Development and validation of a health and nutrition empowerment module for the Women's Empowerment in Agriculture Index
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This presentation was given by Jessica Heckert (IFPRI/A4NH), as part of the Annual Gender Scientific Conference hosted by the CGIAR Collaborative Platform for Gender Research. The event took place on 25-27 September 2018 in Addis Ababa, Ethiopia, hosted by the International Livestock Research Institute (ILRI) and co-organized with KIT Royal Tropical Institute. Read more: http://gender.cgiar.org/gender_events/annual-conference-2018/
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Development and validation of a health and nutrition empowerment module for the Women's Empowerment in Agriculture Index
- 1. Jessica Heckert with Elena Martinez, Audrey Pereira, Sunny Kim, Shalini Roy, Greg Seymour, and Hazel Malapit Addis Ababa, Ethiopia September 25, 2018 Development & Validation of a Health & Nutrition Empowerment Module for the Women’s Empowerment in Agriculture Index
- 2. Women’s Empowerment in Agriculture Index (WEAI)
- 3. Many agricultural development projects have nutrition- sensitive objectives Photo credits: (L) Zillus Rhman, FAARM & (R) Julie Gostlaw, ANGeL
- 5. pro-WEAI Health and Nutrition Module Photo credits: (TL) FAARM; Allan Gichigi, Kenya; Jessica Heckert, MoreMilk; Animul Khandaker, ANGeL; Hazel Malapit; Elizabeth Bryant, iDE: Animul Khandaker, ANGeL; Animul Khandaker, ANGeL; Amanda Wendt, FAARM; Kalyani Raghunathan, WINGS
- 6. Burkina Faso: Grameen & SE LEVER Mali: WorldVeg Bangladesh: ANGeL FAARM TRAIN
- 7. Power with (collective agency) Power to (instrumental agency) Power within (intrinsic agency) Three types of agency measured in the WEAI
- 8. Who makes decisions about…. To what extent she participates in decisions about….
- 9. Decisions to purchase key foods and health products Can acquire them by some means (e.g., cultivation, from someone else)
- 10. Our Road Map Cognitive Interviewing Identifying Indicators Cutoffs for adequacy
- 11. Cognitive Interviewing Photo credit: Anika Hannan Collaboration with Emory University & DATA Bangladesh Improved question structure Clarified confusing terms
- 12. Cognitive Interviewing Lessons Change the wording of questions so that respondents can better understand which part of the question is prompting a response OLD: Who in the household generally makes decisions about whether to purchase [PRODUCT]? REVISED: When decisions are made whether or not to purchase [PRODUCT], who generally makes the decision? Reorder questions Similar themes together Sensitive questions later Clarify confusing terms Milk or milk products added “other than breastmilk” Feedback from DATA field teams Enumerator and respondents find the questions easier Sequence is more relevant and natural
- 13. Cognitive Interviewing Lessons Change the wording of questions so that respondents can better understand which part of the question is prompting a response OLD: Who in the household generally makes decisions about whether to purchase [PRODUCT]? REVISED: When decisions are made whether or not to purchase [PRODUCT], who generally makes the decision? Reorder questions Similar themes together Sensitive questions later Clarify confusing terms Milk or milk products added “other than breastmilk” Feedback from DATA field teams Enumerator and respondents find the questions easier Sequence is more relevant and natural
- 14. Cognitive Interviewing Lessons Change the wording of questions so that respondents can better understand which part of the question is prompting a response OLD: Who in the household generally makes decisions about whether to purchase [PRODUCT]? REVISED: When decisions are made whether or not to purchase [PRODUCT], who generally makes the decision? Reorder questions Similar themes together Sensitive questions later Clarify confusing terms Milk or milk products added “other than breastmilk” Feedback from DATA field teams Enumerator and respondents find the questions easier Sequence is more relevant and natural
- 15. Cognitive Interviewing Lessons Change the wording of questions so that respondents can better understand which part of the question is prompting a response OLD: Who in the household generally makes decisions about whether to purchase [PRODUCT]? REVISED: When decisions are made whether or not to purchase [PRODUCT], who generally makes the decision? Reorder questions Similar themes together Sensitive questions later Clarify confusing terms Milk or milk products added “other than breastmilk” Feedback from DATA field teams Enumerator and respondents find the questions easier Sequence is more relevant and natural
- 16. Identifying Indicators Exploratory factor analysis Confirmatory factor analysis ?Different indicators in Bangladesh and West Africa
- 17. Input into: Whether to breastfeed When to wean Giving other foods Control over weaning and breastfeeding Input into: Rest when ill Foods to prepare Foods to eat Control over own health and diet Input into: Feeding child ♦eggs, ♦milk, ♦meat Control of child’s diet Input into: Work and rest Eating ♦eggs, ♦milk, ♦meat Control over health and diet during pregnancy
- 18. Input into: Doctor for ♦illness, ♦pregnancy, ♦sick child, ♦child well-visits Freedom to seek healthcare Can acquire–some means: Food, animal-source foods, medicines, toiletries Access to food and health products Input into purchasing: Food, animal-source foods, medicines, toiletries Freedom to purchase food and health products
- 19. Developing Definitions of Adequacy and Cutoffs Alkire-Foster methods Sensitivity comparisons Normative approach Supported by qualitative insights Eliminated redundant items
- 20. Percent Achieving Empowerment 0 10 20 30 40 50 60 70 Control over own health and diet Control over own health and diet during pregnancy Control over child's diet Control over weaning and breastfeeding Freedom to seek healthcare Freedom to purchase food and health products Access to foods and health products West Africa Bangladesh All projects
- 21. Where Next for the pro-WEAI Health & Nutrition Module? Strengthen case for external validity Follow-up data from impact evaluations weai.ifpri.info
Editor's Notes
- This morning I am going to be presenting on our ongoing work developing a health and nutrition module for the project-level women’s empowerment in agriculture index This work is in collaboration with a team of colleagues and supported by the Gates Foundation, USAID, and A4NH.
- Many of you may be familiar with the Women’s Empowerment in Agriculture Index. This is a survey-based index that is designed to measure the inclusion of women in the agricultural sector. It was developed jointly by USAID, IFPRI, and OPHI in 2012 using similar methodologies to other multi-dimensional poverty indices. In the past three years, we have been working to develop a project-level WEAI, which is specifically designed to measure the impact of agricultural development projects on women’s empowerment.
- Why do we need additional survey content that focuses specifically on women’s empowerment related to health and nutrition? Many agricultural development projects that aim to empower women also have nutrition-sensitive objectives. These projects may aim to increase the consumption of foods produced by the household or increase women’s income so that they are able to obtain food and health inputs
- It is important to capture the multidimensionality of women’s empowerment. For example, women who have control over when a cow is sold, might not have control over healthcare seeking or be able to allocate certain foods to herself or children. The WEAI has focused primarily on women’s inclusion in agriculture and the production domain. The health and nutrition module we are developing focuses more specifically on aspects related to her own health and that of her children. These indicators are necessary to help us better understand gender-related nutrition-sensitive pathways.
- And we had to find a way to bring this all together
- Pro-WEAI is being developed in collaboration with 13 agricultural development projects shown in purple and green on this map with clusters of projects in South Asia, East Africa, and West Africa. You are seeing presentations related to several of these projects during this conference. Six of these projects, shown in green, specifically agreed to pilot the health and nutrition module. Three of these projects are located in Bangladesh. Three of these projects are in the West Africa cluster, two in Burkina Faso and one in Mali.
- Theoretically, the WEAI is grounded in 3 different types of agency: The first is Power Within or intrinsic agency. This can be thought of a someone’s internal sense of agency. The second in gray is power to, or instrumental agency. This is the power to enact change and make decisions. The outer circle in purple is power with or collective agency. And this refers to the power gained from working with others. The health and nutrition module compliments this theoretical model by focuses on another aspect of instrumental agency, or the power of women to leverage resources in favor of the health and nutritional status of herself and her children.
- In the pro-WEAI health & nutrition module, we first ask who in the household makes decisions about certain topics. We then ask to what extent she participates in those decisions. I’d like to highlight the importance of “to what extent.” From previous work, we learned that a very high percentage of women contribute to these decisions, as these topics relate to her own body or children who she cares for. However, it is unclear if she has a significant voice in the decision or if she is simply told what to do We ask these questions for topics related to women’s own health: Animal-source foods; healthcare; rest/work; diet and health during pregnancy and lactation We also ask these questions for child nutrition and health: Animal-source foods; healthcare; breastfeeding/weaning
- We also consider important health and nutrition products, such as hygiene products, medicine; and specific foods. For each of these items, we also ask who makes the decision to purchase it. Many of these products may be acquired throughout means other than purchase. Thus we ask whether she is usually able to acquire the product through some means, whether by purchasing, cultivating it, or having someone get it for her.
- The module has so far been implemented in the baseline surveys of the projects I mentioned a few slides back. I am going to walk us through the methods we used and the findings for three aspects of this: Cognitive Interviewing Identifying Indicators Establishing cutoffs for adequacy
- Many of the questions we used were adapted from existing surveys. We wanted to ensure that the questions were understood as intended. Cognitive interviewing is a method that can identify potential sources of survey response error. I am not going to talk extensively about our findings for this sub-study, but the findings led us reword questions so that they were more well understood and could better prompt responses.
- Some DATA team members implemented the old version with TRAIN and have now implemented the new version with ANGeL
- Next, we moved on to identifying potential domains with a factor analysis approach that we could eventually use as pro-WEAI indicators. Throughout this process we had the goal of a pro-WEAI that would be the same in multiple contexts, but, based on the existing body of research, we wanted to be open to the fact that these domains might look different in Bangladesh and West Africa. We began with exploratory factor analysis, which is a statistical method used to identify underlying latent relationships among variables. We randomly selected half of cases from our largest data sets in each region: TRAIN in Bangladesh and Se Lever in Burkina Faso. For decisions about specific activities, we used individual items on the extent of decision making input for each activity. For purchases we used information on whether the woman participated, and for whether she can acquire these items, we used a yes/no binary variable. Once we identified factor structure in the exploratory factor analysis, we tested those structures using confirmatory factor analysis with the remaining data sets for each of those regions to see what aspects of the factor structure were replicable in different samples, collected by different survey teams.
- Through this process we identified 7 indicators Control over own health and diet reflects women’s input into decisions related to her ability to rest and make decisions about foods to prepare and what to eat. Control over health and diet during pregnancy reflects a women’s input into rest and work and the consumption of animal-source foods specifically during pregnancy. These first two items actually emerged as one factor in Bangladesh and two in West Africa. For that reason, we have decided to use them as two separate indicators. They will just be more highly correlated with one another in Bangladesh than in West Africa. The next two indicators are control of child diet, specifically being able to give children animal-source foods. And, Control over breastfeeding and weening, which reflect a woman’s input into decisions about breastfeeding, weaning, and introducing foods to her child Again, these second two emerged as one factor in Bangladesh and two in West Africa. We suspect this is because in this region breastfeeding is tied with long periods of postpartum sexual abstinence.
- The next indicator is freedom to seek healthcare, whether for pregnancy, illness, or for one’s child. Freedom to make essential health and nutrition purchases reflects whether women participate in decisions to purchase these items. Access to food and health products reflects whether women are typically able to acquire these same health and nutrition products, by some means.
- Our third stop on this journey was to develop definitions of adequacy and cutoffs for them. Through this process we looked at the sensitivity of the indicators across alternative definitions. We also drew on insights from qualitative work that projects conducted. We used a normative approach, which means that if a definition showed that too many women were empowered, it was likely not an accurate definition. Additionally, with the goal of shortening the survey, we aimed to identify redundancies so that questions could later be dropped.
- For all of our decision-making questions, we settled on women having sole input or a high level of input on all activities that applied to her. For the purchasing and access indicators, she had to participate in the purchasing decision for all items or be able to access all items to be classified as achieving adequacy. The average adequacy across all projects ranges from a low of around 35% for freedom to purchase food and health products and control over child diet to around 60% for control over weaning and breastfeeding. This chart shows the percentage of women who achieved adequacy for each indicator that we developed, separated for each region and combined for all projects, which is the purple bar. I want to note here that the data come from baseline surveys for different projects and not population samples. The projects and baseline samples were designed differently, and thus we are not aiming to draw conclusions about the differences between the two regions with these data. Importantly, across the full scope there is room for improvement, which means it is possible to use these indicators to detect impact.
- Where do we go from here? In our continued work developing indicators, we are going to further strengthening evidence of external validity be determining the extent to which these indicators are correlated with related indicators form the pro-WEAI. Once, follow-up data are collected we will be able to evaluate their usefulness in detecting impact. If you are interested in using these modules, we encourage you to reach out to the WEAI resource center. Weai.ifpri.info