JOURNAL TRANSCRIPT
Women’s decision-making autonomy and their nutritional status in Ethiopia Yibeltal Tebekaw Abstract The main objective of this research was to explore the relationship between women's empowerment and their nutritional status in Ethiopia. The study used nationally representative data from the 2005 Ethiopia DHS and employed logistic regression model for the multivariate analyses part. The findings indicate that more than 28% (rural=32.1%) of Ethiopian women were undernourished. Women with low decision-making autonomy are more likely (OR=1.54) to be undernourished than those with high decision-making autonomy. Women’s educational attainment, employment status, and household property possession are identified as the major pathways through which the decision-making autonomy of women affects their nutritional status. It is concluded that women’s decision-making autonomy is an important determinant of their nutritional status. There is a need to incorporate women empowerment as part of the national nutrition strategy and also further research is suggested to see the effects of the agro-ecological variations and cultural factors on women’s nutrition. Key words: Women’s decision-making autonomy, BMI, Undernourishment
1. Introduction Malnutrition1 is a major public health and human development problem especially in developing countries. Worldwide, FAO estimates that, mainly as a result of high food prices, the number of chronically hungry people in the world rose by 75 million in 2007 to reach 923 million (FAO, 2008). In 2004, 92 % of all worldwide hunger related deaths were associated with chronic hunger and malnutrition (WFP, 2005). The global hunger index (GHI2) also shows that the world has made slow progress in reducing food insecurity since 1990. According to this report, Ethiopia is among the countries with very high GHI value (31) or among the countries with the least rank (82nd out of 88 countries). The recent advent of higher food prices has also uneven effects across countries of the world (Grebmer et al., 2008; FAO, 2008). The status of women in a society is also one important determinant of the nutritional status of women, although not widely documented except the application of the concept in many demographic studies. Women’s lower social status challenges their decision-making autonomy on the desired family size, health care-seeking behavior and the amounts and types of food fed to children and themselves and amount of time to spend on child-rearing (Haddad, 1999; Heaton and Forste, 2007). In Ethiopia, male dominance remains more pronounced in the society, public and private spheres. Women traditionally enjoy little independent decision-making on most individual and family or household issues, including the option to choose whether to get modern health services during illness, birth, reproductive health services and others (Bogalech and Mengstu, 2007). This paper has combined two important global and national development issues, the rights of women towards decision-making and women’s health in terms of nutrition. The study identifies the link between women’s household decision-making autonomy and a public health and human development problem, i.e., malnutrition. The recommendation based on this finding will serve as a reference to design specific programs to solve the problem and ultimately this will contribute to the achievement of the third and fifth MDGs, i.e., women empowerment and gender equality and improving maternal health. Although improvements in women’s status is a key factor in women’s health status in general and their nutritional status in particular, its relative importance is not clearly understood as many researchers fail to make distinction between the direct measures of women’s decision-making autonomy and proxy indictors such as education, employment or household wealth status. In many earlier studies, most of the attention was directed to the impact of proxy variables on 1
Malnutrition refers to any disorder of nutrition whether it is due to dietary deficiency, under-nutrition, excess diet, overnutrition (Britannica Student Encyclopedia, 2005). 2 GHI is a multidimensional approach to measuring hunger and malnutrition by combining three weighted indicators: the proportion of undernourished as a percentage of the population (the share of population with insufficient dietary energy intake); the prevalence of underweight in under-five children (weight loss & reduced growth); and the mortality rate of under-five children (fatal synergy between inadequate dietary intake and unhealthy environments).
nutritional status of women through the proximate determinants of malnutrition i.e. disease and inadequate dietary intake. The various aspects of women’s decision-making autonomy, including their access to and control over resources have often been overlooked. Therefore, this study tries to investigate the influence of women’s empowerment on their nutritional status. The main limitation of the study is that it surveyed only women of reproductive ages, most of them mothers of one or more children (81%). The sample population in this study includes only those who are currently married (15-49), i.e., during the time of the data collection. Besides, the research findings might not be reflections of the current or most recent situation of the research questions. Pregnant women and lactating women were excluded because of fear of weight gain during pregnancy and the impact of lactation on maternal weight. DHS, being a cross-sectional data, it only allows observing associations and hence the relationship between the different independent variables and nutritional status (BMI) would contain biases of an unknown magnitude and direction or may not be seen as causal. Besides, the type of women’s empowerment measured may be too crude to capture the type of empowerment that shapes nutritional status. 1.1 Background Malnutrition and hunger have been found to increase the incidence and fatality rate of conditions that cause up to 80% of maternal death (Hall and Rosenthal, 1995). Women who are underweight prior to pregnancy and who gain little weight during pregnancy are at increased risk of complications and death (FAO, 2005). Malnourished mothers are more likely to give birth to low birth-weight babies who face a greatly increased risk of dying in infancy. They are also more likely to suffer from stunting during childhood which will greatly increase their own risk of dying during childbirth or giving birth to another generation of low birth-weight babies. Underweight or CED is common among women in developing countries. Evidence for maternal malnutrition indicates that between 5 and 20 % of African women have a low BMI as a result of chronic hunger. In these countries there is some evidence that individuals with a BMI below 18.5 kg/m2 show a progressive increase in mortality rates as well as increased risk of illness. Some 51.3% of women in Bangladesh were underweight, about half of them were moderately or severely underweight, with a BMI below 16.99 kg/m2. In Africa all levels of underweight i.e., mild, moderate and severe underweight, are highly prevalent (ACC/SCN, 2000; Uthman and Aremu, 2007). With reference to a recent cross-country study result, the prevalence of undernutrition is widespread in Burkina Faso, Niger, and Senegal, where approximately 20% of women are underweight (Bradley and Mishra, 2008). The proportions of women who are malnourished in selected sub-Saharan African countries for which a DHS was recently conducted range from 7 (Cameroon) to 37% (Eritrea). Ethiopia has one of the highest proportions of malnourished
women. The percentage age of women who are overweight or obese ranges from a low of 4% in Ethiopia to a high of 29 % in Cameroon (Macro International Inc., 2008). Women’s role in food production, preparation and child care are critical foundations for the social and economic development of a community. However, efforts in this direction are hampered by malnutrition (Oniang’o and Mukudi, 2002). Nutrition is one of the essential determinants of maternal health; the right to adequate food being one of the fundamental human rights preserved in many international documents (http://www.pdhre.org/rights/food.html). Perhaps the greatest challenge that Ethiopia has faced today is that of food insecurity. This is mainly due to the poor agricultural technology, limited rural infrastructure; shrink in land size, non-availability of off-farm employment and other factors. Food insecurity incorporates low food intake, variable access to food, and vulnerability (Devereux, 2000). The prevalence of undernutrition in Ethiopia is the highest in sub-Saharan Africa (Bradley and Mishra, 2008). EDHS (2000) report shows that over 30 % of women were found to be chronically undernourished (BMI