Association of women's empowerment with anaemia and haemoglobin concentration in children in sub-Saharan Africa: A multilevel analysis

We assessed the associations between women's empowerment and anaemia and haemoglobin concentration among children (6-59 months) in 31 sub-Saharan African (SSA) countries. We included 72,032 mother-child pairs from Demographic and Health Surveys conducted between 2006 and 2019. A three-dimensional women's empowerment index (attitude towards violence, decision making and social independence) was constructed using principal components analysis, and associations between the index and any anaemia and Hb concentration were assessed using multilevel regression. The mean (standard deviation) haemoglobin concentration was 102.3 (16.0 g/L) and 65.8% of the children were anaemic. The odds of anaemia reduced with increasing empowerment in the dimensions of attitude towards violence [quintile (Q5) versus Q1, OR 0.77; 95% confidence interval [CI] 0.65-0.89, p(trend) = 0.006], decision making (Q5 vs. Q1, OR 0.72; 95% CI 0.61-0.84, p(trend) < 0.001) and social independence (Q5 vs. Q1, OR 0.86; 95% CI 0.76-0.97, p(trend) = 0.015). The mean Hb concentration increased with increasing women's empowerment in the dimensions of attitude towards violence (Q5 vs. Q1, mean difference [MD] 1.40 g/L; 95% CI 0.63-2.17, p(trend) < 0.001) and social independence (Q5 vs. Q1, MD 1.32 g/L; 95% CI 0.36-2.28, p(trend) = 0.001). There was no evidence for a linear trend in the association between decision making and haemoglobin concentration (p(trend) = 0.051). Women's empowerment was associated with reduced odds of any anaemia and higher haemoglobin concentration in children. The promotion of women's empowerment may play a role in reducing the burden of childhood anaemia in SSA.