Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
Senior Public Health Intelligence Analyst, Medway Council, Chatham, England.
PLoS One. 2022 May 11;17(5):e0268126. doi: 10.1371/journal.pone.0268126. eCollection 2022.
Despite India's steady economic growth over recent the period, the burden of childhood malnutrition persists, contributing to higher neonatal and infant mortality. There is limited evidence available to contextualise mothers' crucial role in childcare practices and health status in the Indian context. This study attempts to assess the association between maternal autonomy and the nutritional status of children under five. We used samples of 38,685 mother-child pairs from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015-16. We considered three widely used indicators of child nutrition as outcome variables: stunting, wasting, and underweight. Maternal autonomy (measured from three dimensions: household decision-making, freedom of physical movement, and access to economic resources/control over assets) was the key predictor variable, and various child demographics, maternal, and household characteristics were considered control variables. Stepwise binary logistic regression models were performed to examine the association. Of study participants, 38%, 21%, and 35% of children were stunted, wasted, and underweight, respectively. Our results (models 1 to 4) indicate that mothers with greater autonomy were significantly associated with lower odds of malnourished children. After controlling for all potential confounding variables (in model 5), maternal autonomy had a statistically insignificant association with children's stunting (Odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.87, 1.00) and wasting (OR: 0.92; 95% CI: 0.85, 1.00). However, a significant relationship (though marginally) was retained with underweight (OR: 0.94; 95% CI: 0.88, 0.99). In addition, socio-demographic characteristics such as child age, birth order, maternal education, maternal BMI, place of residence and household wealth quintile were found to be strong predictors of child nutritional status. Future policies should not only inform women's empowerment programmes but also emphasise effective interventions toward improving female educational attainment and nutritional status of women, as well as addressing socioeconomic inequalities in order to combat the persistent burden of childhood malnutrition in India.
尽管印度在最近一段时间经济稳步增长，但儿童营养不良的负担仍然存在，导致新生儿和婴儿死亡率上升。在印度背景下，有关母亲在儿童保育实践和健康状况方面的关键作用的证据有限。本研究试图评估母亲自主权与五岁以下儿童营养状况之间的关系。我们使用了 2015-16 年进行的第四次全国家庭健康调查（NFHS-4）的 38685 对母子样本。我们将三种广泛使用的儿童营养指标作为结果变量：发育迟缓、消瘦和体重不足。母亲自主权（从三个维度衡量：家庭决策、身体活动自由和获得经济资源/对资产的控制）是关键预测变量，各种儿童人口统计学、产妇和家庭特征被视为控制变量。我们进行了逐步二元逻辑回归模型来检验相关性。在研究参与者中，分别有 38%、21%和 35%的儿童发育迟缓、消瘦和体重不足。我们的结果（模型 1 到 4）表明，自主权较大的母亲与营养不足的孩子的可能性较小显著相关。在控制所有潜在混杂变量后（在模型 5 中），母亲自主权与儿童发育迟缓（优势比[OR]：0.93；95%置信区间[CI]：0.87，1.00）和消瘦（OR：0.92；95% CI：0.85，1.00）之间的关联具有统计学意义。然而，与体重不足（OR：0.94；95% CI：0.88，0.99）的关系仍然保持显著（尽管略有）。此外，儿童年龄、出生顺序、母亲教育、母亲 BMI、居住地和家庭财富五分位数等社会人口学特征被发现是儿童营养状况的强有力预测因素。未来的政策不仅应告知妇女赋权计划，还应强调有效的干预措施，以提高女性教育程度和妇女的营养状况，并解决社会经济不平等问题，以消除印度儿童营养不良的持续负担。
