This study examined the association between women empowerment and childhood anaemia in SSA. We found that women who were empowered in the attitude towards domestic violence, decision making, education, and social independence domains were less likely to have anaemic children.
Our study findings are consistent with the existing literature on the role of women empowerment in child nutrition in SSA.21–24 However, studies on women empowerment and child nutrition in this region have focused mainly on anthropometrical indicators, particularly stunting and underweight, 21 with only a few looking at anaemia.24,25 One study, whose aim was to explore pathways by which women’s empowerment influences child nutritional status,25 was based on DHS data from five East African countries and found significant and direct positive associations between women’s instrumental agency in household decisions and child haemoglobin concentrations.25 However, the study did not find a direct link between intrinsic agency (attitudes toward violence) with anemia.25 The study also found a significant positive association, both direct and mediated through instrumental agency, between assets (social empowerment) and anemia.25 Our findings are consistent with those of a study in India, which found that mother’s ability to make decisions about own health care, contribution to the family income, newspaper reading or negative attitude towards domestic violence increased the odds that her child will not have anaemia.26 Associations between poor iron status and women’s empowerment in agriculture have also been reported.27
Women’s empowerment can prevent anaemia in children through poverty reduction, improved access to food and promotion of awareness on nutrition, and promotion of appropriate child feeding and other care practices. Moreover, empowerment can lead to better health seeking behaviours 10 including treatment of infections such as malaria, iron supplementation, and deworming, which are key interventions to reduce anaemia.
The prevalence of childhood anaemia was highest among women who were least empowered especially in the decision-making dimension. In a study in Ethiopia, higher women’s empowerment in household decision making was associated with reduced anaemia in children.24 Women participation in decision-making regarding household purchases can promote child nutrition and reduce anaemia though improved dietary diversity.28 Financial empowerment is also likely to lead to improved child and household nutrition because compared to men, women are more likely to invest a larger proportion of their income in their families.29 Education and decision making go hand-in-hand because educated women are likely to access gainful employment and contribute to household finances and decision making. They are also more likely to have knowledge on appropriate child care practices.
This is the first time the association between the SWPER index and anaemia and Hb concentration in children in SSA has been assessed. The findings from this study therefore add to the growing evidence of the importance of women empowerment in promoting nutrition in children. The study’s large sample size increased the power to detect significant differences while the inclusion of data from a large number of countries from SSA increases the generalizability of our findings. Despite these strengths, this being a cross-sectional study, we cannot infer causation or establish a temporal relationship between the indicators of empowerment and the study outcomes. Moreover, our assessment of women empowerment was limited by the variables measured across all the included countries.
In conclusion, women empowerment was associated with reduced odds of anaemia and higher Hb concentration in children. Promotion of women empowerment in attitude towards violence, decision making, social independence and education dimensions may contribute towards reducing the burden of anaemia among children in SSA.