Women's Empowerment Dimensions and Child Stunting in Ethiopia: A Multilevel Analysis of Demographic and Health Surveys 2011-2016.

Child stunting affects 38.3% of children under five in Ethiopia as of 2016. Women's empowerment, defined through both fundamental capabilities and household decision-making authority, has emerged as a critical determinant of child nutritional outcomes. Drawing on Sen's capability approach and Kabeer's empowerment framework, we examined the associations between two distinct dimensions of women's empowerment and child stunting across Ethiopia's diverse regions. We analyzed 18,466 mother-child pairs from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Validated empowerment indices were constructed using factor analysis. We employed hierarchical multilevel models as our primary specification to examine the associations between women's empowerment and child stunting across Ethiopia's 11 administrative regions. Between 2011 and 2016, stunting declined from 42.3% to 36.4%. Women's decision-making authority increased (mean score: 0.70-0.78), while capabilities remained stable (0.17- 0.16). Higher capabilities were significantly associated with lower odds of stunting (β = -0.141, aOR = 0.87, 95% CI: 0.83, 0.91), whereas decision-making showed no association (β = 0.013, aOR = 1.01, 95% CI: 0.98, 1.05). A significant interaction between capabilities and decision-making was observed (β = 0.050, aOR = 1.05, 95% CI: 1.01, 1.09). Regional heterogeneity was substantial: Amhara maintained high stunting rates despite empowerment gains, while Somali saw improvements with low capabilities but increased decision-making. The study findings suggest that interventions should prioritize capability development through region-specific strategies reflecting diverse pastoral, agrarian, and urban contexts; promote multi-sectoral programs linking education and nutrition services; and develop monitoring frameworks to track both dimensions of empowerment at the regional level.