Women’s Empowerment and its Association With Pregnant Women’s Nutritional Status and Birth Weight in West Shewa Zone, Ethiopia: A Follow-Up Study
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Date
2025-03
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Addis Ababa University
Abstract
Background: Maternal nutrition during pregnancy has a significant impact on the health of the mother as well as newborn's birth weight, health, and chances of survival in infancy and beyond. In Ethiopia, a substantial percentage of pregnant women have poor nutritional status due to inadequate dietary intake. Consequently, low birth weight is prevalent in the country. On the other hand, it is well acknowledged that improvements in maternal nutritional status and birth outcomes can be achieved through women's empowerment. Nevertheless, the relationships between the multiple dimensions of women‘s empowerment and nutritional status of pregnant women and birth outcomes have not been adequately explored.
Objectives: To determine the level of women‘s empowerment and its association with nutritional status and dietary diversity of pregnant women, and birth weight among women attending antenatal care at public health facilities in West Shewa Zone, Central West Ethiopia.
Methods: A health facility-based cross-sectional and prospective follow-up studies were conducted from January to December 2021. Multistage sampling was used to enroll 1,453 second- and third-trimester antenatal care-attending pregnant women; and they were followed until delivery. At enrolment, information on socio-demographic, obstetric, and women‘s empowerment characteristics on economic, familial/interpersonal, socio-cultural, time, and
psychological empowerment dimensions was collected using a semi-structured, pretested questionnaire which was administered by interviewers after getting participants‘ written informed consent. Besides, mid-upper arm circumference (MUAC) and hemoglobin levels were measured at enrolment. Data on dietary diversity were gathered at enrolment and in the next antenatal care follow-up visit using the minimum dietary diversity for women tool. Birth weight was measured within one hour after delivery. Univariable descriptive analysis was conducted to describe each variable. Exploratory and confirmatory factor analyses were conducted on half of the samples to identify and validate dimensions of women‘s empowerment. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with women‘s empowerment. Multivariable logistic regression was applied to assess the relationships between pregnant women‘s empowerment and anemia status and mid-upper arm circumference levels. Structural equation modeling was used to examine the mediating effects of women‘s empowerment on dietary diversity during pregnancy, as well as to investigate its direct effect ofwomen‘s empowerment on birth weight. All statistical tests were considered significant at p-value less than 0.05.
Results: The factor analysis results identified and confirmed that household decision-making power, economic, communication, psychological, assertiveness, and time dimensions to operationalize women‘s empowerment for Paper I and II. About 54.2% (95% Confidence Interval (CI): 51.7, 56.8) of the pregnant women were empowered overall. The highest and least empowerment was in household decision-making power and communication dimensions, respectively. Older women were more empowered in economic (adjusted odds ratio (AOR)=2.2, 95%CI: 1.2, 4.0) and assertiveness (AOR=1.9, 95%CI: 1.1, 3.1) dimensions than younger women. Women‘s higher education level was positively associated with household decision-making power (AOR=2.6, 95%CI: 1.4, 4.9), communication (AOR=4.9, 95%CI: 2.8, 8.8), psychological (AOR=2.0, 95%CI: 1.3, 2.9) and time (AOR=4.0, 95%CI: 2.3, 7.2) dimensions. Being rural women, housewives, and having multiple children were negatively associated with the time dimension.
About 32.1% (95% CI: 29.7, 34.5) of the pregnant women were anemic, while 21.1% (95% CI: 19.0, 23.2) of them were undernourished. The odds of being free from anemia among overall empowered pregnant women was 1.91 times higher among less empowered pregnant women (AOR=1.9, 95% CI: 1.5, 2.4). Similarly, empowered pregnant women had higher odds of having MUAC ≥ 23 cm compared to those with less empowered pregnant women (AOR=1.8, 95% CI: 1.3, 2.4). Pregnant women who were empowered in the economic (AOR=1.71, 95% CI: 1.26, 2.22) and assertiveness (AOR=1.90, 95% CI: 1.46, 2.38) dimensions had higher odds of being free from anemia compared to those less empowered in these areas. Empowered pregnant women in household decision-making power (AOR=1.6, 95% CI: 1.2, 2.2) and psychological (AOR=1.4, 95% CI: 1.0, 1.9) dimensions had higher odds of having normal MUAC measures than those less empowered in the respective dimensions.
More than half, 61.8% (95% CI: 59.2, 64.4), of the pregnant women consumed inadequately diversified diets during their pregnancy. Household decision-making power (beta (β)=0.131, p<0.05), psychological (β=0.237, p< 0.001) and time (β=0.146, p<0.01) dimensions were directly and positively associated with dietary diversity during pregnancy. Household decision-making power, psychological and time empowerment were higher among pregnant women who had higher education level. These dimensions were significant mediators in the relationship between pregnant women‘s education and dietary diversity. However, the economic dimension was related to neither pregnant women‘s education nor dietary diversity.
The mean birth weight of the newborns was 3,168.5g (standard deviation=460.6). About 6.3% (95% CI: 5.0, 7.8) of them weighed low at birth. Newborn‘s birth weight was higher among women who had higher household decision-making power (β=0.091, p<0.05). On the contrary, higher economic empowerment among women was associated with delivering infants with lower birth weight (β=-0.444, p<0.001).
Conclusions: Around half of the pregnant women were empowered. Poor nutritional status among pregnant women remains a public health concern in the study area. Generally, empowered pregnant women had better nutritional status compared to those with less empowerment. A significant number of pregnant women did not consume sufficiently diversified diets. Empowerment in household decision-making power, psychological, and time dimensions was linked to the consumption of more diverse diets during pregnancy. Notably, better education of the pregnant women was also significantly associated with their higher empowerment in these dimnsions implying women‘s empowerment as a pathway by which education contributed to adequate dietary diversity during pregnancy. Birth weight was higher among mothers with higher household decision-making power but lower among those who had higher economic empowerment.
Recommendations: Empowering women in economical, household decision-making power, assertiveness, and psychological dimensions can be considered as a strategy in policy and intervention programs to achieve better nutritional status among pregnant women. Interventions that aim at reducing poor dietary diversity during pregnancy should emphasize on women‘s empowerment in household decision-making power, psychological and time dimensions as well as increasing availability of formal education to women, which is also important for empowering them. Birth weight can be improved by empowering women in household decision-making power. Further examinations on the mechanisms of the influence of women‘s empowerment dimensions on pregnant women‘s nutritional status and birth weight are recommended to enhance the effectiveness of empowerment interventions in improving maternal and child health.
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Pregnant women, nutritional status, dietary diversity, birth weight, women‘s empowerment, West Shewa Zone, Ethiopia