Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina.
Helen Keller International Nepal, Kathmandu, Nepal.
Matern Child Nutr. 2020 Jan;16(1):e12883. doi: 10.1111/mcn.12883. Epub 2019 Sep 3.
Women's intra-household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross-sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multisectoral programme in Nepal, focusing on households with children 0-23 months (n = 1787). We examined if women's bargaining power was related to exposure to IYCF information and if exposure to IYCF information was in turn associated with improved IYCF practices: early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency and dietary diversity. Bargaining power consisted of four domains: (i) ownership and control of assets; (ii) social participation; (iii) workload; and (iv) household decision-making control and were primarily measured using additive scales. We used generalized structural equation modelling to examine if exposure to IYCF information mediated the relationship between the bargaining domains and the four IYCF practices, separately. Social participation was positively associated with exposure to IYCF information (β = 0.266, P < .001), which in turn was related to early initiation (β = 0.241, P = .001). We obtained similar results for the relationship between social participation and dietary diversity. Decision-making control was directly associated with exclusive breastfeeding (β = 0.350, P = .036). No domains were associated with minimum meal frequency. Different domains of women's bargaining power may relate to exposure to nutrition information and IYCF behaviours. Understanding specific domains of bargaining power is critical to developing interventions that can effectively address gender-related issues that underlie child nutrition outcomes.
妇女在家庭中的议价能力是儿童营养状况的一个重要决定因素，但关于其如何与婴幼儿喂养（IYCF）实践相关的证据有限。我们使用尼泊尔多部门计划 Suaahara 的影响评估 2012 年基线数据进行了横断面分析，该计划重点关注 0-23 个月大的儿童的家庭（n=1787）。我们研究了妇女的议价能力是否与接触 IYCF 信息有关，以及接触 IYCF 信息是否与改善 IYCF 实践有关：早期开始母乳喂养、纯母乳喂养、最低用餐频率和饮食多样性。议价能力由四个领域组成：（i）资产的所有权和控制权；（ii）社会参与；（iii）工作量；以及（iv）家庭决策控制，主要通过加性量表进行衡量。我们使用广义结构方程模型分别检验了 IYCF 信息的暴露是否在议价领域和四个 IYCF 实践之间的关系中起中介作用。社会参与与接触 IYCF 信息呈正相关（β=0.266，P<0.001），而接触 IYCF 信息又与早期开始（β=0.241，P=0.001）有关。我们在社会参与与饮食多样性之间的关系中获得了类似的结果。决策控制与纯母乳喂养直接相关（β=0.350，P=0.036）。没有领域与最低用餐频率相关。妇女议价能力的不同领域可能与接触营养信息和 IYCF 行为有关。了解议价能力的具体领域对于制定能够有效解决儿童营养结果背后的性别问题的干预措施至关重要。
