Do changes in women's household status in Nepal improve access to food and nutrition?

Abstract

Women's nutritional status remains poor in South Asia, impacting maternal and infant health outcomes. Women's household status is also low, as evidenced by eating behaviours. We started with triadic qualitative interviews with newly married women, husbands and mothers‐in‐law to explore the link between women's status and eating patterns, followed by longitudinal data from a cohort of 200 newly married women in rural Nepal to measure associations over time. Quantitative data were collected every 6 months for 18 months (four rounds of data) between 2018 and 2020. Interviews suggested that household relationships, women's status, and how much and what types of food she was given were intricately linked. Using mixed effects logistic regression models, we explore the association between markers of changing women's status (becoming pregnant, giving birth and working outside the home) on two outcomes (eating last always/usually and achieving minimum dietary diversity). We also explore for interaction between women's status and household food insecurity. Pregnancy increases women's dietary diversity, but this is not sustained post‐partum. Women who work outside the home are less likely to eat last in the household. Food insecurity is associated with both the order of household eating and dietary diversity. Interactions between food insecurity and giving birth suggested that women who give birth in food insecure households are more likely to eat last in the household. Changes in women's household status are associated with some improvements in dietary diversity and order of household eating, but the associations are not long‐lasting and depend on food security status.

“Can’t live willingly”: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia

“…We found that newly married women and girls in particular had their decision-making restricted, as they have not yet gained status through their reproductive role. However, quantitative evidence from Nepal and Bangladesh suggests that the household status of women and girls does not increase with time or with the delivery of a child [131][132][133][134]. These nuances are context-specific and difficult to measure, requiring research at a local level, which we were unable to undertake in this regional review [135].…”

The relationship between the gendered norm of eating last and mental health of newly married women in Nepal: A longitudinal study

“…• The low status of women and harmful gender norms place them in situations that are detrimental to their mental health and well-being. likelihood of eating last in the household (Diamond Smith et al, 2022). Another qualitative study from Nepal also found that even when women became pregnant, women continued to conform to these gendered norms of eating last in the household to show deference to elders (Morrison et al, 2021).…”

“…However, this might change as newly married women gain status in the household––as women go out to work, get pregnant, or have children. A recent study of newly married women observed that there was no significant association between becoming pregnant and eating last but working outside the home was associated with a lower likelihood of eating last in the household (Diamond Smith et al, 2022 ). Another qualitative study from Nepal also found that even when women became pregnant, women continued to conform to these gendered norms of eating last in the household to show deference to elders (Morrison et al, 2021 ).…”

“…Household food insecurity may moderate the order in which household members eat and the distribution of food resources within the household (Diamond‐Smith et al, 2022 ; Gittelsohn, 1991 ). As defined by the United Nations Committee on World Food Security, food security is where ‘all people at all times have both physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life’ (Swindale & Bilinksy, 2006 ).…”

Crop diversity, sustainable food and nutritional security among smallholder farmers in Ghana

“…However, market access does not always lead to better nutritional outcomes (Moe, 2002;Nandi et al, 2021;Usman and Callo-Concha, 2021). Similarly, as established in the intra-household decision-making literature, control and ownership of household income and assets tend to influence crop sales and nutrition outcomes (Diamond-Smith et al, 2022;Kulkarni et al, 2021).…”