Maternal empowerment and gender equality for child undernutrition: a multilevel study in Africa

BACKGROUNDS: Women's empowerment is a complex construct that requires a multi-level conceptualization, yet its association with child undernutrition has been restricted to single-level analysis and the existing evidence are mixed. METHODS: We pooled recent Demographic and Health Surveys from 28 sub-Saharan African countries (N = 137,699 children <5 years old). Undernutrition was defined as stunting, underweight, and wasting. Maternal empowerment at individual-level was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making with each domain divided into terciles. As for country-level gender inequality, Gender Inequality Index (GII) was used. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII with child anthropometric failures as well as their interactions, adjusting for sociodemographic covariates. RESULTS: Compared to children of mothers with high-level of empowerment, children of mothers with low-level of empowerment had higher odds of stunting for all domains of SWPER (Ranging ORs=1·15 to 1·21). A similar pattern was observed for underweight and wasting. GII also increased the probability of underweight and wasting. Our interaction analyses indicates that for social independence and decision-making domain, the gap in probabilities of stunting between high versus low-level of empowerment was widest in countries with highest GII. CONCLUSIONS: In countries with stricter gender norms, achieving mother's social independence and decision-making power are found to be the strategies that should be prioritized in the first place to reduce their children's anthropometric failures. Policies and interventions aimed at promoting maternal empowerment should be carefully tailored to the specific national context to effectively address child undernutrition in sub-Saharan Africa. KEY MESSAGES: • Advanced our understandings of the role of maternal empowerment on child undernutrition by discovering that each domain of empowerment differently functions across larger social contexts. • In countries with stricter gender norms, achieving mother's social independence and decision-making power should be prioritized in the first place to improve their children's nutrition.