Women's empowerment and nutritional outcomes of children under five in low, lower-middle, and upper-middle income countries: A systematic review Open Access

Bardin, Lauren (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/kd17cs92v?locale=en


Objective: Approximately 6.9 million children under the age of five die each year, of which, an estimated 53% of deaths are associated with malnutrition. Disproportionately affected are those from low and middle-income countries. While global prevalence of stunting and wasting decreased over the past ten years, it has increased in sub-Saharan Africa and some areas of Asia. Further barriers exist to child health outcomes when the mother or caregiver is disempowered and ill-equipped to provide appropriate care. Motivated by the need for continued research on how nutrition-sensitive approaches can be incorporated into nutrition-specific interventions, this systematic review assessed the relationship between women's agency (a component of empowerment) and nutritional outcomes of children younger than five in low, lower-middle, and upper-middle income countries as identified in current literature.

Methods: A systematic search of peer-reviewed, population-based literature was conducted in five electronic databases: Embase, PubMed, SocIndex, Web of Science, and Women's Studies International. Studies that evaluated the association between women's agency, defined through women's decision-making and freedom of movement, and nutritional outcomes of children under five, defined by anthropometric assessment, were included for review. A total of 1,818 abstracts were screened for inclusion and ten studies met our final inclusion and exclusion criteria.

Results: Of the ten included studies, two were from the sub-Saharan Africa, two from Latin America and the Caribbean, and six from Southeast Asia regions. Eight of the ten included studies determined components of women's agency were associated with nutritional outcomes of children under five, with decision-making most frequently associated with nutritional outcomes.

Conclusions: Nine of the ten studies defined agency through the term 'autonomy' however, not one used the same items or methods to create this variable. Inconsistency in functional definitions and measurements of agency emphasizes a fragmented interpretation of what agency actually is. While the development community is promoting women's empowerment as a means to improve nutritional outcomes, this indicates a need for the community to adopt a consistent definition to ensure clarity in approaches. Additional research is needed to address the inconsistent findings and better identify the association between agency and nutrition.

Table of Contents

Chapter 1: Introduction

1 1.1 Introduction and rationale

2 1.2 Problem statement

3 1.3 Purpose and objectives

3 1.4 Research goals

4 1.5 Significance statement

4 1.6 Definition of terms

Chapter 2: Comprehensive Review of the Literature

7 2.1 Nutrition interventions

10 2.2 Defining women's empowerment

12 2.3 Relationship between women's empowerment and nutrition

Chapter 3: Manuscript

16 Student contribution

18 Abstract

19 3.1 Introduction

20 3.2 Materials and methods

22 3.3 Results

27 3.4 Discussion

31 3.5 Conclusion

32 3.6 Acknowledgements

32 References for manuscript

36 Tables and Figures for manuscript

Chapter 4: Conclusion and Policy Implications

47 Conclusion and policy implications

References for Thesis

52 References for Chapter 1-4


57 Appendix 1. Data extraction and quality assessment tool

62 Appendix 2. Sample data analysis tool

Table of Figures and Tables

12 Figure 1. Naila Kabeer's Framework of Empowerment

36 Table 1. Search terms for identifying role of agency and nutritional status on children under 5 years of age

37 Figure 2. Identification and assessment of studies for inclusion in the systematic review

38 Table 2. Criteria for inclusion and exclusion of literature

39 Table 3. Characteristics of included studies

41 Table 4.Indicators and response categories used to measure agency

42 Table 5. The association between women's agency and nutritional outcomes

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