Data collection

Quantitative data were collected using structured questionnaire through face-to-face interviews during house-to-house visits. The questionnaire comprised socio-demographic characteristics of mothers/caregivers, autonomy level of mothers and anthropometric measurements of mother and child.

The main explanatory variable in this study was women's autonomy. There were two main outcome variables. The first was postnatal growth which was defined quantitatively as length-for-age Z-score (LAZ) and weight-for-length Z-score (WLH). The categorical equivalents of these as binary variables are stunted/not stunted and wasted/not wasted, respectively. A child was classified as stunted if HAZ is below −2 sd below the population median, wasted if WHZ is below −2 sd below the population median and underweight as weight-for-age below −2 sd from the median of the WHO Child Growth Standards⁽¹⁸⁾.

The other outcome variable was child dietary intake which was measured qualitatively in terms proportion of children aged 6–23 months who received minimum acceptable dietary intake and postnatal growth of children aged 6–24 months.

Other confounders included (1) age and gender of the child; (2) maternal education, and utilisation of prenatal care and (3) household wealth status and maternal age. The main independent and dependent variables were measured as follows.

Of the several dimensions of women's autonomy described in the literature, four were assessed in this study: health care autonomy, general maternal household decision-making autonomy, movement autonomy and financial autonomy.

The index for general decision-making autonomy was composed of five questions, including the following:

Who makes the decision if you need to buy clothes for yourself?

Who makes the decision if you need to buy large household items/furniture?

Who makes the decision when your children have stationeries/school needs to be addressed?

Who makes the decision on how to spend the family's income?

Who in your household usually has the final say on having another child?

The responses to the questions were scored as follows: two points for decisions made by the woman; one point by decisions made jointly by both the woman and her husband; zero for all of the decisions taken by others.

Health care autonomy was defined as women's autonomy over her own or child's health care and was measured using three questions as follows:

Who makes the decision whether a child is sick enough to go for treatment?

Who in your household usually has the final say on your own health care?

If you are ill and need to see a doctor, do you first have to ask someone's permission?

Financial autonomy was related to evidence of women's control over financial resources. It was composed of three items: Whether a woman could spend her earn money without consulting anyone?; Who decides how family income is spent?; Who makes the decision whether a woman should work outside of the home?

The mobility/social autonomy dimension measured a mother's freedom of movement through her ability to independently travel to various places, attend social events or visit family and friends. The index of freedom of movement consisted of five items pertaining to whether women are usually allowed to go to some places on her own: just outside her house or compound, local market to buy things, local health centre or doctor, neighbourhood for recreation and home of relatives or friends in the neighbourhood⁽¹⁹⁾. The responses were scored as 1 (no permission required) and 0 (yes permission always required).

An overall composite index of women autonomy (CIWA), combining the four dimensions was also calculated. Two categories (i.e. low and high) of the individual components and the CIWA were created on the basis of the average value of each variable in the study sample. The women scoring less than the average score were put in the low autonomy category and women of at least the average score were categorised as high autonomy.