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Women’sEmpowermentinNutritionIndex(WENI):Measuringnutritionalempowermenttobetterlink

agriculturetonutrition

ErinLentz,UTAustin,USAJuly13,2017KathmanduInnovativeMetricsandMethodsfor

AgricultureandNutritionActions

ResearchTeam• ErinLentz,UniversityofTexas,Austin,USA• Sudha Narayanan,IndiraGandhiInstituteforDevelopmentResearch,Mumbai,India

• Marzia Fontana,IndependentResearcher,UK• CollaborativeResearchandDissemination,NewDelhi,India

• Bharati KulkarniNationalInstituteofNutrition,Hyderabad,India

• Sabarmatee,IndependentResearcher,India• withKrushna Ranaware,Ankita Mondal,UdayanRathore,Nirali Bakhla,andothers

• Civilsocietypartners

Women’sNutritionalEmpowerment

• Thecapacityforawoman,andnotjust herchildren,tobewellfedandhealthy;tohaveameaningfulsayinhouseholdnutritionalpractices;andtoreceivesupportinimplementingthem.– OurstartingpointisKabeer’s (1999)conceptualizationofempowerment:resources,agency,andachievements

Approach• Formativeresearchon“overlooked”factors– Reviewofliterature,surveys,andongoingquantitativework

– Communitybasedresearch(Paprocki andCons2014)toidentifyfactorsthatmayinfluencenutritionalempowerment

• GenerateWENIandvalidateWENI– Examineitsabilitytopredictnutritionalstatusofwomen(andtheirchildren)

Women’sNutritionalEmpowerment

Work

Structuralconditions,support,institutions

Nutritionaloutcomesofwomen(BMI,

Anemia)

Knowledge

Resources

Agency

IntermediateAchievements

DimensionsofEmpowerment Domains

Health(fertility)

Food

Achievements

UltimateAchievements

TBDwithquantitative

work

QuantitativeLiterature:FactorsinfluencingnutritioninSouthAsia

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• Richliteratureexaminingundernutritionofchildren• ConsistentsetoffactorsinSouthAsia:

– Educationofparents(Headeyetal.2015)– Agriculture(mixed)(Kadiyala etal.2014)– Assetsandorincome(Headeyetal.2015)– Demographicfactors:Childgender(Rajetal.2015);birthintervaland

fertility(Coffey2015);rankwithinhouse(Coffeyetal.2017)– Empowerment(Chowdhuryetal.2013;Malapit etal.2015;

Cunninghametal.2015)– Servicesandinstitutions:(Gillespieetal.2017;Kohli etal.2017;

Nisbett etal.2017)– Sanitation:(CoffeyandSpears2017)– Maternalheight(Headeyetal.2015)– Domesticviolence(Yount etal.2011;Ziaei etal.2012)

Aim:Identify“overlooked”factors

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• Quantitativeliteraturegetsatseveralissues,butdoesn’tcoverallaspects– Quantitativemodelsexplain~30%ofvarianceinstuntingratesand~50%ofimprovements(Headeyetal.2015)

– Manygoodreasonsforthis

• Arethere“overlooked”factorsthatinfluencenutritionalempowermentthatwomenthemselvesidentifyasimportant?

• Focushereonattributesnotcommonlyincludedinquantitativestudies

Method:CommunityResearch

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Threesites:– Northern Bangladesh– Odisha,India– Bihar,IndiaNGOpartners:– Nijera Kori– Agragamee– PRADAN– Anwesha– Sambhav– JJSS

Method:CommunityResearch

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• 4-5daysofresearchtrainingwithcommunityresearchers(seePaprocki andCons2014)– Researchethicsandaudiorecorders– Semi-structuredandopen-endedinterviewtechniquesfocusingonnutritionandsourcesoftensionwithintheirhouseholds

• Bangladesh:Conductedabout135interviewsin2districts

• Odisha:Conductedaround160interviewsin4districts

• Focusedonmarginalizedpopulations

Learnings:Structuralconditions,support,resources

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• CommonpoolresourcesinOdisha– “IfoneSiali creepergrowsupthenwedestroyittomaketherope...In

thatwaySiali creepershavegraduallybeendepleted....So,wetookadecisionnottocollecttheplantsforthelasttwoyears.Asaresultofthis,thisyearsomewomenabletogetleaf.Lastyear,wewerenotabletoprepareasingleplateduetoshortageofleaves.”

– Womenfacevariableaccess;somewomenrelyonforestresourcesfordietarydiversity,forstitchingleafplates,etc.whilethisresourceisunavailabletoothers

• ArsenicingroundwaterinBangladesh– Apregnantrespondentexplainedthatherfamilyhasatubewell thathas

testedpositiveforarsenic,andhasa“red”tap,toindicateitiscontaminated.Nootheroffersofremediationweremade.Atthetimeoftheinterview,therespondent’sfamilycontinuedtodrinkfromitbecausetheycouldnotaffordtopurchasefiltersortodigadeeperwell,althoughtheyknewitisbadfortheirhealth.

– Optionstoavoidarsenicvarybyhousehold,dependingonneighborsetc.

Learnings:Intrahousehold variation

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• Healthseekingbehavior– FromOdisha:“Wegiveprioritytothemalemembersofthehouseholdtobetaken

tohospitalbecauseiftheystayfreefromdisease,theywilllookafterus.Whenfemalemembersareill,mostlywestayathomeandtakehomeremediesorprocuremedicineslocally.”

• Foodallocation– FromBangladesh:“Iwouldservefoodfirsttomyhusbandbecausehewasgoing

towork,thentomyfather-in-lawandoldgrandmother-in-law.Then,Iusedtofeedmyyoungchildren.Thereafter,Iwouldtakemymeal.Sometimes,myfather-in-lawwouldcheckthecookingpottoseewhetherImighthavecookedmorerice.Ifhesawsomequantityriceinthepot,hescoldedmethatIhadhiddenriceformyown.Iwouldbearit,cryandremainsilent.”

• Domesticviolence– Already,researchlooksatnutritionoutcomesforchildren(seeYount etal.2011).– Here,womenexplainhowviolenceaffectstheirownnutrition– FromBangladesh:“The[restofthefamily]hadtheprivilegetoeatfirst.Afterall

werefinished,theleftoverpiecesweregiventome.Attimes,Ihadtoreturnmymother’shouseduetohunger....Iaskedmyhusbandtoworkasadaylaborertoearnmoremoneybutherefusedandassaultedme....Mymother-in-lawasked‘Whydoyoutalksomuch?’Ireplied,‘Ineedfoodtolive.’”

ImplicationsforWomen’sEmpowermentinNutrition

• Variationinstructuralconditions/support/resourcesacrosshouseholds– Unpackregionalordistrictfixedeffects– Capturenormsanddeviationsfromthem

• Intrahousehold factorsmeritmoreattention– Seasonalityisoftencapturedatthehouseholdlevel

• Forexample,thecopingstrategiesindex,ameasureoffoodinsecurity,askswhethermealsweremissed

• Weneedtoknowwhomissedthemeal.– Theconsequencesofseasonality,shocks,accesstohealthcare,environmentalchangearedifferentfor(young)womenthanothersinthesamehousehold(seealsoLANSAfindings)

Workahead

• Operationalizethesefindingsinquantitativesurveys– Nutritionaloutcomesofchildrenmaynotbereflectoutcomesforwomen

– Opportunitytoincorporatenormsandperceptions

• ConstructandvalidateWENI

Thankyouforyourtime!Questions?

Approach• Formativeresearchon“overlooked”factors– Reviewofliterature– Communitybasedresearch(Paprocki andCons2014)toidentifyfactorsthatmayinfluencenutritionalempowerment

– Quantitativeresearchtoidentifycandidatecomponents

– Assessingsurveycoverageofourconceptofnutritionalempowerment

• GenerateWENIandvalidateWENI– Examineitsabilitytopredictnutritionalstatusofwomen(andtheirchildren)

ResearchObjective

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• DevelopaWomen’sEmpowermentinNutritionIndex(WENI)thatreflectsnutritionalempowermentofwomeninruralSouthAsia• BangladeshandIndia(Odisha andBihar),fornow• Ruralcontext,fornow

• Examineitsabilitytopredictnutritionalstatusofwomen(andtheirchildren)

Learnings:Intrahousehold variation

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• Healthseekingbehavior– FromOdisha:“Wegiveprioritytothemalemembersofthehouseholdtobetakentohospitalbecauseiftheystayfreefromdisease,theywilllookafterus.Whenfemalemembersareill,mostlywestayathomeandtakehomeremediesorprocuremedicineslocally.”

• Foodallocation– FromBangladesh:“Iwouldservefoodfirsttomyhusbandbecausehewasgoingtowork,thentomyfather-in-lawandoldgrandmother-in-law.Then,Iusedtofeedmyyoungchildren.Thereafter,Iwouldtakemymeal.Sometimes,myfather-in-lawwouldcheckthecookingpottoseewhetherImighthavecookedmorerice.Ifhesawsomequantityriceinthepot,hescoldedmethatIhadhiddenriceformyown.Iwouldbearit,cryandremainsilent.”