Mediating effects of women’s empowerment on dietary diversity during pregnancy in Central West Ethiopia: A structural equation modelling

ABSTRACT

Background

Considerable proportions of pregnant women consume inadequately diversified diets in Ethiopia. On the other hand, women’s empowerment is identified as a means of achieving maternal nutrition improvement. However, evidence on the relationship between multiple dimensions of women’s empowerment and dietary diversity during pregnancy is limited in Ethiopia.

Objective

This study aimed to assess the mediating effects of women’s empowerment in the pathway between women’s education and dietary diversity during pregnancy in West Shewa zone, Ethiopia.

Methods

A health facility-based cross-sectional study was conducted among 1,383 pregnant women in 2021. Dietary diversity was measured using the minimum dietary diversity for women (MDD-W) tool. Exploratory and confirmatory factor analyses were employed to identify and validate women’s empowerment dimensions. Structural equation modelling (SEM) was used to examine the pathways linking pregnant women’s education and empowerment to dietary diversity during pregnancy.

Results

From the latent dimensions of women’s empowerment produced by factor analyses, pregnant women’s education was directly associated with household decision-making power, psychological and time dimensions. In turn, household decision-making power, psychological and time dimensions were associated with dietary diversity during pregnancy. The direct relationship between pregnant women’s education and dietary diversity was insignificant, but the total indirect effect and total effect were significant. Household decision-making power, psychological and time dimensions were significant mediators in the relationship between pregnant women’s education and dietary diversity. However, economic dimension was related to neither pregnant women’s education nor dietary diversity.

Conclusion

This study highlights pregnant women with better education are more likely to be empowered in household decision-making, psychological and time dimensions; and those empowered pregnant women are more likely to consume more diverse diets, suggesting women’s access to higher education could have a positive indirect effect on consumption of more diverse diets during pregnancy by empowering women in the study area.

KEYWORDS:

• Dietary diversity
• pregnant women
• education
• women’s empowerment
• SEM
• Ethiopia

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

The authors thank the study participants who were willing to provide their time and personal information without hesitation. We gratefully acknowledge the data collectors, supervisors and health professionals working at the health institutions found in West Shewa zone for their valuable contributions. We express our gratitude to West Shewa Health Bureau and the public health institutions found in the Zone for allowing us conduct the study. We would like to thank Addis Ababa University’s Office of the Director for Research for its financial support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors contributions

All authors contributed to the conception, design of the work, analysis of data, interpretation of data and revision of the draft work. TE was responsible for acquisition, drafting the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved of the final manuscript to be published.

Ethics and consent

The study was conducted after getting approval from Addis Ababa University, College of Health Sciences Institutional Review Board (protocol number: 107/19/SPH). Permission was obtained from the respective public health facilities. Written informed consent was obtained from all participants before entering the study.

Paper context

Poor dietary diversity affects large proportions of pregnant women. Despite the recognition of women’s empowerment for maternal nutrition improvement, its pathways and effects on dietary diversity during pregnancy are understudied. We observed that pregnant women with better education were more empowered; and those empowered pregnant women were more likely to consume adequately diversified diets. Pregnant women’s household decision-making power, psychological and time empowerment should be considered for improving dietary diversity during pregnancy.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2290303.

Additional information

Funding

This work was supported by the Office of the Director for Research, Addis Ababa University under Grant [Ref. No: RD/LT-074/2019].