Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal

Abstract

Background Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. Objectives We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). Methods We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0–59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. Results Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (β: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (β: 0.233, P < 0.001) and the model with women's and men's domains (β: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (β: −0.0503, P = 0.014) and in the model with women's and men's domains (β: −0.056, P = 0.008). Household decision making for women (β: −0.0631, P = 0.007) and for men (β: −0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. Conclusions Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.

Do changes in women's household status in Nepal improve access to food and nutrition?

“…Thus, we do have some evidence that some factors that positively change status do affect eating patterns, potentially through a pathway of increased bargaining power, agency and decision-making power. Recent studies in Nepal have found that women's bargaining power was associated with child nutritional status, and extend the literature on seeing how this affects women's own nutrition (Kulkarni et al, 2021). However, we find that living in food insecurity holds women back from this advantage.…”

Social and economic factors influencing intrahousehold food allocation and egg consumption of children in Kaduna State, Nigeria

“…Some studies have shown that men have limited participation in direct decision‐making related to breastfeeding and complementary feeding, suggesting that gendered constructed norms obstruct men's involvement in child nutrition (Dewey & Begum, 2011 ; Kansiime et al, 2017 ). Studies from Nepal found that males are more inclined to get involved in child nutrition in cases when they participate in social networks (Kulkarni et al, 2021 ) or when children are sick (Cunningham et al, 2021 ).…”

Perceptions, Knowledge, and Routines of Parents regarding Food Introduction Methods and their Relationship with Speech

“…Studies (Kulkarni et al, 2020;Nankumbi & Muliira, 2015) have shown that traditional gender roles can impact negatively child health through unequal family decision-making and reduced paternal support. Another important aspect to consider is that fathers are not usually included in studies on feeding practices (Harris et al, 2018).…”