicator, which means the literature is missing a very important pathway between gender equity and child nutrition. For example, increasing available healthy foods for children in the household can be achieved by increasing women’s ability to decide which food to buy or by encouraging men to buy healthy foods. Similarly, increasing parental time spent in childcare can be achieved by engaging men in childcare or by having them help more with household chores. After all, having men involved in tasks previously coded as ‘for women’ is an important aspect of gender equity.

So far, the evidence between women’s empowerment and child nutrition has been limited and inconclusive. We believe all eight of these points can contribute to ensuring more useful findings in this burgeoning field, and better design programs that support both women’s empowerment for healthier mothers and children.

Marianne Santoso is a postdoctoral fellow in the Department of Anthropology at Northwestern University. She also manages the Singida Nutrition and Agroecology Project, a nutrition-sensitive agroecological intervention in Singida, Tanzania.