Association of Mother's Decision-Making Autonomy and Presence of Grandparents in the Household with Child Growth in India Open Access

Kaur, Karmjeet

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Introduction: Low height-for-age in childhood, or stunting, is a form of growth failure that leads to several short and long-term adverse consequences including poor mental development, physical morbidities, and mortality. Using recent national survey data, we investigated the interplay between mother's autonomy in decision-making and the presence of grandparents in the household on child height-for-age in India, a setting with disproportionate levels of stunting. As a secondary objective, we also sought to identify household socio-demographic correlates of child height.

Methods: We conducted a secondary analysis of the India Human Development Survey 2011-12 (IHDS-II). A total of 9202 children ages zero to five with complete covariates were analyzed. Decision-making autonomy was a composite of 8 indicators categorized as "high" or "low." Co-residing grandparents were classified as being maternal grandparent(s) only, paternal grandparent(s) only, or both maternal and grandparents; no co-residing grandparents served as the reference. Linear regression was used to assess the associations of maternal decision-making, presence of grandparents, and other socio-demographic factors with child height-for-age z-scores (HAZ). All analyses accounted for the complex survey design.

Results: Children were an average age of 2.6 years and had mean HAZ of -2.2. About 77% of their mothers reported high decision-making autonomy, 54% of children lived with at least one grandparent in the household. There was no statistically significant association between decision-making autonomy and child HAZ before (-0.08; 95% CI: -0.25, 0.095) or after (-0.04; 95% CI: -0.21, 0.14) adjustment. Relative to no grandparents, the presence of paternal grandparent(s) only was positively associated with child HAZ in unadjusted models (0.33; 95%CI: 0.21, 0.45), but this association was attenuated and not statistically significant after socio-demographic adjustment (0.15; 95%CI: -0.05, 0.35). Household income and parental education were the most salient socio-demographic correlates of child height. Findings were robust to treating child weight-for-age, an alternative child growth measure, as the outcome.

Conclusion: Although mother's decision-making autonomy was not associated with child height-for-age, children who co-resided with paternal grandparents tended towards higher attainment of height-for-age. The findings beg further investigation of the role of grandparents in child growth in Indian households.

Table of Contents

Table of Contents


List of Tables and Figures. viii

Chapter 1: Introduction and Literature Review. 1

1.1 Child growth failure: a global public health problem. 1

1.2 Child height-for-age: An informative indicator of child growth. 1

1.2.1 Impact of childhood stunting on later life health. 2

1.3 Causes of child growth failure. 3

1.4 Women's empowerment as a potential leverage point to reduce childhood growth failure. 5

1.5 Measuring empowerment: Women's decision-making autonomy. 5

Table 1. Conceptualization and Operationalization of Women's Decision-Making Autonomy. 6

1.6 Literature regarding decision-making power and nutrition. 7

1.7 Presence of grandparents and influences on decision-making. 11

1.7 Summary. 16

1.8 Problem Statement. 16

1.7 Purpose Statement. 17

1.8 Objectives. 17

Chapter 2: Project Contents. 19

Methods. 19

2.1 Introduction. 19

2.2 Data Source and Sample. 19

2. 3 Study Measures. 20

2.3.1 Study Outcomes. 20

2.3.2 Household caregiving environment. 20

2.3.3 Socio-demographic covariates. 22

2.3.4 Statistical analysis. 22

2.4 Ethical considerations. 24

Results. 24

2.5 Findings. 24

2.5.1 Description of child socio-demographic characteristics and anthropometry. 24

2.5.2 Mother's decision-making autonomy and grandparent(s) in the household. 25

2.5.3 Relationship of socio-demographic characteristics with child growth. 28

Chapter 3: Discussion and Recommendations. 30

3.1 Discussion. 30

3.2 Strengths and Limitations. 32

3.3 Conclusion. 33

3.4 Recommendations. 33

References. 36

Tables and Figures. 39

Appendix A: Supplemental Tables and Figures. 45

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