Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Long-term behavioural impact of an integrated home garden intervention: evidence from Bangladesh

Integrated home garden interventions combine training in gardening practices with education about nutrition knowledge. Such interventions have been shown to improve nutrition behaviour in low income countries. However, to date rigorous evidence is lacking for their long-term impact. We test the impact of an integrated home garden intervention on vegetable production and consumption three years after the intervention ended. We analyse three rounds of survey data for 224 control and 395 intervention households in rural Bangladesh. Three years after the intervention, the average impact on vegetable production per household was 43 kg/year (+49% over baseline levels; p < 0.01), and the effect was not statistically different from the impact one year after the intervention, which demonstrates that impact was maintained in the long-term. The impact on the micronutrient supply for iron, zinc, folate and pro-vitamin A from home gardens was maintained in the long term. These impacts may have been driven by the long-term improvements in women’s nutrition knowledge and gardening practices, explaining the sustainability of the behavioural nutrition change. We also identify positive impacts on women’s empowerment and women’s output market participation, highlighting how integrated programs, even if modest in scope, can be drivers of social change

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

Measuring Autonomy: Evidence from Bangladesh

The search for rigorous, transparent, and domain-specific measures of empowerment that can be used for gendered analysis is ongoing. This paper explores the value-added of a new measure of domain-specific autonomy. This direct measure of motivational autonomy emanates from the ‘self-determination theory’ (Ryan and Deci, 2000). We examine in detail the Relative Autonomy Index (RAI) for individuals, using data representative of Bangladeshi rural areas. Based on descriptive statistical analyses, we conclude that the measure and its scale perform broadly well in terms of conceptual validity and reliability. Based on an exploratory analysis of the determinants of autonomy of men and women in Bangladesh, we find that neither age, education, nor income, are suitable proxies for autonomy. This implies that the RAI adds new information about the individuals and is a promising avenue for further empirical exploration as a quantitative yet nuanced measure of domain-specific empowerment

Measuring Autonomy: Evidence from Bangladesh

The search for rigorous, transparent, and domain-specific measures of empowerment that can be used for gendered analysis is ongoing. This paper explores the value-added of a new measure of domain-specific autonomy. This direct measure of motivational autonomy emanates from the ‘self-determination theory’ (Ryan and Deci, 2000). We examine in detail the Relative Autonomy Index (RAI) for individuals, using data representative of Bangladeshi rural areas. Based on descriptive statistical analyses, we conclude that the measure and its scale perform broadly well in terms of conceptual validity and reliability. Based on an exploratory analysis of the determinants of autonomy of men and women in Bangladesh, we find that neither age, education, nor income, are suitable proxies for autonomy. This implies that the RAI adds new information about the individuals and is a promising avenue for further empirical exploration as a quantitative yet nuanced measure of domain-specific empowerment

Measuring autonomy: evidence from Bangladesh

The search for rigorous, transparent, and domain-specific measures of empowerment that can be used for gendered analysis is ongoing. This paper explores the value-added of a new measure of domain-specific autonomy. This direct measure of motivational autonomy emanates from the ‘self-determination theory’ (Ryan and Deci, 2000). We examine in detail the Relative Autonomy Index (RAI) for individuals, using data representative of Bangladeshi rural areas. Based on descriptive statistical analyses, we conclude that the measure and its scale perform broadly well in terms of conceptual validity and reliability. Based on an exploratory analysis of the determinants of autonomy of men and women in Bangladesh, we find that neither age, education, nor income are suitable proxies for autonomy. This implies that the RAI adds new information about the individuals and is a promising avenue for further empirical exploration as a quantitative yet nuanced measure of domain-specific empowerment