Women's empowerment and women's dietary diversity in urban and rural Bangladesh Open Access

Sinharoy, Sheela Selin (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/z890rt85h?locale=en


Background: Very little evidence exists documenting relationships between women's empowerment and women's nutrition. The objective of this dissertation is to quantify associations between domains of women's empowerment and women's nutrition. Methods: This dissertation uses Naila Kabeer's resources - agency - achievements framework as its conceptual foundation and structural equation modeling methods to quantify the associations between women's completed grades of schooling, women's agency, and women's dietary diversity. The data come from two studies in Bangladesh: Food and Agricultural Approaches to Ending Malnutrition (FAARM), a cluster-randomized controlled trial being implemented in Habiganj district, and a study of urban food consumption in poor neighborhoods of Dhaka City Corporation. The data were collected using quantitative survey methods by field staff of Helen Keller International between February 2015 and October 2016. We used exploratory factor analysis and confirmatory factor analysis on random split-half samples in each study to identify latent variables representing domains of empowerment. We then used structural equation modeling techniques to measure direct and indirect associations between women's schooling, latent variables for women's agency, and dietary diversity. Results: Women's diets in our samples are poor, regardless of the location or time of year. In all three studies, a minority of women consumed adequately diverse diets (≥5 of 10 food groups in the previous day). We observed strong positive associations between having any completed grades of post-primary schooling and dietary diversity at the individual level in the rural, urban, and pooled samples. The standardized adjusted direct association with dietary diversity was β=0.22 (p<.001) in the rural sample, β= 0.21 (p<.001) in the urban sample, and β=0.22 (p<.001) in a pooled sample. Having any post-primary schooling was positively associated with women's decision-making (β31= 0.035, p=.018) and with voice with husband (β41=0.049, p=.010) in the rural sample but was not associated with decision-making (p=.49) and was only weakly associated with voice with husband (β21= 0.094, p=.046) in the urban sample. Relationships between women's agency and dietary diversity followed a similar pattern: we observed positive associations between voice with husband and dietary diversity in the rural sample (β54=0.39, p=.002) but not in the urban sample (p=.16). We observed no association between women's social solidarity and dietary diversity (p=.41) in the rural sample; we did not include questions on social solidarity in the urban sample. In contrast, there was no association between decision-making and dietary diversity in the rural sample (p=.89) but we noted a weak positive association in the urban sample (β43= 0.37, p=.045). We observed no associations between schooling, women's agency, or dietary diversity at the community level. Conclusions: The most consistent associations that we observed were between schooling and dietary diversity at the individual level. The relationship between women's post-primary schooling and their dietary diversity was partially mediated by voice with husband in the rural sample but was not mediated by women's agency in the urban sample. Schooling may be an important resource for women's agency in rural areas but not in poor urban areas. Further research is also needed to better understand these pathways and to explore other domains of women's empowerment that may be important for nutrition.

Table of Contents

Chapter 1: Introduction ...... 1

Chapter 2: Background and Literature Review ..... 5

Definitions ..... 5

Relationships between women's empowerment and nutrition ..... 11

References ..... 23

Chapter 3: Women's dietary diversity in rural Bangladesh: pathways through women's empowerment ..... 28

Introduction ..... 28

Methods ..... 29

Results ...... 34

Discussion..... 37

Conclusion ..... 41

References..... 45

Chapter 4: Women's dietary diversity in urban Bangladesh: pathways through women's empowerment ..... 48

Introduction ..... 48

Methods ..... 49

Results ..... 56

Discussion...... 59

Conclusion ..... 64

References..... 68

Chapter 5: Women's dietary diversity in Bangladesh: pathways through women's empowerment at the community level ..... 72

Introduction ..... 72

Methods ..... 73

Results ..... 79

Discussion ..... 81

Conclusion ..... 85

References ..... 90

Chapter 6: Summary and Conclusions ..... 92

Summary of findings ..... 92

Implications ..... 98

Strengths and innovations ..... 104

Limitations ..... 104

Conclusions and future research ..... 106

References ..... 107

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