Fivian Emily, Harris-Fry Helen, Shankar Bhavani, Pradhan Ronali, Mohanty Satyanarayan, Padhan Shibanath, Prost Audrey, Parida Manoj, Mishra Naba K, Rath Shibanand, Rath Suchitra, Allen Elizabeth, Kadiyala Suneetha
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Clin Nutr. 2025 Aug;122(2):460-473. doi: 10.1016/j.ajcnut.2025.05.027. Epub 2025 May 29.
Improving nutrition for all requires understanding how interventions influence nutrition inequalities within society. Intersectionality, which considers how multiple disadvantages intersect, may offer more precise insight into the equity of these interventions.
Using an intersectionality-informed approach and mediation with exposure-mediator interaction, we investigated how participation in nutrition-sensitive agriculture interventions tested in the UPAVAN trial affected inequalities in women's diets in Odisha, India.
We analyzed cross-sectional endline data from 3294 mothers of children aged 0-23 months in 111 UPAVAN intervention villages. We estimated dietary inequalities as excess relative risk of minimum dietary diversity (MDD-W) according to scheduled tribe (ST) identity (ST or non-ST), education (≥5, <5 y), or wealth (higher, lower) and comparing intersectional groups that combine ST/non-ST with education or wealth group. We used a 4-way decomposition to estimate whether these MDD-W inequalities were affected by social group differences in intervention participation rates (mediation only), participation benefits (interaction only), or both combined (mediated interaction).
Intervention participation and MDD-W were greater among the more advantaged groups of non-ST, higher education, or higher wealth. Often, the more disadvantaged groups had greater participation benefits (interaction only), which narrowed MDD-W inequalities. However, intersectional groups with 2 disadvantaged characteristics (e.g., poorer ST) had smaller participation benefits than those with 1 disadvantaged characteristic (e.g., wealthier ST), which widened MDD-W inequalities. Differences in participation rates had negligible effects on MDD-W inequalities. Often, any marginal widening of MDD-W inequalities due to disadvantaged groups participating less (mediation only) was suppressed by their greater participation benefits (mediated interaction).
To our knowledge, this is the first intersectionality-informed analysis of nutrition interventions. UPAVAN interventions mostly had equitable impacts, reducing several inequalities in maternal diet quality. We demonstrate how intersectionality-informed analyses can help identify inequities in nutrition interventions and inform the design of inclusive interventions that reach and benefit the most marginalized groups.
改善所有人的营养状况需要了解干预措施如何影响社会中的营养不平等现象。交叉性理论考虑了多种劣势如何相互交织，可能会为这些干预措施的公平性提供更精确的见解。
采用基于交叉性理论的方法并通过暴露 - 中介变量交互作用进行中介分析，我们研究了参与在UPAVAN试验中测试的营养敏感型农业干预措施如何影响印度奥里萨邦妇女饮食中的不平等现象。
我们分析了来自111个UPAVAN干预村庄中3294名0 - 23个月儿童母亲的横断面终期数据。我们根据预定部落（ST）身份（ST或非ST）、教育程度（≥5年、<5年）或财富状况（较高、较低），将饮食不平等估计为最低饮食多样性（MDD - W）的超额相对风险，并比较将ST/非ST与教育或财富组相结合的交叉群体。我们使用四向分解法来估计这些MDD - W不平等是否受到干预参与率的社会群体差异（仅中介作用）、参与收益（仅交互作用）或两者结合（中介交互作用）的影响。
在非ST、高学历或高财富等较优势群体中，干预参与度和MDD - W更高。通常，较弱势群体有更大的参与收益（仅交互作用），这缩小了MDD - W不平等。然而，具有两个劣势特征的交叉群体（例如，较贫困的ST）的参与收益比具有一个劣势特征的群体（例如，较富裕的ST）小，这扩大了MDD - W不平等。参与率的差异对MDD - W不平等的影响可忽略不计。通常，由于弱势群体参与较少（仅中介作用）导致的MDD - W不平等的任何边际扩大，都会被他们更大的参与收益（中介交互作用）所抑制。
据我们所知, 这是首次基于交叉性理论对营养干预措施进行的分析。UPAVAN干预措施大多具有公平影响，减少了孕产妇饮食质量方面的几种不平等现象。我们展示了基于交叉性理论的分析如何有助于识别营养干预措施中的不公平现象，并为设计惠及最边缘化群体的包容性干预措施提供参考。
