Is maternal autonomy associated with child nutritional status? Evidence from a cross-sectional study in India.

Despite India's steady economic growth over recent the period, the burden of childhood malnutrition persists, contributing to higher neonatal and infant mortality. There is limited evidence available to contextualise mothers' crucial role in childcare practices and health status in the Indian context. This study attempts to assess the association between maternal autonomy and the nutritional status of children under five. We used samples of 38,685 mother-child pairs from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015-16. We considered three widely used indicators of child nutrition as outcome variables: stunting, wasting, and underweight. Maternal autonomy (measured from three dimensions: household decision-making, freedom of physical movement, and access to economic resources/control over assets) was the key predictor variable, and various child demographics, maternal, and household characteristics were considered control variables. Stepwise binary logistic regression models were performed to examine the association. Of study participants, 38%, 21%, and 35% of children were stunted, wasted, and underweight, respectively. Our results (models 1 to 4) indicate that mothers with greater autonomy were significantly associated with lower odds of malnourished children. After controlling for all potential confounding variables (in model 5), maternal autonomy had a statistically insignificant association with children's stunting (Odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.87, 1.00) and wasting (OR: 0.92; 95% CI: 0.85, 1.00). However, a significant relationship (though marginally) was retained with underweight (OR: 0.94; 95% CI: 0.88, 0.99). In addition, socio-demographic characteristics such as child age, birth order, maternal education, maternal BMI, place of residence and household wealth quintile were found to be strong predictors of child nutritional status. Future policies should not only inform women's empowerment programmes but also emphasise effective interventions toward improving female educational attainment and nutritional status of women, as well as addressing socioeconomic inequalities in order to combat the persistent burden of childhood malnutrition in India.