Association of Mother's Decision-Making Autonomy and Presence ofGrandparents in the Household with Child Growth in India Pubblico

Abstract

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

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Parola chiave	presence of grandparents in household decision making height-for-age height for age mother's decision-making autonomy autonomy India child growth
Committee Chair / Thesis Advisor	Patel, Shivani A, Emory University
Committee Members	Argeseanu, Solveig, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.) University, college or educational institution (other than Emory)

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