Date of Award

2018

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Edward A. Frongillo

Abstract

Child undernutrition is a serious issue in Nepal as 36% of children below five years of age are chronically undernourished. Reducing child undernutrition is an important priority to prevent adverse effects through the life course that perpetuate the cycle of undernutrition and poverty.

Women’s intra-household bargaining power is an important determinant of child nutrition. Intra-household bargaining power is an individual’s relative social and economic position within the household to access and control resources, and influence decision-making. In our research, we use women’s intra-household bargaining power as a resource for care, which enables women to be exposed to nutrition information, gain knowledge, access economic and social opportunities to improve food security, and positively influence child nutrition. While there is evidence on the positive association between women’s bargaining power and child nutrition, research gaps exist in understanding the mechanisms through which this relationship is linked and the role of men’s intra-household bargaining power in children nutrition.

We conducted a cross-sectional analysis of the baseline data from 2012 of the multisectoral program, Suaahara, in rural Nepal. We measured intra-household bargaining power based on four domains: 1) ownership and control of assets, 2) social participation, 3) workload, and 4) household decision-making control. In the first manuscript, we examined the relationship between women’s bargaining power and infant and young child feeding (IYCF) practices in children aged 0-23 months, and tested if exposure to IYCF messages mediated this relationship. Exposure to IYCF information mediated the relationship between social participation and early initiation of breastfeeding and dietary diversity. Household decision-making control had a direct, positive relationship with exclusive breastfeeding.

In the second manuscript, we examined the relationship between bargaining power of women and men with child height-for-age z-score (HAZ) in children aged 0-59 months, and tested if household food insecurity mediated this relationship. Women’s ownership and control of assets was positively associated with higher HAZ and food insecurity partially mediated this relationship. Men’s social participation was directly associated with higher HAZ and indirectly associated through food insecurity.

We found that different domains of women’s and men’s bargaining power relate to child feeding and child nutritional status. Our study attempts to address the research gaps by providing empirical evidence on men’s role in child nutrition and examining potential mechanisms that may be targeted for nutrition programming and policy. Strategies engaging men and women may prove effective for nutrition-specific and nutrition-sensitive interventions.

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