Maternal Empowerment, Childcare Practices, And Child Nutrition In Rural Nepal: Examining The Pathways

Tackling persistent child undernutrition in South Asia will require a deeper understanding of structural determinants, including maternal resources and childcare practices. This study aimed to: (1) synthesise the evidence linking women’s empowerment and child nutritional status in South Asia; (2) investigate associations of women’s empowerment in agriculture and child nutrition in rural Nepal; (3) determine whether these associations differ by dimension of empowerment or nutritional indicator; and (4) explore whether child feeding and WASH facilities and practices mediate these associations. Our review of prior empirical studies on women’s empowerment and child anthropometry in South Asia showed a general association, but heterogeneous and inconsistent findings. Thus, additional research and harmonisation of how women’s empowerment is defined and measured are needed. Using a cross-sectional dataset, we constructed the Women’s Empowerment in Agriculture Index’s (WEAI) 5 Domains of Empowerment (5DE) sub-index to investigate the association between maternal empowerment and child LAZ, WAZ, and WLZ in rural Nepal. The aggregate 5DE was positively associated with LAZ and WAZ. Three component indicators had positive associations: leisure time satisfaction (LAZ), production autonomy (LAZ), and access to credit (LAZ/WAZ). We then used causal mediation techniques to test whether two childcare practices - feeding and WASH practices - mediated these associations. Both feeding and WASH facilities and practices were independtly positively associated with child LAZ; neither feeding nor WASH facilities and practices mediated the credit or production autonomy pathways but an indirect pathway from maternal satisfaction with leisure time to child LAZ was found for WASH facilities and practices. This is the first South Asian study to investigate multiple domains of empowerment and assess pathways from care resources via childcare practices to child nutrition. Findings suggest that particular dimensions of empowerment may influence child nutrition more than others in particular contexts. Addressing child undernutrition in Nepal requires interventions to promote optimal feeding and WASH behaviours but also to address women’s disempowerment.