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Women’s status and child nutrition: Findings from community studies in Bangladesh and Nicaragua
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).ORCID iD: 0000-0001-5396-6624
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The importance of women’s status for child nutrition has recently been recognized. However, pathways through which women’s status can affect their caretaking practices and child nutrition have not been fully determined. The aim of this thesis was to evaluate associations between aspects of women’s status – including exposure to domestic violence and level of autonomy and social support – with their level of stress, feeding practices and child nutritional status in two different cultural settings: Bangladesh and Nicaragua.

Data were acquired from population-based studies. For Study I we used data from the Bangladesh 2007 Demographic and Health Survey, and Study II was embedded in the 2009 Health and Demographic Surveillance System conducted in Los Cuatro Santos, rural Nicaragua. Studies III and IV were part of the MINIMat study, conducted in rural Bangladesh. In-person interviews were conducted and validated questionnaires were used in each of the studies. Anthropometric characteristics of the children were recorded based on standardized World Health Organization techniques.

In Bangladesh, we found women with lifetime experience of domestic violence to be more likely to report emotional distress during pregnancy, cease exclusive breastfeeding before 6 months and have a stunted child. Further, we found a negative association between experience of domestic violence and duration of excusive breastfeeding to be mitigated with breastfeeding counseling. In Nicaragua, a lower level of maternal autonomy was associated with more appropriate breastfeeding practices such as higher odds of exclusive breastfeeding and longer continuation of breastfeeding. Further, a maternal lower level of social support was associated with better child nutritional status.

In conclusion, this investigation showed that different dimensions of women’s status were associated with their feeding practices and child nutritional status and also revealed that the strength and direction of these associations may vary by the child’s age, setting and other contextual factors. These findings suggest that women’s status might have an important public health impact on child health and its role should be considered in programs and policies aiming to improve child health and nutrition.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 61 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1252
Keyword [en]
Women's status, Domestic violence, Autonomy, Social support, Feeding practices, Child nutrition, Bangladesh, Nicaragua
National Category
Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-302015ISBN: 978-91-554-9675-3 (print)OAI: oai:DiVA.org:uu-302015DiVA: diva2:955984
Public defence
2016-10-14, Rosénsalen, Entrance 95/96, Akademiska sjukhuset, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2016-09-23 Created: 2016-08-28 Last updated: 2016-10-11
List of papers
1. Women's exposure to intimate partner violence and child malnutrition: findings from demographic and health surveys in Bangladesh
Open this publication in new window or tab >>Women's exposure to intimate partner violence and child malnutrition: findings from demographic and health surveys in Bangladesh
2014 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 10, no 3, 347-359 p.Article in journal (Refereed) Published
Abstract [en]

Domestic violence, in particular intimate partner violence (IPV), has been recognized as a leading cause of mortality and morbidity among women of reproductive age. The effects of IPV against women on their children's health, especially their nutritional status has received less attention but needs to be evaluated to understand the comprehensive public health implications of IPV. The aim of current study was to investigate the association between women's exposure to IPV and their children's nutritional status, using data from the 2007 Bangladesh Demographic and Health Survey (BDHS). Logistic regression models were used to estimate association between ever-married women's lifetime exposure to physical and sexual violence by their spouses and nutritional status of their children under 5 years. Of 2042 women in the BDHS survey with at least one child under 5 years of age, 49.4% reported lifetime experience of physical partner violence while 18.4% reported experience of sexual partner violence. The prevalence of stunting, wasting and underweight in their children under 5 years was 44.3%, 18.4% and 42.0%, respectively. Women were more likely to have a stunted child if they had lifetime experience of physical IPV [odds ratio n = 2027 (OR)adj, 1.48; 95% confidence interval (CI), 1.23–1.79] or had been exposed to sexual IPV (n = 2027 ORadj, 1.28; 95% CI, 1.02–1.61). The present findings contribute to growing body of evidence showing that IPV can also compromise children's growth, supporting the need to incorporate efforts to address IPV in child health and nutrition programmes and policies.

National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-198258 (URN)10.1111/j.1740-8709.2012.00432.x (DOI)000337613300004 ()22906219 (PubMedID)
Available from: 2013-04-11 Created: 2013-04-11 Last updated: 2017-12-06Bibliographically approved
2. Women´s autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua
Open this publication in new window or tab >>Women´s autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua
Show others...
2015 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 11, 1979-1990 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate the associations of women’s autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua.

Design

Cross-sectional study. Feeding practices and children’s nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women’s autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women’s social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles.

Setting

Los Cuatro Santos area, rural Nicaragua.

Subjects

A total of 1371 children 0–35 months of age.

Results

Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller.

Conclusions

While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

Keyword
social support, decision making, children, nutrition, Nicaragua
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-248695 (URN)10.1017/S1368980014002468 (DOI)000357673600009 ()25409706 (PubMedID)
Available from: 2015-04-07 Created: 2015-04-07 Last updated: 2017-12-04Bibliographically approved
3. Experiencing lifetime domestic violence: associations with mental health and stress among pregnant women in rural Bangladesh: The MINIMat randomized trial
Open this publication in new window or tab >>Experiencing lifetime domestic violence: associations with mental health and stress among pregnant women in rural Bangladesh: The MINIMat randomized trial
(English)Article in journal (Other academic) Submitted
Place, publisher, year, edition, pages
uppsala:
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-302006 (URN)
External cooperation:
Available from: 2016-08-27 Created: 2016-08-27 Last updated: 2016-08-28
4. Breastfeeding counseling mitigates the negative association of domestic violence on exclusive breastfeeding duration in rural Bangladesh: The MINIMat randomized trial
Open this publication in new window or tab >>Breastfeeding counseling mitigates the negative association of domestic violence on exclusive breastfeeding duration in rural Bangladesh: The MINIMat randomized trial
Show others...
(English)Article in journal (Other academic) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-302003 (URN)
External cooperation:
Available from: 2016-08-27 Created: 2016-08-27 Last updated: 2016-08-28

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