Jones Rebecca, Haardörfer Regine, Ramakrishnan Usha, Yount Kathryn M, Miedema Stephanie, Girard Amy Webb
Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA.
Department of Behavioral Sciences and Health Education, Emory University, USA.
SSM Popul Health. 2019 Nov 20;9:100475. doi: 10.1016/j.ssmph.2019.100475. eCollection 2019 Dec.
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.
妇女赋权与儿童营养改善相关，二者均是实现多个可持续发展目标（SDG）的基础。我们研究了妇女赋权影响儿童营养状况的途径。我们汇总了2011年至2016年期间在埃塞俄比亚、肯尼亚、卢旺达、坦桑尼亚和乌干达对有6至24个月大孩子的已婚妇女进行的人口与健康调查中的全国代表性数据（n = 13780）。我们使用贫血、年龄别身高Z评分（HAZ）和年龄别体重Z评分（WHZ）来衡量儿童营养状况。我们使用一种经过验证的测量方法来衡量妇女赋权，该方法由三个潜在领域组成：社会/人力资产（“资产”）、内在能动性（对亲密伴侣暴力的态度）和工具性能动性（在家庭决策中的影响力）。我们使用带有潜在结构的结构方程模型来估计从妇女赋权到儿童营养状况的假设途径，并通过孕产妇体重指数（BMI）进行进一步中介分析以及按财富分层分析。妇女赋权领域与孕产妇BMI呈直接正相关（估计值±标准误：资产，0.17±0.03；内在能动性，0.23±0.03；工具性能动性，0.03±0.01）。孕产妇BMI与儿童HAZ（0.08±0.04）和儿童WHZ（0.35±0.03）呈直接正相关。资产通过内在能动性和孕产妇BMI与儿童HAZ和WHZ存在间接关联。在最贫困财富类别中，妇女赋权对儿童营养状况的直接影响显著（资产和工具性能动性与贫血相关；内在能动性与HAZ相关）。在最富裕财富类别中，妇女赋权对儿童营养状况的直接影响显著（内在能动性和工具性能动性与WHZ相关）。在东非，提高妇女赋权，尤其是内在能动性，可直接改善儿童营养状况，并通过改善孕产妇营养来实现。这些发现表明，实现可持续发展目标5的努力可能会对其他可持续发展目标产生溢出效应。然而，通过赋权方法改善营养的策略可能还需要解决家庭资源限制问题。
