Women's Agency, Nutrition, and Food Insecurity

Book excerpt: "BACKGROUND:Undernutrition is one of the leading causes of death among children worldwide, estimated to have contributed to nearly half of under-5 deaths in 2019. Sub-Saharan Africa is the region with the highest prevalence of moderate-to-severe food insecurity at 55.6% and the highest prevalence of under-5 chronic malnutrition, or stunting, at 42.9%. Limited research has been conducted on the relationship between women's agency and women's and children's nutrition and food security status in sub-Saharan Africa. OBJECTIVES:The present thesis consists of three objectives: (I) develop context-specific models of women's agency; (II) estimate the association between women's agency and (a) women's and children's nutrition and (b) women's food insecurity status; and (III) estimate the association between women's and men's concordance on notions of women's agency and (a) women's and men's dietary diversity and (b) women's food insecurity status. METHODS:The data used for this thesis comes from a cross-sectional survey in Ethiopia, Malawi, Mozambique, and Zambia. In total, 1,261 households in Ethiopia, 708 households in Malawi, 735 households in Zambia, and 1,262 households in Mozambique were surveyed. I used confirmatory factor analysis to build country-specific measurement models for women's agency. I estimated agency scores that were used to model the association between women's agency and women's and children's nutrition and food security. For the third objective, I estimated the association between couples' agreement on domains of women's agency and women's and men's dietary diversity and women's food insecurity experience. RESULTS:The best-fitting models estimated for women's agency in Objective I were different for each country; and domains of agency were not always correlated with conventional measures of women's empowerment. The analyses conducted for Objective II yielded mixed results for the association between women's agency and women's and children's nutrition and food security outcomes. For women's nutrition, the strongest associations were found between women's decision-making and women's nutrition status, with the relationship being positive in some instances and negative in others. Decision-making was associated with an increased risk of children's malnutrition in some countries and a decreased risk in others. While agency was consistently associated with increased dietary diversity in women and children, results for the association between women's agency and women's food insecurity experience were mixed. In my third study, domestic partner concordance on gender-based attitudes improved dietary diversity for women and men in three of the four countries, but was not associated with women's food insecurity experience. Lastly, partner concordance on women's decision-making was differentially associated with women's and men's dietary diversity and women's food insecurity experience both within and between countries. CONCLUSIONS:The findings of my study support a shift away from standardized measures of women's agency towards more nuanced, context-specific and, most importantly, culturally valid alternatives. Results for the association between domains of women's agency and measures of nutrition, dietary diversity, and food insecurity were mixed. The variation of findings--between countries and between different domains of agency in a single country--supports the notion that a given construct of agency can represent distinct phenomena in different settings. Further, my results support the treatment of anthropometry, dietary diversity, and food insecurity as separate, yet interrelated facets of nutrition. Future research would benefit from a more in-depth understanding of how women internalize theoretical constructs of agency and, subsequently, how assertions of agency impact women's and children's nutrition and food security status"--