Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial

Lauren Galvin; Cristiana K Verissimo; Ramya Ambikapathi; Nilupa S Gunaratna; Paula Rudnicka; Amy Sunseri; Joshua Jeong; Savannah Froese O'Malley; Aisha K Yousafzai; Mary Mwanyika Sando; Dominic Mosha; Elfrida Kumalija; Hannah Connolly; George PrayGod; Cara Endyke-Doran; Mary Pat Kieffer

doi:10.1016/j.socscimed.2023.115869

Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial

Soc Sci Med. 2023 May:324:115869. doi: 10.1016/j.socscimed.2023.115869. Epub 2023 Mar 27.

Authors

Lauren Galvin¹, Cristiana K Verissimo², Ramya Ambikapathi³, Nilupa S Gunaratna⁴, Paula Rudnicka⁵, Amy Sunseri⁶, Joshua Jeong⁷, Savannah Froese O'Malley⁸, Aisha K Yousafzai⁹, Mary Mwanyika Sando¹⁰, Dominic Mosha¹¹, Elfrida Kumalija¹², Hannah Connolly¹³, George PrayGod¹⁴, Cara Endyke-Doran¹⁵, Mary Pat Kieffer¹⁶

Affiliations

¹ Global Communities, Silver Spring, MD, USA. Electronic address: lgalvin@globalcommunities.org.
² Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA. Electronic address: cristianakay@gmail.com.
³ Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA. Electronic address: ra578@cornell.edu.
⁴ Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA. Electronic address: gunaratna@purdue.edu.
⁵ Global Communities, Silver Spring, MD, USA. Electronic address: prudnicka@globalcommunities.org.
⁶ Global Communities, Silver Spring, MD, USA. Electronic address: aesunseri@gmail.com.
⁷ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: jjeong@mail.harvard.edu.
⁸ Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA. Electronic address: sfroese@purdue.edu.
⁹ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: ayousafzai@hsph.harvard.edu.
¹⁰ Africa Academy for Public Health, Dar-es-salaam, Tanzania. Electronic address: mmwanyika.sando@gmail.com.
¹¹ Epidemiology Bureau, City of Saint Louis, MO, USA. Electronic address: dfmosha@hotmail.com.
¹² Project Concern International, a Global Communities Partner, Dar-es-salaam, Tanzania. Electronic address: lemyfrida@gmail.com.
¹³ Global Communities, Silver Spring, MD, USA. Electronic address: hconnolly@globalcommunities.org.
¹⁴ Mwanza Research Center, National Institute of Medical Research, Tanzania. Electronic address: gpraygod@yahoo.com.
¹⁵ Global Communities, Silver Spring, MD, USA. Electronic address: cendykedoran@globalcommunities.org.
¹⁶ Global Communities, Silver Spring, MD, USA. Electronic address: mpkieff@gmail.com.

PMID: 37023660
DOI: 10.1016/j.socscimed.2023.115869

Abstract

Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018-May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 to 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.

Keywords: Community health workers; Couples interventions; Engaging fathers; Gender equality; Maternal and child nutrition; Parenting; Randomized controlled trial; Tanzania; Women's empowerment.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Child
Family Characteristics
Fathers
Female
Gender Equity*
Humans
Male
Parenting*
Tanzania

Associated data

ClinicalTrials.gov/NCT03759821