What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries

Mediating effects of women's empowerment on dietary diversity during pregnancy in Central West Ethiopia: A structural equation modelling

BACKGROUND

Considerable proportions of pregnant women consume inadequately diversified diets in Ethiopia. On the other hand, women's empowerment is identified as a means of achieving maternal nutrition improvement. However, evidence on the relationship between multiple dimensions of women's empowerment and dietary diversity during pregnancy is limited in Ethiopia.

OBJECTIVE

This study aimed to assess the mediating effects of women's empowerment in the pathway between women's education and dietary diversity during pregnancy in West Shewa zone, Ethiopia.

METHODS

A health facility-based cross-sectional study was conducted among 1,383 pregnant women in 2021. Dietary diversity was measured using the minimum dietary diversity for women (MDD-W) tool. Exploratory and confirmatory factor analyses were employed to identify and validate women's empowerment dimensions. Structural equation modelling (SEM) was used to examine the pathways linking pregnant women's education and empowerment to dietary diversity during pregnancy.

RESULTS

From the latent dimensions of women's empowerment produced by factor analyses, pregnant women's education was directly associated with household decision-making power, psychological and time dimensions. In turn, household decision-making power, psychological and time dimensions were associated with dietary diversity during pregnancy. The direct relationship between pregnant women's education and dietary diversity was insignificant, but the total indirect effect and total effect were significant. Household decision-making power, psychological and time dimensions were significant mediators in the relationship between pregnant women's education and dietary diversity. However, economic dimension was related to neither pregnant women's education nor dietary diversity.

CONCLUSION

This study highlights pregnant women with better education are more likely to be empowered in household decision-making, psychological and time dimensions; and those empowered pregnant women are more likely to consume more diverse diets, suggesting women's access to higher education could have a positive indirect effect on consumption of more diverse diets during pregnancy by empowering women in the study area.

Women's input and decision-making in agriculture are associated with diet quality in rural Tanzania

Background

Women's empowerment is one critical pathway through which agriculture can impact women's nutrition; however, empirical evidence is still limited. We evaluated the associations of women's participation, input, and decision-making in key agricultural and household activities with women's diet quality.

Methods

We analyzed data from a cross-sectional study of 870 women engaged in homestead agriculture. We used food frequency questionnaires to assess women's diets and computed women's diet quality using the Prime Diet Quality Score (PDQS) (range 0-42), which captures healthy and unhealthy foods. We evaluated women's decision-making in 8 activities, food crop farming, cash crop farming, livestock raising, non-farm economic activities, wage/salary employment, fishing, major household expenditures, and minor household expenditures. Generalized estimating equations (GEE) linear models were used to evaluate associations between (a) women's participation, (b) decision-making, (c) adequate input, (d) adequate extent of independence in decision-making in agriculture, and (e) adequate input in use of agricultural income with their PDQS. Adequate input was defined as input into some, most or all decisions compared to input into few decisions or none. Adequate extent of independence was defined as input to a medium or high extent compared to input to a small extent or none.

Findings

Median PDQS was 19 (IQR: 16-21). Women's adequate input in decision-making on wage and salary employment (estimate: 4.19, 95% CI: 2.80, 5.57) and minor expenditures were associated with higher PDQS vs. inadequate input. Women with independence in decision-making on livestock production (estimate: 0.97, 95% CI: 0.05, 1.90) and minor household expenditures, and women with adequate decision-making in the use of income from wages/salaries (estimate: 3.16, 95% CI: 2.44, 3.87) had higher PDQS. Participation in agricultural activities was positively associated with PDQS.

Conclusions

Women's participation and input in decision-making in wage and salary employment, livestock production, and minor household expenditures were strongly associated with the consumption of better-quality diets. Women participating in multiple farm activities were also likely to have better diet quality. This study adds to the growing evidence on the pathways through which women's empowerment may influence women's nutrition in rural Tanzania.

Measuring Women's Empowerment in Agriculture: Innovations and evidence

This paper addresses women's empowerment in agriculture, innovations in its measurement, and emerging evidence. We discuss the evolution of the conceptualization and measurement of women's empowerment and gender equality since 2010. Using a gender and food systems framework and a standardized measure of women's empowerment, the Women's Empowerment in Agriculture Index (WEAI), we review the evidence on "what works" to empower women based on impact evaluations of a portfolio of 11 agricultural development projects with empowerment objectives and a scoping review of livestock interventions. We then review the evidence on associations between empowering women and societal benefits--agricultural productivity, incomes, and food security and nutrition. We conclude with recommendations for measurement and policy.

Is women's household decision-making autonomy associated with their higher dietary diversity in Bangladesh? Evidence from nationally representative survey

In Bangladesh, a low-quality repetitive diet characterized by starchy staple foods is typical, leading to disorders associated with micronutrient deficiencies, particularly among mothers and their children. The purpose of the study was to validate the link between women's decision-making autonomy and higher dietary diversity score. Participants were ever married women aged 15-49 years old with comprehensive dietary information (n = 17,842), selected from the Bangladesh Demographic and Health Survey, 2014. The dietary diversity score (DDS) was obtained from a 24-h recall of dietary intake from nine food groups, categorized into lower DDS (DDS ≤ 4) and higher DDS (DDS ≥ 5). Descriptive analysis, bivariate and multivariate logistic regression were conducted using STATA version 15. Almost all women consumed starchy foods, flesh (83.86%), and fruits (67.30%). Using logistic regression, the odds of achieving dietary diversity score were higher among women who participated in household purchases (OR 2.40; 95% CI: 1.52-3.83; p = 0.022). Women who had higher and secondary education were 2.72 (95% CI: 1.49-3.02; p = 0.025) and 1.31 (95% CI: 0.58-2.18; p = 0.029) times more likely to achieve higher DDS than women having no education, as well as women in the richest quintile (OR 6.49; 95% CI: 4.12-8.5; p = 0.037) compared to women in the lowest quintile. This study highlighted the association of several socioeconomic conditions of ever married women and their dietary diversity score in Bangladesh. Therefore, promoting the women's education status, improving the socioeconomic conditions, and prioritizing their decisions are recommended for the attainment of higher dietary diversity score.

Linkages between women's empowerment, religion, marriage type, and uptake of antenatal care visits in 13 West African countries

Characteristics which reflect a particular context and unique to individuals, households, and societies have been suggested to have an impact on the association between women's empowerment and women's well-being indicators. However, there is limited empirical evidence of this effect. We used access to antenatal care (ANC) to examine the main and interaction effects of women's empowerment, religion, marriage type, and uptake of services in 13 West African countries. Data was extracted from Phase 6 and 7 of the Demographic and Health Survey, and we measured women's empowerment using the survey-based women's empowerment (SWPER) index for women's empowerment in Africa. ANC visits as the outcome variable was analyzed as a count variable and the SWPER domains, religion, and marriage type were the key independent variables. We utilised ordinary least square (OLS) and Poisson regression models where appropriate to examine main and interaction effects and analyses were appropriately weighted and key control variables were applied. Statistical significance was established at 95% confidence interval. Findings suggest that being Muslim or in a polygynous household was consistently associated with disempowerment in social independence, attitude toward violence, and decision-making for women. Although less consistent, improved social independence and decision-making for women were associated with the probability of increased ANC visits. Polygyny and Islamic religion were negatively associated with increased number of ANC visits. Decision-making for Muslim women appear to increase the probability of increased number of ANC visits. Improving the conditions that contribute towards women's disempowerment especially for Muslim women and to a lesser extent for those who reside in polygynous households is key towards better uptake of antenatal care services. Furthermore, targeting of interventions and polices that could empower women towards better access to health services should be tailored on existing contextual factors including religion and marriage type.

Factors affecting fruit and vegetable consumption and purchase behavior of adults in sub-Saharan Africa: A rapid review

In order to achieve the Sustainable Development Goals, considerable dietary shifts, including an increase in the consumption of fruit and vegetables (FV) will be required. However, worldwide consumption of FV is far below international recommendations, including in many low- and middle-income countries (LMICs), particularly in Africa. Understanding what, where, when, and how people choose to eat requires an understanding of how individuals are influenced by factors in their social, physical, and macro-level environments. In order to develop effective interventions to increase fruit and vegetable consumption, the factors influencing consumer behavior need to be better understood. We conducted a rapid review to assess and synthesize data on individual, social, physical, and macro-level factors that enable or constrain fruit and vegetable consumption and purchase among adults living in sub-Saharan Africa. Our conceptual framework is based on a socio-ecological model which has been adapted to settings in LMICs and Africa. We systematically searched four electronic databases including Scopus, Medline (PubMed), PsycInfo, and African Index Medicus, and screened Google Scholar for gray literature. We included a total of 52 studies and narratively summarized the existing evidence for each identified factor across the different levels. We found that most studies assessed demographic factors at the individual level including household or family income, socio-economic status and education. Furthermore we identified a variety of important factors that influence FV consumption, in the social, physical, and macro environment. These include women's empowerment and gender inequalities, the influence of neighborhood and retail food environment such as distance to market and price of FV as well as the importance of natural landscapes including forest areas for FV consumption. This review identified the need to develop and improve indicators both for exposure and outcome variables but also to diversify research approaches.

Women's Empowerment, Food Security, and Nutrition Transition in Africa

Despite mounting recognition of the essential role of women's empowerment in household dietary and nutrition changes, the diversity of culture across African countries presents ambiguity as to whether its impact is experienced homogeneously across the continent. This article presents a systematic review of whether women's empowerment changes household dietary patterns, contributes to nutrition improvement, and consequently affects diet-related health outcomes in Africa. We find that whilst more research needs to be conducted, particularly with improved methodologies that can establish cause-effect relationships, there is consensus among the literature on the link between women's empowerment and some domains of food security and dietary improvement. Meanwhile, studies on women's empowerment and the additional demand pressure on some food categories are quite limited. This exacerbates the challenge of setting production plans that aim to address the continent's question of food.

Qualitative exploration of the dynamics of women's dietary diversity. How much does economic empowerment matter?

OBJECTIVE

This study qualitatively examined dietary diversity among married women of reproductive age who engaged in two socio-economic activities to explore the dynamics of food availability, access, costs and consumption.

DESIGN

Qualitative in-depth interviews. The food groups in the Minimum Dietary Diversity for women were used to explore women's dietary diversity. IDI were used to develop a roster of daily food consumption over a week. We explored food items that were considered expensive and frequency of consumption, food items that women require permission to consume and frequency of permission sought and the role of economic empowerment. Data analysis followed an inductive-deductive approach to thematic analysis.

SETTING

Rural and peri-urban setting in Enugu State, Nigeria.

PARTICIPANTS

Thirty-eight married women of reproductive age across two socio-economic groupings (women who work only at home and those who worked outside their homes) were recruited in April 2019.

RESULTS

Economic empowerment improved women's autonomy in food purchase and consumption. However, limited income restricted women from full autonomy in consumption decisions and access. Consumption of non-staple food items, especially flesh proteins, would benefit from women's economic empowerment, whereas staple food items would not benefit so much. Dietary diversity is influenced by food production and purchase where factors including seasonal variation in food availability, prices, contextual factors that influence women's autonomy and income are important determinants.

CONCLUSION

With limited income, agency and access to household financial resources coupled with norms that restrict women's income earning, women continue to be at risk for not achieving adequate dietary diversity.

Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality

Background

In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality.

Methods/design

This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women.

Discussion

This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase.

Trial registration

The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12543-z.

Women's Empowerment and Children's Complete Vaccination in the Democratic Republic of the Congo: A Cross-Sectional Analysis

(1) Background: The empowerment of women contributes to better child health and wellness. This study aimed to examine the association between women’s empowerment and complete vaccination of children, as recommended in the National Expanded Program on Immunization (EPI) in the Democratic Republic of the Congo (DRC). (2) Methods: In this cross-sectional study, a principal component analysis (PCA) was conducted on data from the Multiple-Indicator Cluster Survey 6 (MICS-6) to determine the dimensions of women’s empowerment. Logistic regression analysis was used to assess the association between women’s empowerment and complete vaccination of children stratified by household wealth. In total, 3524 women with children aged 12–23 months were included in the study. (3) Results: Women’s empowerment was defined by three dimensions, namely intrinsic agency, enabling resources, and social independence. Children of women with high levels of empowerment had higher odds of complete vaccination, with values of 1.63 (p = 0.002) and 1.59 (p = 0.012) for intrinsic agency and enabling resources of the empowerment, respectively, compared to the children of women with low levels of empowerment; however, social independence failed to be associated with the vaccination status of children. After stratification by household wealth, the OR of complete vaccination was higher in women from middle-income households with high levels of intrinsic agency (OR: 2.35, p = 0.021) compared to women from poor households with high levels of intrinsic agency (OR: 1.92, p = 0.004). (4) Conclusions: Higher levels of women’s empowerment, especially intrinsic agency and enabling resources, were associated with complete vaccination in children in the DRC. Household wealth status influenced the associations. The empowerment of women is crucial in promoting the complete vaccination of children and providing equal access to vaccines.