Women's Empowerment on Health and Nutrition Domains

Women’s Empowerment on Health and Nutrition Domains

Jessica Heckert

Deanna K. Olney, Lilia Bliznashka, Abdoulaye Pedehombga, Andrew Dillon, Marie T. Ruel

Enhanced Homestead Food Production

• Integrated agriculture, nutrition, and health intervention• Designed and implemented by Helen Keller International in

Fada N’Gourma, Burkina Faso • Targeted mothers of children aged 3 to 12 months

• Primary program interventions• Agriculture supplies (e.g. seeds, saplings,

small animals, gardening tools)• Agriculture training by a female village

farm leader• Nutrition and health related trainings

provided by either Older Women Leaders (OWL) or Health Committee (HC) members

Program objectives

Primary objectives:• Increase maternal and child intake of micronutrient-rich foods through women’s

increased production of these foods • Increase income and women’s control over income through sale of surplus

production• Increase adoption of optimal health and nutrition practices by increasing

knowledge and encouraging their adoption

Secondary objectives to empower women:• Increase ownership and control of agricultural assets• Increase production and control of micronutrient-rich foods • Improve knowledge of optimal practices in agriculture, health, hygiene, and

nutrition• Increase decision-making power via ownership and control over assets and

micronutrient-rich foods and increased knowledge• Increase social capital through participation in E-HFP program

Related findings from this intervention

• Reduced prevalence of anemia, wasting, and diarrhea among children (Olney et al. 2015)

• Reduced prevalence of thinness among women (Olney et al. 2015)

• Increase in women’s ownership and control of agricultural assets and small animals; improved perceptions of women’s ability to manage land and participate in agricultural production (van den Bold et al. 2015)

Research objectives

• Estimate impact of program on women’s empowerment

• Examine the associations between women’s empowerment and child nutritional status

• Determine if positive effects of the program on child nutritional status are attributable partially attributable to increases in women’s empowerment

Study design

• Impact evaluation– Cluster-randomized controlled trial

• 25 control villages (N=741 households)• 15 OWL treatment villages (N=514 households)• 15 HC treatment villages (N=512 households)

– Longitudinal design• Baseline February-May 2010 (target children 3-12 months)• Endline February-June 2012 (target children 27-36 months)

– Household survey• Socio-demographic characteristics• Housing quality• Children’s growth and hemoglobin concentration• 30 questions related to women’s empowerment

Women’s empowerment: Decision-making indicators

Component Questions included Response codes Range alpha T1, T2

Purchasing decisions Can you make the decision to purchase the following items? no=0; yes=1 0 to 8 0.89, 0.90

1. Small quantities of food, such as rice, vegetables, and bean

2. Larger quantities of food, such as bags of rice

3. Clothing for yourself

4. Medication for yourself

5. Toiletries such as soap and toothpaste

6. Medication for children?

7. Special foods for your children

8. Can you decide how to spend your money

Healthcare decisions Which household members decide most often about the following issues? Woman contributes:

0 to 2 0.57, 0.77

1. Consult a doctor or go to a clinic when you are pregnant no=0; yes=1 2. What to do when a child is sick

Family planning decisions

Which household members decide most often about the following issues? Woman contributes:

0 to 2 0.66, 0.64

1. Use a contraceptive method no=0; yes=1

2. Have another child

IYCF decisions Which household members decide most often about the following issues? Woman contributes:

0 to 2 0.69, 0.57

1. If you breastfeed a child and when you wean no=0; yes=1

2. How to feed the child during the first year of his or her life

Women’s empowerment: Social capital indicators

Component Questions included Response codes Range alpha T1, T2

Spousal communication How often do you speak to your spouse about… never=0; sometimes=1; often= 2

0 to 14 0.86, 0.95

1. Your professional/agricultural activities

2. Your domestic activities

3. Your expenses

4. Events in your community

5. The health of your child

6. Your child's food

7. Your health

Meeting with other women

Do you meet with women in your community to discuss the following issues?

no=0; yes=1 0 to 5 0.90, 0.94

1. Community problems

2. Educational problems

3. Health problems

4. Problems specific to women

5. Receive information on health and nutrition

Social support Do you have someone to help you when you have the following problems?

no=0; yes=1 0 to 4 0.88, 0.87

1. Host you for multiple nights if necessary

2. Help you financially or lend you money

3. Help you when you do not have enough food at home

4. Talk to you if you have problems

Analysis• Constructed variables

– Women’s empowerment in 7 domains– Housing quality score: floor, roof, walls, water source, latrine, electricity

• Impact on women’s empowerment– Difference-in-difference – Control for maternal age, housing quality index, household characteristics

• Associations between women’s empowerment and child nutritional status– Healthcare decisions, purchasing decisions, family planning decisions, and spousal

communication– Logistic regression– Interaction with availability of resources (housing quality)– Control for child sex, child age, maternal age, maternal education, head’s education,

household size, polygyny.• Program pathways

– Mediation analysis– Calculate direct and indirect pathways (indirect: via women’s empowerment)

• Analyses account for clustering and attrition

Impacts on women’s decision-making and social capital

Impact estimate = 1.2 ** Impact estimate = 0.9 ** Impact estimate = 0.2 **

No impact on spousal communication, social support, family planning decisions or infant and young child feeding decisions.

1Difference-in-difference (DID) impact estimates between control and intervention groups and controlled for age and adjusted for clustering, and attrition. ** p<0.05 for DID estimates.

Women’s empowerment: A tool to leverage resources

Resources (e.g., financial, human capital)

Women’s Empowerment

Health care decisions and child growth

Program impact without mediation Program impact with mediation

Program pathways

Change in outcome

Program Change in outcome

Program c

c’

Mediatora b

Indirect effect = a x bDirect effect = c’Total effect = Direct + Indirect

a = effect of the program on the mediatorb = effect of the mediator on outcome (controlling for program)c ‘ = effect of the program on outcome (controlling for mediator)

Total effect = cc = effect of the program on outcome

Women’s empowerment as a pathway

HC Intervention

Reduction in Wasting

Women’s Empowerment

Total effects -.092**(.043)

Direct effects -.078*(.043)

Indirect effects -.014**(via 4 domains of women's empowerment) (.007)

Note: *** p<0.01, ** p<0.05, * p<0.1

Direct and indirect (via women's empowerment) effects of EHFP on child wasting

Conclusions• EHFP program positively impacted women’s

empowerment on 3 domains: meeting with women, healthcare decisions, and purchasing decisions

• Women’s empowerment leverages resources– Higher levels of empowerment and availability of resources

were jointly associated with lower odds of child undernutition

– In the absence of resources, women’s input into decision making was not associated with better nutritional outcomes

• Positive effect of the EHFP program on reducing wasting is partially attributable to gains in women’s empowerment

Acknowledgements

• Research done by the International Food Policy Research Institute (IFPRI) and Helen Keller International (HKI): – Deanna Olney, Andrew Dillon, Marie Ruel, Julia Behrman, Mara van den Bold,

Esteban Quninones, Jessica Heckert, Lilia Bliznashka, Abdoulaye Pedehombga and Marcellin Ouedraougo

• Programs implemented by HKI with local partner NGOs– In Burkina Faso by: Marcellin Ouedraogo, Abdoulaye Pedehombga, Hippolyte

Rouamba, Olivier Vebamba, Ann Tarini, Fanny Yago-Wienne• Research funded by:

– USAID, Office of U.S. Foreign Disaster Assistance (USAID/OFDA) through Helen Keller International (HKI)

– Gender, Agriculture and Assets Project (GAAP)– CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) led

by IFPRI.• Program and research participants

Purchasing decisions and child growth

Family planning decisions and child growth