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Madzorera I, Bliznashka L, Blakstad MM, Bellows AL, Canavan CR, Mosha D, Bromage S, Noor RA, Webb P, Ghosh S, Kinabo JL, Masanja H, Fawzi WW. Women's input and decision-making in agriculture are associated with diet quality in rural Tanzania. Front Public Health 2023; 11:1215462. [PMID: 38125846 PMCID: PMC10731380 DOI: 10.3389/fpubh.2023.1215462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Isabel Madzorera
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Lilia Bliznashka
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, DC, United States
| | - Mia M. Blakstad
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Alexandra L. Bellows
- Department of International Health (Human Nutrition), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chelsey R. Canavan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | | | - Sabri Bromage
- Institute of Nutrition, Mahidol University, Salaya, Thailand
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Ramadhani A. Noor
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Joyce Ludovick Kinabo
- Department of Food Science Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | | | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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