Women's empowerment in Nigeria: baseline data from an evaluation of the Community Infant and Young Child Feeding (C-IYCF) Counselling Package

Background: In 2010, the Community Infant and Young Child Feeding (C-IYCF) Counselling Package was developed by UNICEF. By 2014, approximately 60 countries had adapted elements of the package, yet there has been little research to assess its effect. The USAID-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, the Nigerian Federal Ministry of Health (FMOH), and the United Nations Children's Fund (UNICEF) are evaluating the effectiveness of the package when implemented at scale in one local government area in Kaduna State, Nigeria. Here we report pre-programme baseline findings on women's empowerment, which has an important role in the improvement of the nutritional status of mothers and children. Methods: We conducted a household survey to assess knowledge and attitudes about nutrition in a sample of pregnant women and mothers of children younger than 2 years in Kaduna State, Nigeria. We also used semi-structured surveys to collect quantitative and qualitative data to record attitudes of community leaders at the state and local government and community levels. Findings: Between December, 2014, and June, 2015, we collected baseline data from 2225 women who were either pregnant or had a child aged under 2 years. We included data from 78 ward and community level representatives, 86% (67) of whom were men. Respondents from the group of pregnant women and mothers reported some decision-making power around infant and young child feeding practices; however, their level of empowerment was limited. Half of these respondents [997 [49·9%] decide for themselves when to stop breastfeeding and what to feed a child (1155 [57·2%], and 78·1% (1583) decide when to feed a child. However, fewer than half of respondents control resources to pay for transport to health centres (905 [40·1%]), medicine (910 [41·3%]), fruits and vegetables (1091 [49·4%]), and meat or other animal-derived foods (969 [44·0%]). Most community leaders disagreed that only men should make important family decisions (70 [90·9%]), but most women agreed (1350 [62·4%]). Most women (1652 [78·3%]) reported that, in their household, the husband alone made decisions about his wife's health care. In addition, 730 women (32·8%) reported that they could not go to the health centre or doctor alone. Interpretation: Baseline findings show that it is important to challenge women's own beliefs and to actively encourage them to become advocates for their own and their children's health. For the best possible results from the C-IYCF programme we recommend discussions of women's empowerment during support group meetings, including examples of how women can express their own ideas and will; promotion of productive activities in support groups to build women's self-efficacy; and the engagement of men in discussions on nutrition and women's role in decision-making as well as priority nutrition practices for her and her child's health. Funding: United States Agency for International Development (USAID)