Alamgir Kabir1,2,3,4, Md Mahbubur Rashid5, Kamal Hossain6, Arifuzzaman Khan7,8, Shegufta Shefa Sikder9, Heather F Gidding10,11,12,13. 1. Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW, 2052, Australia. a.kabir@unsw.edu.au. 2. School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. a.kabir@unsw.edu.au. 3. Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh. a.kabir@unsw.edu.au. 4. Asian Institute of Disability and Development, Dhaka, Bangladesh. a.kabir@unsw.edu.au. 5. Kala-azar Elimination Program, Dhaka, Bangladesh. 6. Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh. 7. Asian Institute of Disability and Development, Dhaka, Bangladesh. 8. School of Public Health, The University of Queensland, Brisbane, Australia. 9. Sexual Reproductive Health and Rights Team, CARE USA, Patna, India. 10. School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. 11. Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia. 12. The University of Sydney Northern Clinical School, Sydney, NSW, Australia. 13. National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
Abstract
BACKGROUND: The burden of maternal undernutrition and low birth weight (LBW) incurs enormous economic costs due to their adverse consequences. Women's empowerment is believed to be one of the key factors for attaining maternal and child health and nutritional goals. Our objective was to investigate the association of women's empowerment with maternal undernutrition and LBW. METHODS: We used nationally representative data from the Bangladesh Demographic Health Survey for 2011 and 2014. We analysed 27357 women and 9234 mother-child pairs. A women's empowerment index (WEI) was constructed using principal component analysis with five groups of indicators: a) education, b) access to socio-familial decision making, c) economic contribution and access to economic decision making, d) attitudes towards domestic violence and e) mobility. We estimated odds ratios as the measure of association between the WEI and the outcome measures using generalized estimating equations to account for the cluster level correlation. RESULTS: The overall prevalence of maternal undernutrition was 20% and LBW was 18%. The WEI was significantly associated with both maternal undernutrition and LBW with a dose-response relationship. The adjusted odds of having a LBW baby was 32% [AOR (95% CI): 0.68 (0.57, 0.82)] lower in the highest quartile of the WEI relative to the lowest quartile. Household wealth significantly modified the effect of the WEI on maternal nutrition; in the highest wealth quintile, the odds of maternal undernutrition was 54% [AOR (95% CI): 0.46 (0.33, 0.64)] lower while in the lowest wealth quintile the odds of undernutrition was only 18% [AOR (95% CI): 0.82 (0.67, 1.00)] lower comparing the highest WEI quartile with the lowest WEI quartile. However, the absolute differences in prevalence of undernutrition between the highest and lowest WEI quartiles were similar across wealth quintiles (6-8%). CONCLUSIONS: This study used a comprehensive measure of women's empowerment and provides strong evidence that low levels of women's empowerment are associated with maternal undernutrition as well as with delivering LBW babies in Bangladesh. Therefore, policies to increase empowerment of women would contribute to improved public health.
BACKGROUND: The burden of maternal undernutrition and low birth weight (LBW) incurs enormous economic costs due to their adverse consequences. Women's empowerment is believed to be one of the key factors for attaining maternal and child health and nutritional goals. Our objective was to investigate the association of women's empowerment with maternal undernutrition and LBW. METHODS: We used nationally representative data from the Bangladesh Demographic Health Survey for 2011 and 2014. We analysed 27357 women and 9234 mother-child pairs. A women's empowerment index (WEI) was constructed using principal component analysis with five groups of indicators: a) education, b) access to socio-familial decision making, c) economic contribution and access to economic decision making, d) attitudes towards domestic violence and e) mobility. We estimated odds ratios as the measure of association between the WEI and the outcome measures using generalized estimating equations to account for the cluster level correlation. RESULTS: The overall prevalence of maternal undernutrition was 20% and LBW was 18%. The WEI was significantly associated with both maternal undernutrition and LBW with a dose-response relationship. The adjusted odds of having a LBW baby was 32% [AOR (95% CI): 0.68 (0.57, 0.82)] lower in the highest quartile of the WEI relative to the lowest quartile. Household wealth significantly modified the effect of the WEI on maternal nutrition; in the highest wealth quintile, the odds of maternal undernutrition was 54% [AOR (95% CI): 0.46 (0.33, 0.64)] lower while in the lowest wealth quintile the odds of undernutrition was only 18% [AOR (95% CI): 0.82 (0.67, 1.00)] lower comparing the highest WEI quartile with the lowest WEI quartile. However, the absolute differences in prevalence of undernutrition between the highest and lowest WEI quartiles were similar across wealth quintiles (6-8%). CONCLUSIONS: This study used a comprehensive measure of women's empowerment and provides strong evidence that low levels of women's empowerment are associated with maternal undernutrition as well as with delivering LBW babies in Bangladesh. Therefore, policies to increase empowerment of women would contribute to improved public health.
Entities:
Keywords:
Bangladesh; Demographic health survey; Low birth weight; Maternal nutrition; Principal component analysis; Women’s empowerment
Authors: Cristina M Gago; Janine Jurkowski; Jacob P Beckerman-Hsu; Alyssa Aftosmes-Tobio; Roger Figueroa; Carly Oddleifson; Josiemer Mattei; Erica L Kenney; Sebastien Haneuse; Kirsten K Davison Journal: Soc Sci Med Date: 2022-01-31 Impact factor: 4.634
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