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Publication Detail
Women's empowerment in a complex public health intervention in rural Nepal
This thesis presents a study of women’s empowerment in Nepal, a low-income country in South Asia with significant gender inequities across multiple dimensions. The thesis took place in the context of a cluster randomized controlled trial called the Low Birth Weight, South Asia Trial (LBW-SAT), which compared the impact of participatory women’s groups either alone or in combination with food or cash transfers on low birth weight. The thesis sought to understand the impacts of participatory women’s groups on women’s empowerment, as well as the role of agency in enabling or obstructing women’s use of cash transfers. First, a scale for measuring women’s agency freedom Deci and Ryan’s Self-Determination Theory [1] was validated and adapted for use in the local context. Second, the adapted tool was applied to evaluate the impact of LBW-SAT on women’s agency freedom. The results showed little evidence for an impact on women’s empowerment across a range of measures, except an improvement in women’s agency in group participation (p<0.01). Third, a grounded theory study was conducted on women’s financial agency in the household. The results showed that daughters-in-law had severely restricted access to cash, while their mothers-in-law were recipients of household income and managers of savings, loans and expenditures. Fourth, results from the same grounded theory study showed that LBW-SAT trial staff put considerable pressure on beneficiary families to avoid non-recommended uses of their cash transfers. Thus, while daughters-in-law were often allowed to spend the cash transfer on food by their family members, daughters-in-law may have feared angering LBW-SAT staff if they spent the cash transfer on non-food items. Future researchers and policy-makers need to better integrate economic and gender considerations into health programming to achieve empowerment objectives.
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