SEARCHCROSS-SECTIONALepidemiology, public health

cross-sectional·epidemiology, public health, pediatrics, nutrition, obstetrics and gynecology·PMC10624287

Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan

PLOS ONE · 6 authors, 3 centres

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TL;DR

Using instrumental variable and fuzzy regression discontinuity designs on Pakistani household surveys, this cross-sectional study finds that both greater maternal empowerment and co-resident grandmothers independently improve weight-for-age z-scores in children under five, with heterogeneous effects across gender, geography, and household wealth.

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This study uses cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) 2017–18 and multiple rounds of the Multiple Indicator Cluster Survey (MICS) from 2008, 2011, 2014, and 2018 to estimate the causal impacts of maternal empowerment and co-resident grandmothers on child nutritional health in Punjab, Pakistan. An instrumental variable approach using the number of sons addresses endogeneity of maternal empowerment, while a fuzzy regression discontinuity design using grandmother's proximity to a potential retirement eligibility age cutoff addresses endogeneity of grandmother co-residence. Height-for-age and weight-for-age z-scores serve as anthropometric outcomes for children under five. Results indicate that WAZ increases by 0.28 SD per one-index-point increase in maternal empowerment, and by 0.098 SD when grandmothers co-reside. Subgroup analyses show maternal empowerment benefits are driven by girls and rural children, while grandmother presence benefits boys, rural children, and poorer households.

STUDY TYPE

cross-sectional

SPECIALTY

epidemiology

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ORIGINAL PAPER

PMC10624287

Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan

PLOS ONE

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ABSTRACT

Abstract We show that i) empowered mothers and ii) coresident grandmothers each benefit children’s nutritional health measured by height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for age groups 5 years and less. First, using cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) for the year 2017–18, we estimate the impact of empowered mothers on child health outcomes using an instrumental variable approach to correct for endogeneity. Empowerment is measured by two indices: as a sum of the questions that gauge both attitudinal and behavioral dimensions of female agency and also and using multiple correspondence analysis (MCA) for these same questions. Second, we use a fuzzy regression discontinuity design (FRDD) to measure the causal impact of coresident grandmothers on the health outcomes of the children using multiple rounds of the Multiple Indicator Cluster Survey (MICS) from the years 2008, 2011, 2014 and 2018. The difference between the actual ages of the grandmother from the Potential Retirement Eligibility Criteria (PREC) has been used to correct for potential endogeneity. The results show that on average, the weight for age z-scores (WFA) for children under five increases by 0.28 SD with a one-index point increase in mother’s empowerment. Similarly, on average, WFA increases by 0.098 SD when grandmothers are present in a household. Finally, we explore heterogeneity in the average effects stated above based upon the gender of the child as well as the wealth and geographic location of the household. The benefits of mothers’ empowerment are largely driven by improvements in girls’ nutrition as well as children living in rural areas while the presence of grandmothers primarily improves the nutrition of boys, children in rural areas, and children belonging to poor families.

CITATION EXPORT

Rabia Arif, Azam Chaudhry, Theresa Chaudhry et al.. Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0285995

AUTHORS

6 · 3 CENTRES

Rabia Arif, Azam Chaudhry, Theresa Chaudhry, Faisal Abbas, Faisal Abbas, Faisal Abbas

1Department of Economics, Lahore School of Economics, Burki (Lahore), Pakistan
2Faculty of Economics, Lahore School of Economics, Burki (Lahore), Pakistan
3National University of Sciences and Technology, PAKISTAN