IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v324y2023ics0277953623002265.html

Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial

Author

Listed:
  • Galvin, Lauren
  • Verissimo, Cristiana K.
  • Ambikapathi, Ramya
  • Gunaratna, Nilupa S.
  • Rudnicka, Paula
  • Sunseri, Amy
  • Jeong, Joshua
  • O'Malley, Savannah Froese
  • Yousafzai, Aisha K.
  • Sando, Mary Mwanyika
  • Mosha, Dominic
  • Kumalija, Elfrida
  • Connolly, Hannah
  • PrayGod, George
  • Endyke-Doran, Cara
  • Kieffer, Mary Pat

Abstract

Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018–May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 and 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.

Suggested Citation

  • Galvin, Lauren & Verissimo, Cristiana K. & Ambikapathi, Ramya & Gunaratna, Nilupa S. & Rudnicka, Paula & Sunseri, Amy & Jeong, Joshua & O'Malley, Savannah Froese & Yousafzai, Aisha K. & Sando, Mary Mw, 2023. "Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial," Social Science & Medicine, Elsevier, vol. 324(C).
    • Handle: RePEc:eee:socmed:v:324:y:2023:i:c:s0277953623002265
    DOI: 10.1016/j.socscimed.2023.115869
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953623002265
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2023.115869?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. repec:qeh:ophiwp:ophiwp058 is not listed on IDEAS
    2. Heckert, Jessica & Olney, Deanna K. & Ruel, Marie T., 2019. "Is women's empowerment a pathway to improving child nutrition outcomes in a nutrition-sensitive agriculture program?: Evidence from a randomized controlled trial in Burkina Faso," Social Science & Medicine, Elsevier, vol. 233(C), pages 93-102.
    3. Jones, Rebecca E. & Haardörfer, Regine & Ramakrishnan, Usha & Yount, Kathryn M. & Miedema, Stephanie S. & Roach, Timmie D. & Girard, Amy Webb, 2020. "Intrinsic and instrumental agency associated with nutritional status of East African women," Social Science & Medicine, Elsevier, vol. 247(C).
    4. Bhagowalia, Priya & Menon, Purnima & Quisumbing, Agnes R. & Soundararajan, Vidhya, 2012. "What Dimensions of Women’s Empowerment Matter Most for Child Nutrition? Evidence Using Nationally Representative Data from Bangladesh:," IFPRI discussion papers 1192, International Food Policy Research Institute (IFPRI).
    5. Quisumbing, Agnes & Ahmed, Akhter & Hoddinott, John & Pereira, Audrey & Roy, Shalini, 2021. "Designing for empowerment impact in agricultural development projects: Experimental evidence from the Agriculture, Nutrition, and Gender Linkages (ANGeL) project in Bangladesh," World Development, Elsevier, vol. 146(C).
    6. Lilia Bliznashka & Ifeyinwa E Udo & Christopher R Sudfeld & Wafaie W Fawzi & Aisha K Yousafzai, 2021. "Associations between women’s empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data," PLOS Medicine, Public Library of Science, vol. 18(9), pages 1-30, September.
    7. Naila Kabeer, 1999. "Resources, Agency, Achievements: Reflections on the Measurement of Women's Empowerment," Development and Change, International Institute of Social Studies, vol. 30(3), pages 435-464, July.
    8. Saha, Shree & Narayanan, Sudha, 2022. "A simplified measure of nutritional empowerment: Using machine learning to abbreviate the Women’s Empowerment in Nutrition Index (WENI)," World Development, Elsevier, vol. 154(C).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Waid, Jillian L. & Wendt, Amanda S. & Sinharoy, Sheela S. & Kader, Abdul & Gabrysch, Sabine, 2022. "Impact of a homestead food production program on women's empowerment: Pro-WEAI results from the FAARM trial in Bangladesh," World Development, Elsevier, vol. 158(C).
    2. Nath, Sunetra & Das, Gurudas, 2025. "Does women empowerment impact child well-being? Evidence from India," Social Science & Medicine, Elsevier, vol. 367(C).
    3. Kassie, Menale & Fisher, Monica & Muricho, Geoffrey & Diiro, Gracious, 2020. "Women’s empowerment boosts the gains in dietary diversity from agricultural technology adoption in rural Kenya," Food Policy, Elsevier, vol. 95(C).
    4. Serra, Renata & McKune, Sarah & Ludgate, Nargiza & Singh, Nitya & Devkota, Kabita & Fall, Mouhamed & Obin, Gordon & Touré, Alioune & Tiwari, Chhavi & Russo, Sandra, 2025. "Intersectionality matters: An analysis of women’s empowerment among livestock holders in Nepal, Senegal and Uganda," World Development, Elsevier, vol. 191(C).
    5. Ambler, Kate & Jones, Kelly M. & O’Sullivan, Michael, 2026. "Increasing women’s empowerment: Evaluating two interventions in Uganda," Journal of Development Economics, Elsevier, vol. 178(C).
    6. Shang, Wenli & Zhou, Ying & Tian, Xu, 2025. "Empowering women, enhancing diets: The impact of women’s bargaining power on dietary quality in urban China," Economics & Human Biology, Elsevier, vol. 58(C).
    7. Malapit, Hazel J. & Sraboni, Esha & Quisumbing, Agnes R. & Ahmed, Akhter, 2015. "Gender empowerment gaps in agriculture and children’s well-being in Bangladesh," IFPRI discussion papers 1470, International Food Policy Research Institute (IFPRI).
    8. Saha, Shree & Narayanan, Sudha, 2022. "A simplified measure of nutritional empowerment: Using machine learning to abbreviate the Women’s Empowerment in Nutrition Index (WENI)," World Development, Elsevier, vol. 154(C).
    9. Hazel Jean L. Malapit & Esha Sraboni & Agnes R. Quisumbing & Akhter U. Ahmed, 2019. "Intrahousehold empowerment gaps in agriculture and children's well‐being in Bangladesh," Development Policy Review, Overseas Development Institute, vol. 37(2), pages 176-203, March.
    10. DiClemente-Bosco, Kira & Weber, Alison Z. & Harrison, Abigail & Tsawe, Nokwazi & Rini, Zanele & Brittain, Kirsty & Colvin, Christopher J. & Myer, Landon & Pellowski, Jennifer A., 2022. "Empowerment in pregnancy: ART adherence among women living with HIV in Cape Town, South Africa," Social Science & Medicine, Elsevier, vol. 296(C).
    11. Annick Makongote & Branly Mbunga & Pierre Akilimali & Sofia Castro Lopes & Dieudonné Mpunga, 2024. "Women’s Empowerment and Associated Factors in Kinshasa, Democratic Republic of Congo: A Secondary Data Analysis of the Performance Monitoring Assessment Survey," IJERPH, MDPI, vol. 21(7), pages 1-14, July.
    12. Alison Riddle & Abby Ramage & Cynthia M. Kroeger & Zulfiqar A. Bhutta & Elizabeth Kristjansson & Monica Taljaard & Carol Vlassoff & Sara Wuehler & Becky Skidmore & Alexandria L. Bennett & Anita Rizvi , 2021. "PROTOCOL: The effects of empowerment‐based nutrition interventions on the nutritional status of women of reproductive age in low‐ and middle‐income countries," Campbell Systematic Reviews, John Wiley & Sons, vol. 17(3), September.
    13. Lecoutere, Els & Spielman, David J. & Van Campenhout, Bjorn, 2023. "Empowering women through targeting information or role models: Evidence from an experiment in agricultural extension in Uganda," World Development, Elsevier, vol. 167(C).
    14. Anderson, C. Leigh & Reynolds, Travis W. & Gugerty, Mary Kay, 2017. "Husband and Wife Perspectives on Farm Household Decision-making Authority and Evidence on Intra-household Accord in Rural Tanzania," World Development, Elsevier, vol. 90(C), pages 169-183.
    15. Malapit, Hazel & Quisumbing, Agnes & Meinzen-Dick, Ruth & Seymour, Greg & Martinez, Elena M. & Heckert, Jessica & Rubin, Deborah & Vaz, Ana & Yount, Kathryn M., 2019. "Development of the project-level Women’s Empowerment in Agriculture Index (pro-WEAI)," World Development, Elsevier, vol. 122(C), pages 675-692.
    16. Lumet, Kenedy & Gitau, Raphael & Owuor, George, . "The influence of women’s empowerment on poverty reduction: A case of smallholder sugarcane farmers in western Kenya," African Journal of Agricultural and Resource Economics, African Association of Agricultural Economists, vol. 17(3).
    17. Ross, Kara L. & Zereyesus, Yacob & Shanoyan, Aleksan & Amanor-Boadu, Vincent, . "The Health Effects of Women Empowerment: Recent Evidence from Northern Ghana," International Food and Agribusiness Management Review, International Food and Agribusiness Management Association, vol. 18(01), pages 1-17.
    18. Holland, Cara & Rammohan, Anu, 2019. "Rural women’s empowerment and children’s food and nutrition security in Bangladesh," World Development, Elsevier, vol. 124(C), pages 1-1.
    19. Etienne Lwamba & Shannon Shisler & Will Ridlehoover & Meital Kupfer & Nkululeko Tshabalala & Promise Nduku & Laurenz Langer & Sean Grant & Ada Sonnenfeld & Daniela Anda & John Eyers & Birte Snilstveit, 2022. "Strengthening women's empowerment and gender equality in fragile contexts towards peaceful and inclusive societies: A systematic review and meta‐analysis," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(1), March.
    20. Egamberdiev, Bekhzod & Bobojonov, Ihtiyor & Ren, Yanjun, 2025. "Women’s Empowerment in Agriculture for Nutritional and Food Security Benefits in Tajikistan: Latent Analysis Approach," EconStor Preprints 312281, ZBW - Leibniz Information Centre for Economics.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:324:y:2023:i:c:s0277953623002265. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.