Women's empowerment and child anthropometric failures across 28 sub-Saharan African countries: A cross-level interaction by Gender Inequality Index

초록

Background: Child undernutrition remains a major global health issue particularly in sub-Saharan Africa (SSA). Given the important role mothers play in early childhood health and development we examined how individual-level women's empowerment and country-level Gender Inequality Index (GII) are jointly related with child undernutrition in SSA. Methods: We pooled recent Demographic and Health Surveys from 28 SSA countries. For 137699 children <5 years old undernutrition was defined using anthropometric failures (stunting underweight wasting). Women's empowerment was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence social independence and decision-making; and country-level gender inequality was measured using GII from United Nations Development Programme. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII as well as their interactions with child anthropometric failures after adjusting for sociodemographic covariates. Results: Overall 32.85% of children were stunted 17.63% were underweight and 6.68% had wasting. Children of mothers with low-level of empowerment for all domains of SWPER had higher odds of stunting (attitude to violence: OR=1.15; 95% CI 1.11-1.19; social independence: OR=1.21; 95% CI 1.17-1.25; decision-making: OR=1.16; 95% CI 1.12-1.20) and consistent results were found for underweight and wasting. Independent of women's empowerment country-level GII increased the probability of underweight (ranging ORs=1.46; 95% CI 1.15-1.85 to 1.50; 95% CI 1.18-1.90) and wasting (ranging ORs=1.56; 95% CI 1.24-1.97 to 1.61; 95% CI 1.27-2.03). Significant interaction was found between women's empowerment and country-level GII for stunting and underweight (p<0.05). Conclusions: In SSA countries with greater gender inequality improving women's social independence and decision-making power in particular can reduce their children's risk of anthropometric failures. Policies and interventions targeted at strengthening women's empowerment should consider the degree of gender inequality in each country. © 2024 The Authors

키워드