Water, sanitation, and hygiene practices mediate the association between women's empowerment and child length-for-age z-scores in Nepal

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.

Drivers of Nutritional Change in Pakistan: A Decomposition Analysis

The global reduction in child undernutrition highlights the international and national commitment to prioritizing future generations' health. This study aims to find out the previous trends in nutrition and the key drivers of these changes in different regions of Pakistan. For empirical investigation, we employed a regression-based decomposition model by using two distinct rounds of demographic and health surveys: 2012-13 and 2017-18. Results showed children with stunted growth reduced substantially in Balochistan, while Punjab exhibited the highest progress for underweight children. Regression estimates showed that maternal nutritional status and household wealth were more pronounced in reducing all measures of child malnutrition. Some determinants, including mother age at marriage and prenatal visits to the hospital, are significant only for long-term nutritional status-stunting, while mother education contributed to reducing wasted and underweight children. The rest of the factors, like father education and household environment, appear to play a humble role in explaining nutritional improvements. From disaggregated analysis based on different regions, we found that modeled factors used in this study explained changes disproportionately. Thus, it is recommended to use multidimensional nutrition policies incorporating a broader range of sectors, and region-specific programs should be designed for more effective outcomes.

Maternal socioeconomic status and infant feeding practices underlying pathways to child stunting in Cambodia: structural path analysis using cross-sectional population data

OBJECTIVES

To identify and investigate complex pathways to stunting among children aged 6-24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting.

DESIGN, SETTING AND PARTICIPANTS

We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children's height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients.

OUTCOME MEASURE

The primary outcome measure was height-for-age Z-scores as a continuous measure.

RESULTS

Findings suggest that children's dietary diversity and continued breast feeding mediate the association between socioeconomic status and children's height. While there was no significant direct effect of maternal education on children's height, results suggested significant indirect pathways through which maternal education effects children's height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children's height was mediated by either dietary diversity or continued breast feeding.

CONCLUSION

We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status.

The Indirect Impact of Smallholder Vegetable Production on Children's Nutrition Outcomes in Rural Vietnam

Childhood undernutrition, particularly stunting, wasting, and micronutrient deficiencies, remains a major health concern in rural Vietnam. While literature suggests leveraging agriculture to improve child nutrition via agricultural diversification, market engagement, and women's empowerment, very few studies have empirically explored how smallholder vegetable production can influence household nutrition. This paper examines the association of household-level vegetable diversity, market access, and market participation with nutrition outcome measures of children in smallholder households. We use a cross-sectional household dataset, collected in 2016 in northwest Vietnam, covering 234 children aged 6–60 months. We estimate and compare the results of regression models using three-stage least squares (3SLS), ordinary least squares (OLS), logistic regression, and seemingly unrelated regression (SUR), to explore variations in six nutrition outcome measures: height-for-age z-score (HAZ), weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), stunting, wasting, and underweight. Our results suggest smallholder vegetable production has a significant indirect association with children's nutrition status via market participation. Market participation is an important factor in improving girls' HAZ and WHZ, and in reducing the probability of boys being stunted and underweight. The additional income from selling vegetables allows households to purchase nutritious food, which is likely to have a positive impact on children's nutrition outcomes.

What are the outcomes of marine site protection on poverty of coastal communities in Southeast Asia? A systematic review protocol

BACKGROUND

Many conservation management interventions have been set up to bring win-win outcomes for both biodiversity conservation and the well-being of the local communities. Nevertheless, the implementation process of marine protected areas (MPAs) can generate unexpected outcomes and fail to reach its objectives in addressing communities' challenges. Therefore, it is crucial to have a better understanding of how MPAs influence the socioeconomic aspects of the coastal communities. This paper describes the protocol to conduct a systematic review which aims to explore and review the evidence that reflects the outcomes of marine site protection on poverty reduction in terms of economic and material living standards among the coastal communities in Southeast Asia. The review question is "What are the outcomes of marine site protection implementation on poverty in terms of material and economic living standards of coastal communities in Southeast Asia?".

METHODS

The systematic review uses rigorous search strategies and selection methods based on pre-defined eligibility criteria to identify and examine published journal articles and grey literature that are available on the review topic. Relevant studies and grey literature will be extracted from a recent systematic map of the evidence documenting the effect of marine or coastal nature conservation or natural resource management activities on human well-being in Southeast Asia. We will search online databases including Web of Science Core Collection, Ovid Medline®, Environmental Complete, Scopus, as well as Google Scholar and sources of grey literature for any additional literature available since the evidence map was created. For this review, the populations of interest are from coastal communities in the Southeast Asia region. Comparators to marine site protection will be no intervention and/or pre-MPA implementation. The economic and material living standards, which are the poverty domains, will be evaluated as outcomes. Once we have identified relevant literature, we will perform a critical appraisal, data extraction, and synthesis appropriate to the type of literature found, to investigate the effect of marine site protection on poverty reduction.

Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal

BACKGROUND

Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition.

OBJECTIVES

We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ).

METHODS

We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering.

RESULTS

Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (β: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (β: 0.233, P < 0.001) and the model with women's and men's domains (β: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (β: -0.0503, P = 0.014) and in the model with women's and men's domains (β: -0.056, P = 0.008). Household decision making for women (β: -0.0631, P = 0.007) and for men (β: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ.

CONCLUSIONS

Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.

Assessing the Impacts of Relative Wealth and Geospatial Factors on Water Access in Rural Nepal: A Community Case Study

As one of the poorest nations, citizens of Nepal lack access to safe, affordable, and sufficient drinking water. While many nationwide studies have been performed at a country or regional level in Nepal to determine regions of the highest vulnerability, this study uniquely recognizes the economic heterogeneity within a single rural village and assesses the impact of household socioeconomic status on water access at the intracommunity level. Household surveys in a rural village setting provided the information for a locally-informed relative wealth index. A spatial analysis determined suitable locations for future installation of improved water sources to prioritize water access for the community’s most vulnerable households. Three sites were shown to be optimal for future water source construction. This study provides a blueprint to assess water inequalities within a single village and incorporate forward-thinking development approaches to water access.

A Multisectoral Nutrition Program in Nepal Improves Knowledge of Dietary Diversity, Sick Child Feeding, and Handwashing, but Not All Practices: a Program Impact Pathways Mediation Analysis

BACKGROUND

Few intervention studies have focused on how inputs link with outcomes.

OBJECTIVES

This study tested whether Suaahara I program inputs translated into intended outcomes and identified gaps along the theorized program impact pathway to improved nutrition, care, and water, sanitation, and hygiene behaviors.

METHODS

We used household-level, cross-sectional survey data from a process evaluation of Suaahara I conducted in 2014. A total of 480 households with a pregnant woman or child aged <2 y were selected with an equal split between intervention and comparison arms. We used regression models to test associations between exposure to Suaahara I and 3 primary outcomes and 3 parallel knowledge mediators: child minimum dietary diversity, child feeding during illness, and proper handwashing during child care. We used generalized structural equation modeling using full information maximum likelihood to test whether knowledge mediated associations between exposure and outcomes.

RESULTS

In the adjusted regression models between maternal exposure to Suaahara I and 3 behavioral outcomes, we found a small positive association for handwashing (β: 0.21; 95% CI: 0.10, 0.31), but no association with the other 2 outcomes. In the mediation analysis, maternal exposure to Suaahara I, however, was associated with the mediator (knowledge) for all 3 outcomes: handwashing with soap and water (β: 0.05 ± 0.02), child minimum dietary diversity (logit = 0.06; P = 0.03), and child feeding during illness (logit = 0.09 ± 0.02). We found a positive, significant association for the full indirect pathway of program input to output via knowledge for child feeding during illness (logit = 0.07 ± 0.03) only.

CONCLUSIONS

Exposure to Suaahara I behavior change interventions improved knowledge, but this did not always translate into improved practices. It is important to address barriers to optimal practices beyond knowledge in future nutrition programs in Nepal.

Pathways and Associations between Women's Land Ownership and Child Food and Nutrition Security in Pakistan

Women’s land ownership plays a noteworthy role in improving various development indicators, including her own wellbeing and children’s food and nutrition security. However, the literature linking women’s access to land rights to the nutritional security of children in Pakistan is limited, even though it is a country facing enormous challenges of childhood malnutrition and gender discrimination. This paper contributes to the existing literature on the benefits of empowering women by studying the association and pathways between women’s land rights and child nutrition, using the 2012–2013 Pakistan Demographic and Health Survey. The ordinary least squares (OLS) regression results indicate that women’s individual land ownership and women’s autonomy in large-scale family purchases have a positive impact on children’s food and nutrition security (FNS). The results of quantile regression (QR) show that these effects are more pronounced in cases of children with severe stunted growth. In addition, a structural equation model shows that the positive relationship between women’s land ownership and child nutrition is partially mediated by women’s increased decision-making power in large-scale household purchases. Our research concludes that ensuring women’s land rights can improve women’s autonomy, which can be an effective policy tool that not only improves women’s welfare but also improves their children’s nutritional security.

Water, sanitation, and hygiene practices mediate the association between women's empowerment and child length-for-age z-scores in Nepal

In Nepal, more than one-third of children are stunted. Prior studies have shown that women's empowerment in agriculture is associated with child (<2 years) length-for-age z-scores (LAZ) in Nepal. This study tests whether child dietary diversity (DD) and household water, sanitation, and hygiene (WASH) facilities and practices mediate the associations between women's empowerment and LAZ. With a cross-sectional dataset of 4,080 households from 240 rural communities across 16 districts of Nepal, we used ordinary least squares regression models to first estimate the associations between women's empowerment and LAZ for children 6 to 24 months (n = 1,402; our previous published analysis included all children <24 months of age), using the Women's Empowerment in Agriculture Index's Five Domains of Empowerment subindex. We used standardized structural equation models to test whether child DD and/or household WASH mediated the association between women's empowerment and child LAZ. Overall, women's empowerment was positively associated with child LAZ (β = 0.24, P = 0.03), as found in our previous analyses. In the mediation analysis, women's empowerment was positively associated with WASH (β = 0.78, P < 0.001), and in turn child LAZ (β = 0.09, P < 0.001). Women's empowerment was not associated with DD, but DD was associated with LAZ (β = 0.06, P = 0.05). Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women's empowerment and child LAZ. More research is needed to explore other pathways by which women's empowerment may affect child nutrition outcomes.