Whether Recent Upswing in Women's Empowerment has a Potential to Address Malnutrition among Women and Children? Evidence from Fourth Round of Indian Demographic Health Survey

Abstract

Background: Socio-political status of women in India has been improved considerably in the last decades and has been perceived to be an important catalyst behind the improvement in maternal and child health situation. Many evil and masculine forces still prevail in the modern Indian society that resists the forward march of women folk.

Full text

International Journal of Women’s Health Care
Whether Recent Upswing in Women’s Empowerment has a Potential to Address
Malnutrition among Women and Children? Evidence from Fourth Round of Indian
Demographic Health Survey
Research Article
Int J Women’s Health Care, 2017
Shri Kant Singh1, Swati Srivastava1*, Gudakesh1, Y. Vaidehi2 and Jitendra Gupta1
*Corresponding author
Swati Srivastava, Research Scholar, International Institute for Population
Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India.
Submitted: 17 Aug 2017; Accepted: 24 Aug 2017; Published: 01 Sep 2017
1International Institute for Population Sciences.
2 Consultant ICF, USA.
Abstract
Background: Socio-political status of women in India has been improved considerably in the last decades and has
been perceived to be an important catalyst behind the improvement in maternal and child health situation. Many
evil and masculine forces still prevail in the modern Indian society that resists the forward march of women folk.
Methods: Using the information from the 4th round of National Family Health Survey (2015-16) and multivariate
linear regression analysis this study explored that whether the recent swings of women empowerment has potential
to address the nutritional status of women and children in India.
Results: Result shows a considerable variation in level and inequality in women’s empowerment across states.
Regression results shows a positive association between inequalities in possession of house/land, bank account, at
least 10 years of schooling and working status of women with malnutrition among women and children; whereas
negative relationship with household decision making and use of mobile. The study highlighted that there had
been amelioration in the situation of women, but their true empowerment is still awaited. The study highlighted
that inequalities in different dimensions of women’s empowerment are positively associated with nutritional status
of women and children.
Conclusions: The study concluded that inequalities in women’s empowerment are associated with nutritional
status of women and children. Ensuring equity in women’s empowerment should be topmost priority through
structural interventions. Many states have considerable gap in institutional births and colostrum’s feeding as well
as 3+DPT and exclusive breastfeeding. Minimizing this missed opportunity may improve the nutritional status of
women and children.
Keywords: Women’s empowerment, Inequality, Malnutrition,
Shannon Diversity Index, Correlation.
Abbreviations
SDG-Sustainable Development Goals
NFHS-National Family Health Survey
BMI-Body Mass Index
HAZ-Height-for-Age
WHZ-Weight-for-Height
WAZ-Weight-for-Age
ICDS-Integrated Child Development Scheme
MNP- Minimum Needs Programme
TINP-Tamil Nadu Integrated Nutrition programme
JSY-Janani Surakhsha Yojna
Introduction
Malnutrition among women and children is a major public health
problem in most of the developing countries across the world.
Lowering malnutrition levels among women and children is one
of the most important objectives of the Sustainable Development
Goals (SDGs). Improved health of women and children is not only
a matter of human rights but it also plays a signicant role in the
country’s growth and improving its economy. because poor health
of women and children erodes social and economic gain of the
country as it is burdened with disease, poor nutritional status and
poverty [1]. Many global, regional and national level efforts have
been made to reduce malnutrition among women and children
in different parts of the world, despite these efforts; situation of
malnutrition is still dire [2,3]. In poor and developing countries,
malnutrition among women or children, occurs when a person does
not receive adequate nutrients from their diet. This causes damage
to vital organs and functions of the body. However in developed
countries the causes of malnutrition may be varied [4]. Also, poor
diet of women during pregnancy and/or during lactation period
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Int J Women’s Health Care, 2017
affects health of their children. Moreover, some parental factors,
for instance- low BMI of women during pregnancy, age of women
during pregnancy, lack of knowledge about good child feeding
practices, women’s endowments, women’s empowerment, etc. are
also responsible for poor health of women and children.
Women’s empowerment refers to the creation of an environment for
women where they can freely live their life with a sense of self-
worth, respect, dignity, having equal rights for social and economic
justice and having equal rights to participate in social, religious and
public activities. In other words, women’s empowerment means
emancipation of women from the vicious grips of social, economic,
political, religion, caste and gender-based discrimination. Women’s
empowerment does not mean ‘deifying women’ but rather it means
replacing patriarchy with parity [5].
For a long time women in India have remained within the four walls
of their household, where they totally depended on their counterparts.
It is also evident from the history of India that from Rig-Vedic period
to later Vedic civilization the position of women has deteriorated.
Women were denied to having right to education, right to widow
remarriage and, right to inheritance and ownership of property.
Apart from these hurdles, many social evils like child marriage,
dowry system, and Sati Pratha surfaced and started to overwhelm
women. Many social reformers such as Raja Rammohun Roy,
Ishwar Chandra Vidyasagar, and Jyotirao Phule started agitations
for the empowerment of women. Their efforts led to the end of Sati
and formulation of the Widow Remarriage Act.
In recent times, major steps have taken place to improve the situation
of women in Indian society. In 1961, a ‘Dowry Prohibition Act, 1961’
was initiated which prohibits the request, payment or acceptance of
a dowry. Under this act asking or giving dowry is punishable by
imprisonment as well as ne. Another Act, namely, ‘Protection
of Women from Domestic Violence Act, 2005’ was formulated to
provide a more effective protection of the rights of women who
were victims of domestic violence. A breach of this Act is punishable
with both ne and imprisonment. Moreover, ‘Sexual Harassment
of Women at Work Place (Prevention, Prohibition, and Redressal)
Act, 2013’ has been initiated to create a conducive environment
for women at the workplace where they should not be subjected to
any sort of sexual harassment [5]. Furthermore, many provisions
have been made under the constitution of the Government of India.
For example ‘Right to equality under Article 14’ of the Indian
Constitution, which means that every person who is living within
the territory of India have an equal right before the law. This right
conrms that there should be no discrimination based on sex. Also,
‘Equal pay for equal work under Article 39(d)’ guards the economic
rights of women by guaranteeing equal pay for equal work. Another
one is ‘Maternity Relief under Article 42’ which allows provisions to
be made by the state for securing just and humane condition of work
and maternity relief for women. The concern about empowerment
is not restricted to the above mentioned constitutional Acts and can
be also seen in various reservation systems. Until recent times, in
Indian society, the suppression of women’s political rights was a
manifestation of the patriarchal mindset. It was considered that from
birth till death, identity of women can only be derived from a man;
either from her father or her husband. Therefore, participation of
women in politics was made effective with a provision, namely,
‘Panchayati Raj Institutions’ which was included in the 73rd and
74th Constitutional Amendment Act, which reserved one-third of
their seats for women out of all the local elected bodies. Further,
‘Women’s Reservation Bill’ has been proposed to reserve 33 percent
of all seats in the LokSabha and in all State Legislative Assemblies
for women. Apart from these efforts, Government of India launched
various welfare schemes and policies at both state and central levels
for development and empowerment of women. Some such major
programmers and schemes are- Swadhar (1995), Swayam Siddha
(2001), Support to Training and Employment Programme for
Women (STEP-2003), Sabla Scheme (2010), National Mission for
Empowerment of Women (2010), etc. All such policies and programs
focused on social, economic and educational empowerment of
women across various age groups.
Because of these concentrated efforts, the status of women in
social, economic and political life began to elevate in the Indian
society. Based on the ideas championed by our founding fathers
for women’s empowerment many social, economic and political
provisions were incorporated in the Indian Constitution. Women
in India now participate in areas such as education, sports,
politics, media, art and culture, service sector and science and
technology. However, in the last two decades, discourse and
attention to the concept of women’s empowerment has gained
impetus to achieve various developmental goals. United Nations
Development Programmers focus on gender equality and women’s
empowerment not only as basic human rights but also because they
are a pathway to achieving the Sustainable Development Goals [6].
Research on the subject shows that the linkages between women’s
empowerment and nutritional indicators have been increasing over
the years. The pathway, from women’s empowerment to improved
nutrition has been inuenced by some factors such as social norms,
knowledge, skills, and decision-making power within households
[7]. (See Figure below).
Source: Herforth and Harris, 2014
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Int J Women’s Health Care, 2017
Empowerment of women has been considered to not only be
an important but also a crucial indicator of nutritional outcome,
because women are primary caregivers of the family as well as
children, therefore, they can inuence their nutritional status and,
children’s nutritional status through childcare practices [8,9].
Many studies demonstrated the association between women’s
empowerment (using direct and indirect measures of women’s
empowerment) and nutritional status of themselves their own
as well as their children [8,10-17]. Moreover, several studies
highlighted the consequences of women’s empowerment [8,18-
21]. However, some of the studies found that domestic violence (an
indicator of ultimate disempowerment) as the probable reason for
low levels of antenatal care, breastfeeding and child immunization
[8,22-24]. In the Indian context also, many studies found a positive
association between the measures of maternal autonomy (like-
nancial independence, participation in decision-making within
the household, acceptance of domestic violence, and freedom of
movement) with child growth outcomes [25,26]. Many studies
have found an association between women’s empowerment and
variety of good health outcomes of a child (including greater use
of health care, better immunization and nutritional status and
reduced child mortality) [27,28].
After facing extensive discrimination and many years of struggle,
women have been given property rights, voting rights, equality
in civil rights before the law, rights in matters of marriage and
employment, but there still are many issues because of which they
are struggling against many handicaps and social evils in a male-
dominated society [29]. Many evil and masculine forces still prevail
in the modern Indian society that resists the forward march of women
folk. Due to the deep-rooted patriarchal mentality in the Indian
society, women are still subjected to discrimination in the social,
economic and educational eld. There has been amelioration in the
situation of women but still there is lack of equality in women’s
empowerment that is why achieving gender equality became the
one of the important objective of sustainable development goals.
Therefore, by focusing on sustainable development goals, this study
has an objective to determine the association between inequality
in women’s empowerment and nutritional status of women and
children by exploring two important research questions - up to what
extent the recent improvement upswing of women’s empowerment
has affected malnutrition among women and children and what
are the potential gaps in maternal and child health program which
need to be addressed effectively in order to improve the nutritional
status of women and children. In this connection, this study aims
to hypothesize that there is no association between inequalities in
the indicators of women’s empowerment and malnutrition among
women and children in India.
Materials and Methods
Data
The study used the information from state and national fact sheets
of two rounds of National Family Health Survey (NFHS), which
was conducted during the year 2005-06 and 2015-16 in states of
India. NFHS is large scale survey which covered approximate 99
percent population of India. This survey was conducted under the
stewardship of Ministry of Health and Family Welfare, Government
of India. The International Institute for Population Sciences,
Mumbai was designated as the nodal agency for different rounds
of NFHS and ORC Macro, Calverton, Maryland, USA, which
is currently known as the ICF International, was providing the
technical support in various rounds of NFHS. In the fourth round
of the National Family Health Survey (NFHS-4) conducted in
2015-16, information regarding different dimensions of women’s
empowerment was collected from approximately 649,775 women
of age 15-49 across 29 states in India.
Description of Variables
Outcome variables
The outcome variables of interest were related to the nutritional
status of women and children. Women’s nutritional status were
assessed through body mass index < 18.5 kg/m2, however nutritional
status of children was accessed through height-for-age (<-2SD) and
weight-for-age (<-2SD) under age 5 years.
Women BMI
Women’s weight and height measurements were used to derive their
BMI, expressed as the weight in kilograms divided by the square of
the height in meters (kg/m2).
Child anthropometry
Weight and height/length measurements of children under ve
years. Anthropometric measurements of each child were compared
to WHO child growth standards reference.
Exposure variables
Women’s empowerment was assessed through different dimensions
of empowerment indicators like- household decision making,
ownership of house/land, bank account (either jointly or alone),
mobile phone which woman can use independently, employment
status (worked in the last 12 months and paid in cash) and schooling
of 10 years of more.
Household Decision Making
Currently married women were asked who make decisions about
their own health care, major household purchases, and visits
to their own family or relatives. If their response was either
“alone” or “jointly with someone”, it has been considered as their
participation in HH decision making.
Ownership of House/Land
Women age 15-49 were asked whether they have ownership of land
or house. If their response was either “having alone” or “jointly with
someone”, it has been considered as their ownership of household
assets.
Bank or saving Account
Women age 15-49 were asked whether they have saving bank
account, which they themselves can use. If their response was either
“having alone” or “joint account”, it has been considered as having
a bank or saving account.
Mobile Phone
Women age 15-49 were asked whether they have a mobile phone
that they themselves use. If their response was “yes”, it has been
considered to have it.
Working in the last 12 months and paid in cash
This question was asked to women age 15-49, if they worked in
the last 12 months and paid in cash.
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At least 10 years of schooling
Women age 15-49 were asked about their education attainment in
terms of years of schooling and classied accordingly.
Methods
Shannon diversity index was used to determine the inequality in a
different domain of women’s empowerment by using the different
domains to measure empowerment. Diversity index is a mathematical
measure to determine diversity in habitat in the community. In the
present study, women were treated as habitats that are living in the
different states of India.
The proportion of women (i) relative to the total number of women
(pi) is calculated and then multiplied by the natural logarithm of
this proportion (lnpi). The resulting product is summed across
women, and multiplied by ‘-1’
Shannon’s equitability (EH) can be calculated by dividing H by
Hmax. Equitability assumes a value between 0 and 1.
Bivariate association was determined to understand the association
between exposure and outcome variables. However, multivariate
regression analysis was used to determine the adjusted effect of
exposure variables on outcome variables. Let x1, x2, x3...xn be the
predictors of response variable y where b1, b2, b3...bi represent the
coefcient of each predictor variable included in the model and ‘e’ is
the error term. The linear regression model can be written as-
yj=b0+b1 x1+b2 x2+b3 x3+……..+bi xi+e
All the analysis has been done in MS-Excel.
Results
Table 1 shows the percentage of women who reported to have
different dimensions of women’s empowerment in state. Table 2
shows the diversity index inequalities in the different dimensions
of women’s empowerment by state. Table 3 shows the nutritional
status of women (body mass index <18.5 kg/m2) and children
(stunting and underweight) by state, from NFHS-3 and NFHS-
4. Table 4 shows the correlation matrix between the different
dimensions of women’s empowerment, for year 2015-16. Table 5
shows the results of the multivariate linear regression for nutritional
status of women and children, for year 2015-16. Table 6 shows the
percentage of births in the ve years preceding the survey. Figures
1-18 show the key ndings from the bivariate association (Figures
1-18th as been shown in appendix).
Levels and inequality in women’s empowerment among states
Women’s empowerment is an active, multi-dimensional process
which enables women to realize their potential and powers in all
spheres of life. It is not only necessary for social justice and equal
opportunity for women but also essential to eliminate poverty,
under nutrition and to achieve better health and education for
society. (Table 1) shows percentage of women who own house/
land, bank account, mobile phone, participate in the household
decision making, have at least ten years of schooling, worked in
last 12 months and were paid in cash across 29 states of India and
for the country.
Table: 1 Percentage of women who report to have different dimensions of women’s empowerment in India and states, 2015-16
State Owning house or
land
Owning
bank account
Having
mobile
Household
decision making
Working and
were paid in cash
(in last 12 months)
Having 10 or
more year of
schooling
North
Haryana 35.8 45.6 50.5 76.7 17.6 45.8
Himachal Pradesh 11.3 68.8 73.9 90.8 17.0 59.4
Jammu and
Kashmir
33.3 60.3 54.2 84.0 12.4 37.2
Punjab 32.1 58.8 57.2 90.2 18.5 55.1
Rajasthan 24.1 58.2 41.4 81.7 18.6 25.1
Uttarakhand 29.2 58.5 55.4 89.8 15.5 44.6
Central
Chhattisgarh 26.4 51.3 31.0 90.5 36.8 26.5
Madhya Pradesh 43.5 37.3 28.7 82.8 29.9 23.2
Uttar Pradesh 34.2 54.6 37.1 81.7 16.6 32.9
East
Bihar 58.8 26.4 40.9 75.2 12.5 22.8
Jharkhand 49.7 45.1 35.2 86.6 24.8 28.7
Odisha 63.5 56.2 39.2 81.8 22.5 26.7
West Bengal 23.8 43.5 41.9 89.9 22.8 26.5
Northeast
Arunachal Pradesh 59.7 56.6 56.6 89.1 17.1 31.0
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Assam 52.3 45.4 46.0 87.4 17.0 26.2
Manipur 69.9 34.8 63.1 96.2 40.9 45.9
Meghalaya 57.3 54.4 64.3 91.4 35.9 33.6
Mizoram 19.7 57.4 77.3 96.0 29.3 29.3
Nagaland 34.7 38.9 70.5 97.4 97.4 33.3
Sikkim 24.8 63.5 79.8 95.3 19.9 40.7
Tripura 57.3 59.2 43.9 91.7 26.3 23.4
West
Goa 33.9 82.8 80.9 93.8 23.6 58.2
Gujarat 27.2 48.6 47.9 85.4 30.2 33.0
Maharashtra 34.3 45.3 45.6 89.3 28.9 42.0
South
Andhra Pradesh 44.7 66.3 36.2 79.9 42.1 34.3
Karnataka 51.8 59.4 47.1 80.4 29.1 45.5
Kerala 34.9 70.6 81.2 92.1 20.4 72.2
Tamil Nadu 36.2 77.0 62.0 84.0 30.5 50.9
Telangana 50.5 59.7 47.8 81.1 45.2 43.3
India 38.4 53.0 45.9 84.0 24.6 35.7
Results show that 38 percent of women possess house/land (jointly
or alone) in India. However, 53 percent of women have a bank
account and 46 percent of women possess mobile phone which
they themselves use. Study also highlighted that 84 percent of
women participated in household decision. Furthermore in India,
only 25 percent of women who worked during the last 12 months
before the survey have been paid in cash. The data also shows that
only a little over one-third (36 percent) of women have at least 10
years of schooling.
The pattern of different dimensions of women’s empowerment varies
considerably by state. Women owning house/ land (jointly or alone) is
highest in Manipur (70%) followed by Odisha (64%) and Arunachal
Pradesh (60 %). On the ip side, women belonging to Himachal
Pradesh (11%), Mizoram (20%), West Bengal, Rajasthan (24 %),
Sikkim (25%) and Chhattisgarh (26%) are relatively less likely to
own house/land. Further, about 83 percent of women in Goa possess
bank account followed by 77 percent in Tamil Nadu and 71 percent in
Kerala. However, this percentage is much lower among women from
Bihar (26%), Manipur (35%) and Madhya Pradesh (37%). More than
four-fths of women from Kerala and Goa (81% each), and Sikkim
(80%) have a mobile phone that they themselves use compared with
less than one-third of women from Chhattisgarh (31%) and Madhya
Pradesh (29%) which is the lowest among all states. The results
show that household decision making autonomy, as part of women’s
empowerment varies from a minimum of 75 percent in Bihar to a
maximum of 97 percent in Nagaland. This implies that a large majority
of women from all states have substantial participation in household
decision making. The percentage of women having at least 10 years of
schooling is highest in Kerala (72%) followed by Himachal Pradesh
(59%), Goa (58%), Punjab (55%) and Tamil Nadu (51%). The
proportion of women having at least 10 years of schooling is much
lower (23%-26%) in Assam, Rajasthan, Tripura, Madhya Pradesh
and Bihar. The percentage of women who worked in last 12 months
and were paid in cash is disappointingly low across most states. Less
than 50 percent of women across states who reported that they worked
during the last 12 months and were paid in cash. This percentage is
highest in Telangana, Andhra Pradesh, and Manipur (40%-45%). In
states like Jammu & Kashmir, Bihar, Uttarakhand, Uttar Pradesh,
Assam, Himachal Pradesh, Arunachal Pradesh, Haryana, Punjab,
Rajasthan and Sikkim less than 20 percent of women who worked in
last 12 months were paid in cash. These numbers clearly indicate the
discrimination and exploitation of working women exists by varying
degrees across states.
Inequality has been assessed through Shannon diversity index,
which shows the perfect homogeneity at 0 and perfect heterogeneity
at ‘1’. (Table 2) shows that inequalities in indicators of women’s
empowerment by state in which varied from 0.483 to 0.998. Results
presented in (Table 2) shows that Northeastern states, Goa and
Sikkim have lower inequality about with regard to ownership of
house/land compared to states in the northern part of India. While
comparing inequalities in empowerment indicators of the north
and the central part of India, it has been found that women from
north Indian states have higher inequality in comparison to women
from central parts of India. Furthermore, women from southern and
western parts of the country also face the maximum inequality to
have a different dimension of women empowerment. Moreover,
smaller states have lower inequality; however, bigger states have
higher inequality regarding women empowerment indicators
which may be primarily due to gradual diffusion of social change,
values and norms, which originates from the state capitals or more
developed urban areas and moving to the peripheral regions with a
time lag.
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Table 2: Diversity in different dimensions of women’s empowerment (Shannon diversity index) in states of India, 2015-16.
State Household
decision making
Owning house or
land
Having
bank account
Having
mobile
Working and
were paid in cash
(in last 12 month)
Having 10 or
more years of
schooling
North
Haryana 0.992 0.951 0.983 0.990 0.971 0.981
Himachal Pradesh 0.996 0.967 0.996 0.998 0.976 0.989
Jammu and
Kashmir
0.985 0.898 0.992 0.996 0.953 0.980
Punjab 0.995 0.896 0.995 0.996 0.990 0.993
Rajasthan 0.98 0.905 0.979 0.970 0.982 0.931
Uttarakhand 0.972 0.965 0.985 0.981 0.954 0.925
Central
Chhattisgarh 0.971 0.957 0.979 0.953 0.993 0.896
Madhya Pradesh 0.972 0.950 0.973 0.966 0.979 0.937
Uttar Pradesh 0.983 0.972 0.985 0.979 0.977 0.957
East
Bihar 0.986 0.965 0.978 0.992 0.988 0.946
Jharkhand 0.966 0.962 0.969 0.965 0.978 0.897
Odisha 0.981 0.988 0.985 0.964 0.969 0.920
West Bengal 0.996 0.944 0.993 0.989 0.992 0.964
Northeast
Arunachal Pradesh 0.991 0.951 0.986 0.978 0.987 0.918
Assam 0.987 0.966 0.995 0.995 0.965 0.966
Manipur 0.846 0.867 0.866 0.866 0.879 0.833
Meghalaya 0.826 0.840 0.836 0.842 0.845 0.847
Mizoram 0.836 0.860 0.862 0.863 0.866 0.859
Nagaland 0.869 0.865 0.883 0.889 0.901 0.808
Sikkim 0.59 0.660 0.670 0.672 0.673 0.669
Tripura 0.722 0.692 0.660 0.697 0.726 0.579
West
Goa 0.510 0.499 0.497 0.495 0.483 0.497
Gujarat 0.994 0.889 0.998 0.993 0.990 0.971
Maharashtra 0.994 0.954 0.988 0.986 0.983 0.978
South
Andhra Pradesh 0.992 0.980 0.997 0.997 0.997 0.986
Karnataka 0.960 0.965 0.962 0.963 0.964 0.961
Kerala 0.990 0.962 0.997 0.996 0.977 0.992
Tamil Nadu 0.993 0.959 0.997 0.997 0.992 0.991
Telangana 0.885 0.897 0.892 0.892 0.896 0.886
Changes in prevalence of malnutrition among women and
children in India from 2005-06 to 2015-16
India, the second most populous country in the world, is the home
to the largest number of children in the world. In India, issues
related to maternal and child health, especially malnutrition among
women and children, is a continuing enigma [30]. Malnutrition
is a major concern which hinders development and is associated
with enormous human and economic causes [31]. (Table 3) shows
the changing pattern of nutritional status of women and children
in India and its states over the last one decade (2005-06/2015-
16). A woman with BMI less than 18.5 kg/m2 is considered as an
indicator of women’s poor nutritional status.
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Table 3: Changes in prevalence of nutritional status of women and children from NFHS-3 to NFHS-4 in India and states,
2005-16.
State Women BMI <18.5 Stunting Underweight
NFHS-3 NFHS-4 NFHS-3 NFHS-4 NFHS-3 NFHS-4
North
Haryana 31.4 15.8 45.7 34.0 39.6 29.4
Himachal
Pradesh
29.9 16.2 38.6 26.3 36.5 21.2
Jammu and
Kashmir
28.0 11.5 35.0 27.4 25.6 16.6
Punjab 18.9 11.7 36.7 25.7 24.9 21.6
Rajasthan 36.7 27.0 43.7 39.1 39.9 36.7
Uttarakhand 30.0 18.4 44.4 33.5 38.0 26.6
Central
Chhattisgarh 43.4 26.7 52.9 37.6 47.1 37.7
Madhya Pradesh 41.7 28.3 50.0 50.0 60.0 42.8
Uttar Pradesh 36.0 25.3 56.8 46.3 42.4 39.5
East
Bihar 45.0 30.4 55.6 48.3 55.9 43.9
Jharkhand 42.9 31.5 49.8 45.3 56.5 47.8
Odisha 41.4 26.4 45.0 34.1 40.7 34.4
West Bengal 39.1 21.3 44.6 32.5 38.7 31.5
Northeast
Arunachal
Pradesh
16.4 8.5 43.3 29.4 32.5 19.5
Assam 36.5 25.7 46.5 36.4 36.4 29.8
Manipur 14.8 8.8 35.6 28.9 22.2 13.8
Meghalaya 14.6 12.1 55.1 43.8 48.8 29
Mizoram 14.4 8.3 39.8 28.0 19.9 11.9
Nagaland 17.4 12.2 38.8 28.6 25.2 16.8
Sikkim 11.2 6.4 38.3 29.6 19.7 14.2
Tripura 36.9 18.9 35.7 24.3 39.6 24.1
West
Goa 27.9 14.7 25.6 20.1 25.0 23.8
Gujarat 36.3 27.2 51.7 38.5 44.6 39.3
Maharashtra 36.2 23.5 46.3 34.4 37.0 36.0
Andhra Pradesh 30.8 17.6 38.4 31.4 29.8 31.9
Karnataka 35.4 20.7 43.7 36.2 37.6 35.2
Kerala 18.0 9.7 24.5 19.7 22.9 16.9
Tamil Nadu 28.4 14.6 30.9 27.1 29.8 23.8
Telangana - 23.1 - 28.1 - 28.5
India 35.5 22.9 48 38.4 42.5 35.7
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(Table 3) shows that percentage of women having poor nutritional
status (BMI<18.5 kg/m2) has declined by almost 13 percent
points in India over the last decade (36% to 23%). The percentage
decline in nutritional status is varied consistent across states.
Meghalaya, Sikkim, Nagaland, Manipur, Arunachal Pradesh,
Assam and Mizoram are some of the northeastern states which
have shown minimum decline in the percentage of undernourished
women in the last decade. It may be noted that the proportion of
undernourished women in these states was low in both rounds of
the survey (NFHS-3 and NFHS-4). Except to other northeastern
states, Tripura is the state which has relatively higher proportion
of undernourished women in both rounds of NFHS and maximum
decline in undernourished women. In some of the north Indian
states, Gujarat and Maharashtra the proportion of women with less
than normal BMI is quite high in both rounds of NFHS though
the decline over the last decade is considerable. Among the
southern states, Andhra Pradesh, Tamil Nadu, and Karnataka have
shown maximum decline and in Kerala the decline is minimum.
Moreover, rest of the states like Odisha, Haryana, Jammu &
Kashmir, Chhattisgarh and West Bengal shows a relatively higher
reduction in women with less than normal BMI.
The study has considered stunting and underweight as the
nutritional indicators for children under age ve years. (Table
3) further shows a decline of approximately 10 percent points in
stunted children and 8 percentage points decline in underweight
children in India from NFHS-3 to NFHS-4. The study found
that all the states have experienced a decline in undernourished
children from 2005 to 2016. The proportion of stunted children also
reduced from NFHS-3 to NFHS-4 in all states. In some states like-
Kerala, Goa, Tamil Nadu, Jammu & Kashmir, Manipur, Sikkim,
and Andhra Pradesh the decline in percentage of stunted children
is marginal though it should be noted that the percentage of stunted
children was also low in these states in both NFHS-3 and NFHS-
4. Karnataka, Rajasthan, Jharkhand and Madhya Pradesh are the
states which have large proportion of stunted children but seen
lower reduction. Moreover states like- Tripura, Punjab, Himachal
Pradesh, Arunanchal Pradesh, West Bengal, Gujarat, Chhattisgarh,
and Meghalaya have seen the moderate to large reduction in stunted
children, however the share of stunted children was highest in
these states. Like stunted children, percent of underweight children
also have been declined from 2005 to 2016 in all states of India,
except Andhra Pradesh (increases by 2 percent point). A very sharp
reduction in underweight children has been seen in Meghalaya
(reduced by 20 % point) Madhya Pradesh (reduced by 17% point)
and Tripura (reduced by 16 % point); however the proportion of
underweight children was higher in these states. Contrary to this,
states like- Sikkim, Kerala, Punjab, Goa and Tamil Nadu have the
relatively lower proportion of underweight children in NFHS-
3 and NFHS-4 though the reduction in underweight children is
low in these states. Furthermore, Assam, Maharashtra, Karnataka,
Rajasthan, Odisha and Uttar Pradesh are the states with high
proportion of underweight children however lower reduction in
underweight children during 2005 to 2016.
Linkages between inequality in women empowerment and
malnutrition among women and children
Bivariate association between inequalities in women’s empowerment
with nutritional status of women and children without controlling
other variables has been given through Figures 1-18 (see in
appendix). All scatter diagrams show the positive association
between exposure and outcome variables. (Figures 1-6) shows that
percentage of women with poor nutritional status (BMI<18.5 kg/m2)
increases with increasing inequalities in all indicators of women’s
empowerment. Women belonging to smaller states like Goa, Sikkim
and Tripura have lower inequality (lies between 0.50-0.70) in all
selected dimensions of women’s empowerment and, have a lower
percentage of women with poor nutritional status.
Figure 1: Bivariate association between inequality in HH decision
and women’s BMI (<18.5) in India, 2015-2016.
Figure 2: Bivariate association between inequality in ownership
of house/land and women’s BMI (<18.5) in India, 2015-16.
Figure 3: Bivariate association between inequality in ownership
of bank account and women’s BMI (<18.5) in India, 2015-16.
Figure 4: Bivariate association between inequality in ownership
of mobile and women’s BMI (<18.5) in India, 2015-16.
Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 8 of 16

Figure 5: Bivariate association between inequality in working
status (who were paid in cash in last 12 months) and women’s
BMI (<18.5) in India, 2015-16.
Figure 6: Bivariate association between inequality in women’s at least
10 years of schooling with women’s BMI (<18.5) in India, 2015-16.
However, remained northeastern states (Meghalaya, Manipur,
Nagaland and Mizoram), some North Indian states (Haryana, Jammu
& Kashmir, Himachal Pradesh, and Punjab) and some south Indian
states (Tamil Nadu, Kerala) have relatively high inequality in various
dimensions of women empowerment with lower percent of women
less than normal BMI. Rest of the states reects higher inequality in
empowerment indicators with the higher proportion of women less
than normal BMI. Likewise to women BMI, a positive association
has been found between inequality in empowerment indicators with
childhood stunting (Figures 7-12) and underweight (Figures 13-18).
Figure 7: Bivariate association between inequalities in HH decision
with childhood stunting in India, 2015-16.
Figure 8: Bivariate association between inequalities in ownership
of house/land with childhood stunting in India, 2015-16.
Figure 9: Bivariate association between inequalities in bank
account with childhood stunting in India, 2015-16.
Figure 10: Bivariate association between inequalities in use of mobile
phone with childhood stunting in India, 2015-16.
Figure 11: Bivariate association between inequalities in working
status (who was paid in cash in last 12 months) with childhood
stunting in India, 2015-16.
Fgure 12: Bivariate association between inequalities in women’s at
least 10 years of schooling with childhood stunting in India, 2015-16.
Figure 13: Bivariate association between inequalities in HH decision
with childhood underweight in India, 2015-16.
Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 9 of 16

Figure 14: Bivariate association between inequalities in ownership
of house/land with childhood underweight in India, 2015-16.
Figure 15: Bivariate association between inequalities in possession
of bank account with childhood underweight in India, 2015-16.
Figure 16: Bivariate association between inequalities in use of
mobile phone with childhood underweight in India, 2015-16.
Figure 17: Bivariate association between inequalities in working
status (who has worked and were paid in cash in last 12 months)
with childhood underweight in India, 2015-16.
Figure 18: Bivariate association between inequalities in women’s
at least 10 years of schooling with childhood underweight in India,
2015-16.
The data on the nutritional status of children was collected by
measuring the height and weight of all the children under age ve
years. Figures 7-12 highlighted that Goa, Sikkim, and Tripura
are the states which have the lower inequality in empowerment
indicators as well as the lower proportion of stunted children under
age ve years in states of India. While possessing higher inequality
in women empowerment indicators, states like Mizoram,
Telangana, Kerala, Arunachal Pradesh, Andhra Pradesh, Tamil
Nadu, Punjab and Himachal Pradesh have a relatively smaller
proportion of stunted and underweight (<30 %) children under age
ve years. Moreover, the states like Bihar, Uttar Pradesh, Madhya
Pradesh, Chhattisgarh, Jharkhand, and Meghalaya have the higher
inequality in women empowerment as well as higher proportion of
stunted children.
The multivariate linear regression analysis by controlling all
selected empowerment indicators with the nutritional outcome of
women and children is shown in (Table 5). Likewise, the result of
the bivariate model, increasing inequalities among women owning
house/land, having bank account, work status (working during
past 12 months and paid in cash) and women with at least ten
years of schooling have a positive association with poor nutritional
status of women (BMI<18.5kg/m2) and children (stunting and
underweight).
Women’s participation in household decision making and
possession of mobile that they themselves use gets to change its
direction when coming to adjusted model from bivariate model.
This reects that increased inequality in household decision
making and mobile use decreases the likelihood of BMI<18.5
among women and stunting and underweight among children,
though it is not signicant in the model.
Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 10 of 16

Table 5: Multivariate linear regression for women’s and childhood nutritional status across the states of India, 2015-16.
Inequality
in indicators
of women
empowerment
BMI<18.5 Stunting Underweight
Coefcients P-value Coefcients P-value Coefcients P-value
Intercept -0.72 0.27
R2 = 0.266
0.01 0.93
R2= 0.101
-1.0 0.22
R2= 0.252
Household
decision making
-1.69 0.61 -1.40 0.70 -1.50 0.73
Owning House or
Land
0.47 0.35 -0.02 0.96 0.55 0.41
Having bank
account
1.14 0.54 0.92 0.65 1.26 0.61
Having mobile -0.82 0.62 1.01 0.58 -0.97 0.66
Working and were
paid in cash (in last
12 months)
1.62 0.22 0.33 0.82 1.89 0.28
Having at least 10
years of schooling
0.24 0.57 -0.58 0.22 0.19 0.73
Discussions
This study provided evidence by demonstrating the association between inequality in indicators of women’s empowerment with
nutritional status of women and children in India. The study found that inequality in women’s empowerment in terms of owning a
house/land, having a bank account, having at least ten years of schooling and working in the past 12 months and paid in cash have
a positive association with women’s and children’s nutritional status. This relationship holds true even after controlling the effect of
other indicators of empowerment in the regression model. This nding corroborated the ndings from earlier research [8, 10,25,26].
Further, the bivariate association between inequality in household decision making and bank account shows a positive relationship with
nutritional status of women and children (Table 4) but this direction gets reversed in the regression model. The study further highlighted
that autonomy in household decision making is positively and strongly correlated with having bank account, having a mobile phone that
women uses herself and working during last 12 months and paid in cash (Table 4). Additionally, there exists high correlation between
possession of bank account and mobile phone for their own use. But some states like Manipur and Nagaland, women have good access of
cell phone and less ownership of bank account, which they can use independently. Conversely, at least ten years of schooling of women
is weakly correlated with ownership of house/land and working status (who were paid in cash in last 12 months) (r2=0.22) (Table 4).
Table 4: Correlation matrix between different dimensions of women empowerment in India, 2015-16.
Household
decision making
Owning house/
land
Having
bank account
Having mobile Working and Were
paid in cash (in last
12 months)
Having at least
10 years of
schooling
Household decision making 1.00
Owning House or Land 0.64 1.00
Having bank account 0.96 0.68 1.00
Having mobile 0.94 0.50 0.90 1.00
Working and were paid in
cash (in last 12 months)
0.79 0.64 0.71 0.63 1.00
Having at least 10
years of schooling
0.63 0.22 0.67 0.73 0.22 1.00
The study found that Goa is the only state, which shows the lowest
inequality in all dimensions of women empowerment and has
minimum share of undernourished women and children. Also,
the percentage of women who own house/land and earned in cash
(in last 12 months) is also quite low in Goa. The possible reasons
for this could be that Goa is a small state and is one of the few
developed states of India where women’s status is considerably
high on the west coast of India, which has attracted much attention,
as it features prominently on the national as well as international
holiday seekers’ map. Possibly because of its geography, history
or its cultural amalgamation, Goa has also earned a reputation for
being a unique Indian state. Furthermore, the human development
indicators such as high per capita income, high literacy rate, low
fertility rate, low infant mortality rate and universal knowledge of
contraception are often used to highlight the advantageous position
of women in Goa, particularly when the same are compared with
that of other Indian states.
In the northeastern part of the country, Sikkim and Tripura are
the states with higher equity (60-70%) in women empowerment
indicators compare to other northeastern states (83-98%).
Moreover, these states have the lower proportion of undernourished
women. These ndings are consistent with another study [32].
While looking at level of empowerments indicators, it has been
Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 11 of 16

found that women’s autonomy on household decision and control
over the ownership of house/land is high in the northeastern states,
where more than 86 percent of women have control over the
household decision making and more than 50 percent of women
own house/land. Further, results also highlight that the proportion
of undernourished children is relatively small in the northeastern
region. Possible reason might be the fair distribution of vitamin
A supplement, coverage of immunization, effective programs to
promote good health of women and child are better in northeastern
states than all Indian average [33,34]. Moreover, women from the
northeastern states have the good breastfeeding and vitamin A rich
food that is why the nutritional status of northeast children shows
the relative better result of stunting and underweight [35].
Southern states having very high inequality in indicators of women’s
empowerment, while possess small proportion of undernourished
women and children. When looking at level of empowerment indicators
it has been found that, except the women’s participation in household
decision making, all 5 dimensions of empowerment have low to
moderate coverage. Additionally, some more states like-Uttarakhand,
Haryana, Jammu & Kashmir, Himachal Pradesh, Punjab, have a
relatively lower proportion of undernourished women and children.
However, the level of empowerment indicators is very low while
inequality is high in these states. The justied reason might be that,
these are the state which ranked at top 10 states with a higher proportion
of female obesity; therefore, these states contributes a minimum
share of women with less than normal BMI. Providing food outside
of the home, rst introduced in the southern states of India. Notably,
southern states are already reached at the second stage of demographic
transition, where TFR is low, family planning is good, education is
high and many nutritional programmes run very well. Additionally,
mid-day meal program was rst introduced in Tamil Nadu and Kerala.
ICDS, MNP and Tamil Nadu integrated nutrition project (TINP) which
was for rural women, which offers food and health services to children
under age ve years, pregnant and lactating women. Government
commitments, attention on detailed program planning, accountability
targeted services delivery and quality supervision played a decisive
role in the better nutritional status of women and children.
In contrast, the remaining bigger states like Madhya Pradesh, Bihar,
Jharkhand, Orissa, Uttar Pradesh, Chhattisgarh, Rajasthan, Gujarat,
Maharashtra and West Bengal have high inequality in empowerment
indicators and, have a higher proportion of underweight women.
These larger states of India have the higher number of districts
and, the status of women which has been access through women
empowerment is quite low in these states. Except West Bengal,
Gujarat and Maharashtra other states belong to Empowered Action
Group States, which already have poor demographic prole in terms
of health and nutrition. However, for the states like West Bengal
and Orissa nutritional imbalance might be the one possible reason.
For instance, food pattern like, rice and sweats are the staple food
and it is very rare to see meals without sweets and rice in these
states. Furthermore, for the states like Jharkhand, Chhattisgarh and
Madhya Pradesh, majority of the population are tribal, where the
sexual violence is high.
Furthermore, it has been seen that since last two years food
production in Maharashtra has been affected by numbers of
droughts in several parts of states, which directly affected the
nutrition of individuals. Furthermore, the study indicates that in
these state BMI is a function of development and that narrow,
person-level, health-focused solutions may not succeed in reducing
variability in this measure [36]. This reason may be arising from
the lack of knowledge of child feeding practices which is affected
by different socio-economic characteristic. Food security at
household level at proper food distribution system and availability
of health facility are the important factors which positively
affects the nutritional status of women. These ndings are also
in the queue of the studies which found the relationship between
women empowerment and childhood under nutrition (stunting and
underweight) [8,12,23,25,26,37,].
Strategies to minimize the missed opportunities to address
cofactors of malnutrition among children
Maternal and child health (MCH) programmes were started for
providing medical and social services to mothers and children.
These programmes have been highly effective when they were
implemented as part of the National Rural Health Mission (NRHM).
Some of the schemes launched under this were Janani Surakhacha
Yojna (JSY), Universal Immunization Program (UIP) and Integrated
Child Development Services (ICDS). These initiatives have resulted
into substantial reduction in maternal deaths, promoted child survival
and safe motherhood, and ensured the birth of a healthy child through
strengthening of components of maternal health care like antenatal
care checkups (ANC), institutional delivery, postnatal checkups
(PNC), etc. and immunization programs. It is worth mentioning that
these programmes and services have also provided an opportunity to
enhance contact with health personnel during prenatal, delivery and
postnatal care and immunization. Health personnel provide a range
of services for both the mother and child. They provide knowledge
about maternal nutrition, importance of colostrum’s feeding and
exclusive breastfeeding, and other child feeding practices.
Over the years there has been growing evidence suggesting association
between colostrum’s feeling, increasing immunities against childhood
morbidities and nutritional status of children. Therefore increasing
prevalence of institutional deliveries may be the best strategy to
minimize the missed opportunity to address this issue. Table 6 shows
the gap between institutional births and colostrums feeding for India
and its states. Level of institutional delivery has improved from 39
percent to 79 percent during the last decade. There is considerable
improvement in colostrum’s feeding (increased from 23% to 42%)
during the last decade but there is still a large gap. As per NFHS-
4 results, the gap between institutional delivery has increased 15 to
37 percent points during these time. The difference is substantial in
Punjab (60 percentage points), Rajasthan (56 percentage points),
Telangana (54 percentage points) and Andhra Pradesh (52 percentage
points). The gap between intuitional delivery and colostrum’s feeding
has widened during the last decade mainly due to great improvement
in institutional deliveries in these states from during last one decade.
However, the difference is minimum in Manipur, Assam, and
Mizoram and in Arunachal Pradesh, Meghalaya, and Nagaland gap
is negative, that is, percentage of births receiving colostrum’s feeding
is greater that percentage of institutional births. Thus, to minimize
the gap between institutional delivery and colostrums feeding,
strategies to make sure active involvement of health care providers
may be developed. They should be trained to provide counseling and
information before and after delivery, which can be achieved without
any additional nancial burden.
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Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 13 of 16
Table 6: Potential Opportunity to address missed opportunity during NFHS-3 to NFHS-4 in India and states, 2005-16.
State NFHS-3 NFHS-4 NFHS-3 NFHS-4
Institutional
delivery
Colostrums
feeding
Institutional
delivery
Colostrums
feeding
3+DPT Exclusive
breastfeeding
3+DPT Exclusive
breastfeeding
North
Haryana 35.7 22.3 80.5 42.4 74.2 16.9 76.5 50.3
Himachal
Pradesh
43.1 43.4 76.4 41.1 85.1 27.2 85.0 67.2
Jammu and
Kashmir
50.2 31.9 85.7 46.0 84.5 42.3 88.1 65.4
Punjab 51.3 10.3 90.5 30.7 70.5 35.7 94.5 53.0
Rajasthan 29.6 13.3 84.0 28.4 38.7 33.2 71.6 58.2
Uttarakhand 32.6 32.9 68.6 27.8 67.1 31.2 80.0 51.0
Central
Chhattisgarh 14.3 24.6 70.2 47.1 62.8 82.0 91.4 77.2
Madhya
Pradesh
26.2 14.9 80.8 34.5 49.8 21.6 73.4 58.2
Uttar Pradesh 20.6 7.2 67.8 25.2 30.0 51.3 66.5 41.6
East
Bihar 19.9 4.0 63.8 34.9 46.1 28.0 80.2 53.5
Jharkhand 18.3 10.9 61.9 33.2 40.3 57.8 82.4 64.8
Odisha 35.6 54.4 85.4 68.6 67.9 50.8 89.2 65.6
West Bengal 42.0 23.7 75.2 47.5 71.5 58.6 92.7 52.3
Northeast
Arunachal
Pradesh
28.5 55.0 52.3 58.7 39.3 60.0 52.3 56.5
Assam 22.4 50.7 70.6 64.4 44.9 63.1 66.5 63.5
Manipur 45.9 57.2 69.1 65.4 61.2 62.1 77.8 73.6
Meghalaya 29.0 58.6 51.4 60.6 47.3 26.3 74.0 35.8
Mizoram 59.8 65.5 80.1 70.2 66.8 46.1 61.7 60.6
Nagaland 11.6 51.4 32.8 53.2 28.7 29.5 52.0 44.5
Sikkim 47.2 43.3 94.7 66.5 84.3 37.2 93.0 54.6
Tripura 46.9 33.1 79.9 44.4 60.2 36.1 71.1 70.7
West
Goa 92.3 59.7 96.9 73.3 87.5 17.7 94.2 60.9
Gujarat 52.7 27.1 88.7 50.0 61.4 47.8 72.7 55.8
Maharashtra 64.6 51.8 90.3 57.5 76.1 53.0 74.9 56.6
South
Andhra
Pradesh
68.6 22.4 91.6 40.1 61.0 63.0 89.0 70.2
Karnataka 64.7 35.6 94.3 56.4 74.0 58.6 77.9 54.2
Kerala 99.3 55.4 99.9 64.3 84.0 56.2 90.4 53.3
Tamil Nadu 87.8 55.2 99.0 54.7 95.7 34.1 84.5 48.3
Telangana - - 91.5 37.1 - - 87.9 67.3
India 38.7 23.4 78.9 41.6 55.3 40.6 78.4 44.9

Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 14 of 16
Vaccination is a cornerstone of child health interventions to reduce
morbidity and mortality in developing countries and most of studies
suggest that malnourished children can mount adequate protective
responses to vaccines [38,39]. Further, it is assumed that children
receiving three doses of DPT vaccination may be in close contact with
health personnel at least up to six months of age. As a result, those
completing three doses of DPT can be expected to be exclusively
breastfed up to six months, if mothers counseled by the health care
providers engaged in immunization of children. Therefore, any gap
in these two proportions may be treated as the missed opportunity
to address one of the important cofactors of childhood malnutrition.
Table 6 shows that percentage of children who have received three
doses of DPT in India has increased considerably from 55 percent to
78 percent during last decade. However, improvement in exclusive
breastfeeding was only 41 to 45 percent. This gap exists in all the
states, though the differences are more pronounced in EAG states.
The difference between third dose of DPT vaccination and exclusive
breastfeeding is widening (15 % points to 34% points). Highest
difference has been observed in Punjab (41% points), followed by
West Bengal (41% points), Rajasthan and Meghalaya (38% points).
Again, the difference was found minimum in the northeastern states
like Tripura (0.4% points), Mizoram (1% points), Assam (3% points),
Manipur (4% points), and Arunachal Pradesh (-4%points). But still
low coverage of third dose of DPT vaccination is most important
factor behind this smaller amount of difference. The overlapping
(Figures 19-21) reects the women’s education and colostrums
feeding, which affect the childhood stunting under age three years in
29 states of India. (Figure 19) show that increasing prevalence of
colostrums feeding decreases the likelihood of stunting in all states
except Uttar Pradesh, Madhya Pradesh Bihar and Jharkhand.
Figures 19: Percentages of mother’s education, colostrums feeding and childhood stunting in states of India, 2015-16.
Figures 20: Percentages of mother’s working status, 3 DPT and childhood underweight in states of India, 2015-16.
Figures 21: Percentages of mother’s education, household decision making and maternal BMI<18.5 in states of India, 2015-16.

Int J Women’s Health Care, 2017 Volume 2 | Issue 2 | 15 of 16
The ndings of this study need to be considered in the context of
its limitations and strength. Due to the unavailability of individual
level data one can only talk about state level association between
exposure and outcome variables, instead of unit level association.
On the other hand, the strength of the study is that it is based on
a recent large scale nationwide household survey in which for
the rst-time information about various dimensions of women’s
empowerment have been collected and ndings are available at the
state level and for the country as a whole.
Conclusions
The study concluded that inequalities in different dimensions
of women’s empowerment at the state level are associated with
women’s as well as child nutritional status. Based on the results of
this study, researchers, programme managers and policy makers
who are working on improving maternal and child nutritional
status in India should pay attention to some specic dimensions
of women’s empowerment such as autonomy to own house/land,
have a bank account and possession of mobile phone which they
can use independently. Further, the focus should be given to
improve the educational attainment of women in society, because
reduced inequality in education can solely mitigate the inequality
in other dimensions of empowerment.
The present study does not conrm the causal association;
therefore further research should be done to test the gains in
women and child nutritional status that can be achieved by some
targeted interventions which aim to improve these specic aspects
of women’s empowerment in India. Additional research can also
be done to see whether the relationships between inequality in
women’s empowerment and women and child nutritional status
which are also found in other South Asian contexts. Research from
the different corners of the world gauges the different information
related to women’s empowerment and concluded that the women’s
empowerment in any direction directly improves welfare and health
of women and children through greater food security and income.
Better child health outcome will come from side of women, rather
than men alone by making key household decisions.
Ethical approval and consent to participate
This analysis is based on a secondary dataset with no identiable
information on the survey participants. This dataset is available in
public domain for research use hence no approval was required
from any institutional review board as there is no question of
human subject protection arising in this case.
Authors’ contributions
SKS conceived the idea. SKS, SS designed the experiment, analyzed
it, interpreted the results and drafted the rst round of manuscript.
SKS, SS, YV, JG, G drafted second round of manuscript. All the
authors read and approved the nal manuscript.
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Copyright: ©2017 Swati Srivastava, et al. is is an open-access article
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medium, provided the original author and source are credited.
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