Intersectional role of paternal gender-equitable attitudes and maternal empowerment in child undernutrition: a cross-sectional national study from India

OBJECTIVES: To investigate the role of the intersection of maternal empowerment, paternal gender-equitable attitudes, and household wealth in stunting and severe stunting among underfives in India. DESIGN: Cross-sectional study. SETTING: Community-based setting, nationally representative household survey from India. PARTICIPANTS: We used a sample of 22 867 mother–father–child triads from the fourth round of India’s National Family Health Survey (2015–2016). Our inclusion criterion was children below the age of 5 years. The exclusion criterion was a lack of information on paternal gender-equitable attitudes and maternal empowerment. Observations with missing data on any of the covariates were also excluded. PRIMARY OUTCOME: Stunting and severe stunting among underfives in India. RESULTS: Our survey-adjusted logistic regression models revealed that even among children from poorer households, those with either an empowered mother or a father with gender-equitable attitudes versus those with none such parents, had a lower odds of stunting (adjusted OR (AOR): 0.92, 95% CI: 0.84 to 1.02) and severe stunting (AOR: 0.87, 95% CI: 0.77 to 0.98), independent of all covariates. We also found substantially lower odds of severe stunting in groups with parental concordance in a woman-friendly outlook, whether non-affluent (AOR: 0.80, 95% CI: 0.67 to 0.94) or affluent (AOR: 0.50, 95% CI: 0.38 to 0.67). CONCLUSION: We argue that while women’s autonomy could reduce the risk of child undernutrition, focusing on men’s attitudes towards gender equity also holds promise for reducing undernutrition. Our findings not only underscore how patriarchy is embodied in undernourished children, but also suggest programmatic interventions to address this deep-rooted scourge in India.