Dutta Susmita, Dutta Ajay, Maiti Suraj
Independent Researcher, Mumbai, India.
International Institute for Population Sciences, Mumbai, 400 088, India.
Sci Rep. 2025 Aug 4;15(1):28402. doi: 10.1038/s41598-025-08368-6.
Women's nutritional health is significantly influenced by their social standing, especially in low- and middle-income countries where patriarchal structures restrict women's decision-making. In India, women have limited autonomy over personal and domestic matters, which restricts their decision-making power and access to resources. In this context, this study investigates the relationship between women's empowerment and their nutritional health in India. We used nationally representative data from the most recent iteration of the National Family Health Survey (NFHS-5), 2019-2021. Women's autonomy was measured using a composite Women's Autonomy Index (WAI), encompassing decision-making power, asset ownership, and freedom of movement. Logistic regression models were used to estimate the association between WAI and underweight (BMI < 18.5 kg/m), controlling for sociodemographic and household factors. Robustness checks were performed, which included modelling continuous BMI, using alternative autonomy specifications (WAI Modified), and performing stratified analysis by urban-rural residence. A total of 14.0% (95% CI 13.6, 14.4%) of the study participants were underweight. Higher autonomy was associated with significantly lower odds of being underweight (adjusted OR: 0.951; 95% CI 0.923, 0.980). The margins analysis indicated that the predicted underweight prevalence was 9.5% among women with the highest autonomy scores compared to 16.3% among those with no/low autonomy. Continuous BMI models showed a positive gradient, with BMI increasing by approximately 1.5 kg/m across the full range of autonomy scores. Stratified analysis revealed stronger autonomy effects in urban areas. These associations remained robust when we used an expanded autonomy measure that incorporated joint decision-making. Women's age, educational status, work status, husband's educational level, place of residence, household size, and household wealth were strong predictors of women's nutritional status. We find a strong association between women's autonomy and nutritional status, with higher autonomy reducing the risk of undernutrition. In addition, regional and socioeconomic disparities are also factors that affect women's nutritional status. Policy interventions that ameliorate women's decision-making power, asset control, and mobility can effectively address undernutrition among women and promote broader health gains.
女性的营养健康受到其社会地位的显著影响，尤其是在低收入和中等收入国家，父权结构限制了女性的决策权。在印度，女性在个人和家庭事务上的自主权有限，这限制了她们的决策权和资源获取。在此背景下，本研究调查了印度女性赋权与其营养健康之间的关系。我们使用了2019 - 2021年最新一轮全国家庭健康调查（NFHS - 5）具有全国代表性的数据。女性自主权通过综合女性自主权指数（WAI）来衡量，该指数涵盖决策权、资产所有权和行动自由。使用逻辑回归模型来估计WAI与体重过轻（BMI＜18.5kg/m²）之间的关联，并控制社会人口学和家庭因素。进行了稳健性检验，包括对连续BMI进行建模、使用替代自主权规格（修改后的WAI）以及按城乡居住地进行分层分析。共有14.0%（95%CI 13.6，14.4%）的研究参与者体重过轻。更高的自主权与体重过轻的几率显著降低相关（调整后的OR：0.951；95%CI 0.923，0.980）。边际分析表明，自主权得分最高的女性中预测的体重过轻患病率为9.5%，而无自主权/低自主权女性中的这一患病率为16.3%。连续BMI模型显示出正梯度，在整个自主权得分范围内，BMI大约增加1.5kg/m²。分层分析显示城市地区的自主权效应更强。当我们使用纳入共同决策的扩展自主权衡量标准时，这些关联仍然稳健。女性的年龄、教育状况、工作状况、丈夫的教育水平、居住地、家庭规模和家庭财富是女性营养状况的有力预测因素。我们发现女性自主权与营养状况之间存在很强的关联，更高的自主权可降低营养不良的风险。此外，地区和社会经济差异也是影响女性营养状况的因素。改善女性决策权、资产控制权和行动能力的政策干预措施可以有效解决女性的营养不良问题，并促进更广泛的健康改善。
