Training Session 1: Decision-Making Indicators Deanna Olney: Impact of HKI Enhanced-Homestead Food Production on Nutrition and Women’s Empowerment

1. THE IMPACT OF HELEN KELLER
INTERNATIONAL’S (HKI) ENHANCED-HOMESTEAD
FOOD PRODUCTION (E-HFP)
PROGRAM IN BURKINA FASO ON DIETARY
DIVERSITY, WOMEN’S NUTRITIONAL STATUS
AND COMPONENTS OF WOMEN’S
EMPOWERMENT
Deanna K. Olney, Lilia Bliznashka, Abdoulaye Pedehombga,
Andrew Dillon, Marie T. Ruel, Jessica Heckert

2. Acknowledgements
 Research done by the International Food Policy Research Institute
(IFPRI) and Helen Keller International (HKI):
 Deanna Olney, Andrew Dillon, Marie Ruel, Julia Behrman, Mara van den Bold,
Esteban Quninones, Jessica Heckert, Lilia Blishnashka, Abdoulaye
Pedehombga and Marcellin Ouedraougo
 Programs implemented by HKI with local partner NGOs
 In Burkina Faso by: Marcellin Ouedraogo, Abdoulaye Pedehombga, Hippolyte
Rouamba, Olivier Vebamba, Ann Tarini, Fanny Yago-Wienne
 Research funded by:
 USAID, Office of U.S. Foreign Disaster Assistance (USAID/OFDA) through
Helen Keller International (HKI)
 Gender, Agriculture and Assets Project (GAAP)
 CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) led
by IFPRI.
 Program and research participants

3. Background
 Integrated agriculture and nutrition programs consistently improve agriculture
production and dietary diversity.
 They are also posited to improve maternal and child health and nutrition
outcomes by simultaneously addressing some of the underlying factors of
maternal and child malnutrition and through empowering women.
 However, there is limited documented evidence about whether integrated
agriculture and nutrition programs can improve the health and nutritional
status of women and children and if they do – how and why they achieve this
impact.
 To generate this evidence, rigorous, comprehensive evaluations that include
impact and process evaluations are needed.

4. Overall objective of E-HFP program in Burkina
Faso
 To improve the nutritional status of women, infants and
young children through a set of production and nutrition
interventions targeted to women with children 3-12
months of age through three primary program impact
pathways
1. Increased availability of micronutrient-rich foods
through household production during the secondary
agriculture season.
2. Income generation through the sale of surplus
household production.
3. Increased knowledge and adoption of optimal nutritional
practices including consumption of micronutrient-rich
foods
 Primary program
interventions
 Agriculture supplies (e.g.
seeds, saplings, small
animals, gardening tools)
 Agriculture training
 Nutrition and health related
trainings

5. Secondary objective of E-HFP program in
Burkina Faso
 To empower women through:
1. Increased ownership of agriculture assets and control over
these assets.
2. Increased production of micronutrient-rich foods and control
over these foods.
3. Increased human capital through improvements in knowledge of
optimal practices in agriculture and health, hygiene and nutrition
4. Increased decision-making power through their increased
ownership and control over assets and micronutrient-rich foods
and through their increased agriculture, health, hygiene and
nutrition knowledge.
5. Increased social capital through participation in E-HFP program
activities that connect women and give them leadership

6. Study design
 Impact evaluation
 Cluster-randomized controlled trial
 25 control villages (N=741 households)
 30 treatment villages (N=1026 households)
 Longitudinal design
 Baseline February-May 2010 (target children 3-12 months of age)
 Endline February-June 2012 (target children 21-40 months of age)
 Quantitative household survey along with children’s growth and hemoglobin
concentration measures and women’s height and weight
 Two rounds of process evaluation
 Beneficiary and non-beneficiary women randomly selected from households that
participated in the baseline study (N=220)
 Purposive sample of key informants (N=118)
 First round April-May 2011
 Second round April-June 2012
 Qualitative semi-structured interviews

7. Methods: Quantitative survey
 Women’s empowerment
 Women responded to 30 questions thought to reflect underlying components of women’s
empowerment.
 No aggregate women’s empowerment measures have been developed and validated in the context
of this study.
 Exploratory factor analysis was conducted using baseline data and structure was reexamined and
confirmed in the follow-up data.
 Our a priori expectations were based on items that we theoretically expected to “hold together” in the data.
 Decisions for final components were made based on i) data realities (i.e., observed factor structure) and ii)
theory (i.e., do these items conceptually make sense together?)
 Dietary diversity
 Household consumption of individual food groups was examined using detailed consumption data
with a seven-day reference period and categorized using 11 of the 12 food groups included by
Swindale and Bilinsky for the construction of a household dietary diversity score
 Women’s dietary intake was assessed using a 24-hour recall period.
 Women’s intake of individual food groups was examined using the same groups as were used for
household dietary diversity but women’s dietary diversity was calculated using 9 food groups.
 Women’s nutritional status
 Women’s height was measured at baseline and weight was measured at both baseline and
endline.

8. Women’s Empowerment: Decision-making
indicators
Component Questions included Response codes Rang
e
alpha T1,
T2
Purchasing
decisions
Can you make the decision to purchase the following items? no=0; yes=1 0 to 8 0.89, 0.90
1. Small quantities of food, such as rice, vegetables, and bean
2. Larger quantities of food, such as bags of rice
3. Clothing for yourself
4. Medication for yourself
5. Toiletries such as soap and toothpaste
6. Medication for children?
7. Special foods for your children
8. Can you decide how to spend your money
Healthcare
decisions
Which household members decide most often about the following
issues?
Woman contributes: no=0;
yes=1
0 to 2 0.57, 0.77
1. Consult a doctor or go to a clinic when you are pregnant
2. What to do when a child is sick
Family planning
decisions
Which household members decide most often about the following
issues?
Woman contributes: no=0;
yes=1
0 to 2 0.66, 0.64
1. Use a contraceptive method
2. Have another child
IYCF decisions Which household members decide most often about the following
issues?
Woman contributes: no=0;
yes=1
0 to 2 0.69, 0.57

9. Women’s empowerment: Social capital
indicators
Component Questions included Response codes Range alpha T1,
T2
Spousal
communication
How often do you speak to your spouse about… never=0; sometimes=1;
often= 2
0 to 14 0.86, 0.95
1. Your professional/agricultural activities
2. Your domestic activities
3. Your expenses
4. Events in your community
5. The health of your child
6. Your child's food
7. Your health
Meeting with other
women
Do you meet with women in your community to discuss the
following issues?
no=0; yes=1 0 to 5 0.90, 0.94
1. Community problems
2. Educational problems
3. Health problems
4. Problems specific to women
5. Receive information on health and nutrition
Social support Do you have someone to help you when you have the following
problems?
no=0; yes=1 0 to 4 0.88, 0.87
1. Host you for multiple nights if necessary
2. Help you financially or lend you money

10. What was the impact of the E-HFP program on dietary
diversity, women’s nutritional status and
empowerment?

11. Impact of the E-HFP program on household
and women’s dietary diversity
Household dietary
diversity
Women’s dietary diversity

12. Impact of the E-HFP program on women’s BMI
and prevalence of thinness
Figure 1: Change in women’s body mass index
(BMI)1
21.2
21.0
20.8
20.6
20.4
20.2
20.0
Baseline Endline
Women’s BMI
Survey time point
Control Intervention
Figure 2: Change in the prevalence of thinness
among women1
30%
25%
20%
15%
10%
**
Baseline Endline
Prevalence of thinness
Survey time point
Control Intervention
Impact estimate = 0.03 Impact estimate = -8.7 %**
1Difference-in-difference (DID) impact estimates between control and intervention groups and controlled for age and adjusted
for clustering, and attrition. ** p<0.05 for DID estimates.

13. Impact of the E-HFP program on women’s
decision-making and social capital
5
4
3
2
1
0
Meeting with other
women (0-5)
**
Baseline Endline
Control Intervention
Impact estimate = 1.2
**
Purchasing
decisions
(0-8)
**
Impact estimate = 0.9
**
2
1.5
1
0.5
Healthcare
decisions (0-2)
**
Impact estimate = 0.2
**
5
0
Baseline Endline
Control Intervention
0
Baseline Endline
Control Intervention
No impact on spousal communication, social support, family planning decisions
or infant and young child feeding decisions.
1Difference-in-difference (DID) impact estimates between control and intervention groups and controlled for age and adjusted
for clustering, and attrition. ** p<0.05 for DID estimates.

14. How did the E-HFP program improve women’s
nutritional status and components of
empowerment?

15. Women’s thinness
 Supporting evidence from the impact evaluation
 Increases in women’s ownership of small animals
 Increases in women’s agriculture production
 Increases in household dietary diversity
 Increases in women’s intake of meat and fruit
 Supporting evidence from the process evaluation
 Establishment of home gardens
 Participation in BCC sessions
 Positive changes in women’s ability to control agriculture
inputs and products and to keep the money generated from
sale of those goods

16. Women’s empowerment
 Supporting evidence from the impact evaluation
 Increase in women’s ownership of agriculture assets
 Increase in women’s ownership of small animals
 Supporting evidence from the process evaluation
 Establishment of home gardens
 Participation in BCC sessions
 Participation in VMF activities
 Men’s and women’s beliefs that women are able to manage their
gardens
 Positive changes in women’s ability to control agriculture inputs
and products and to keep the money generated from sale of
those goods

17. Conclusions
 The E-HFP program improved household and women’s dietary diversity,
women’s nutritional status and empowerment.
 Improvements in women’s nutritional status can enhance women’s ability to
have positive impacts on household food security by increasing their ability
to participate in productive activities.
 In addition, these improvements can positively impact their children’s health
and nutritional status through their ability to care for their children, both in
terms of access to and control over resources, through their participation in
productive activities and through their own improved health and nutritional
status.
 The positive impacts of the E-HFP program on changes in women meeting
with other women and in women’s decision-making power may have
positive impacts on other important outcomes such as women’s own well-being,
food security and child health and nutritional status, both

18. On-going and future analyses
 Further examine the pathways through which
components of women’s empowerment were improved
through the EHFP program and if and how those
improvements were related to improvements in women’s
dietary intake and nutritional status.
 Examine the relationship between changes in
components of women’s empowerment and changes in
children’s anemia and anthropometric measures.