title: Women's participation in household decision-making and higher dietary diversity: findings from nationally representative data from Ghana.
abstract: Low-quality monotonous diet is a major problem confronting resource-constrained settings across the world. Starchy staple foods dominate the diets in these settings. This places the population, especially women of reproductive age, at a risk of micronutrients deficiencies. This study seeks to examine the association between women's decision-making autonomy and women's achievement of higher dietary diversity (DD) and determine the socio-demographic factors that can independently predict women's attainment of higher DD.
  
  
  
  The study used data from the 2008 Ghana Demographic and Health Survey. The participants comprised of 2262 women aged 15-49 years and who have complete dietary data. The DD score was derived from a 24-h recall of intake of foods from nine groups. The score was dichotomized into lower DD (DD ≤4) and higher (DD ≥5). Logistic regression was used to assess the association between women decision-making autonomy (final say on how to spend money, making household purchases, own health care, opinions on wife-beating, and sexual intercourse with husband) and the achievement of higher DD. The logistic regression models were adjusted for covariates at the individual and household levels.
  
  
  
  The analysis showed that women participation in decision-making regarding household purchases was significantly associated with higher DD, after adjusting for individual and household level covariates. The odds of achieving higher DD were higher among women who had a say in deciding household purchases, compared to women who did not have a say (OR = 1.74, 95 % CI = 1.24, 2.42). Women who had more than primary education were 1.6 times more likely to achieve higher DD, compared to those with no education (95 % CI = 1.12, 2.20). Compared to women who lived in polygamous households, those who lived in monogamous households had higher odds of achieving higher DD (OR = 1.42, 95 % CI = 1.04, 1.93).
  
  
  
  Net other covariates, women who have a say in making household purchases are more likely to achieve higher DD compare to those who do not have a say. This may indicate autonomy to buy nutritious foods, suggesting that improving women decision-making autonomy could have a positive impact on women dietary intake.
authors.affiliation: African Population and Health Research Centre, APHRC Campus, P.O. Box 10787-00100, Nairobi, Kenya. damugsi@aphrc.org.
authors.forename: Dickson A
authors.initials: DA
authors.lastname: Amugsi
authors.affiliation: Nutrition Division, Economic and Social Department, Food and Agriculture Organization, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Lartey
authors.affiliation: African Population and Health Research Centre, APHRC Campus, P.O. Box 10787-00100, Nairobi, Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kimani
authors.affiliation: African Population and Health Research Centre, APHRC Campus, P.O. Box 10787-00100, Nairobi, Kenya.
authors.forename: Blessing U
authors.initials: BU
authors.lastname: Mberu
mesh_terms: D000293:Adolescent; D000328:Adult; D003657:Decision Making; D003906:Developing Countries; D004032:Diet / Q000592:standards*; D004522:Educational Status; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D005869:Ghana; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008393:Marriage; D011939:Mental Recall; D016017:Odds Ratio; D011209:Power, Psychological; D055815:Young Adult
keywords: Dietary diversity; Ghana; Higher; Women