August 2021, Volume 71, Issue 8

Short Reports

Correlates of mothers’ nutritional status in developing economies: Evidence from demographic and health surveys

Mariam Abbas Soharwardi  ( Department of Economics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan. )
Tusawar Iftikhar Ahmad  ( Department of Economics The Islamia University of Bahawalpur, Bahawalpur )
Mussab Ali Khan Manj  ( 4th Year MBBS Student, Central Park Medical College, Lahore, Pakistan )
Rana Ejaz Ali Khan  ( Department of Economics The Islamia University of Bahawalpur, Bahawalpur )


The study investigates the determinants of the nutritional status of mothers in developing countries. For a panel of 38 developing countries, data were obtained from the nationally representative Demographic and Health Surveys (DHS). Married women of reproductive age group (15 to 45 years), currently living with their husbands were selected as the target population. Body mass index was used as a proxy measure to gauge the nutritional status. Both bivariate and multivariate statistical analyses were employed to assess the socioeconomic determinants of mothers’ nutritional status. The findings from both descriptive and probability analyses identified the mothers’ poor educational status, early marriage, high fertility rate, low birth interval, low women empowerment status, household poverty, and belonging to rural areas as the main determinants of poor nutritional status of mothers in developing countries; hence, there is a need to focus more on this group in order to stop the sustained transmission of intergenerational malnutrition.

Keywords: Malnutrition, early marriages, high birth rates, poverty, women’s empowerment.





In developing countries, most of the women suffer from protein-energy malnutrition, micronutrient malnutrition and vitamin-A deficiency. These deficiencies reduce the chances of weight gain during pregnancy, which results in inadequate growth of the foetus.1-3 Mothers with low body mass index (BMI<18.5kg2) or those who are underweight face adverse effects such as low blood pressure, fatigue, low bone mineral density, anorexia nervosa, and bulimia nervosa, which further leave adverse effects on their physical and mental health.4,5

In the literature, women’s age, education, and familial wealth status are known to have a significant effect on their BMI.6,7 Women's health and women empowerment are complementary to each other.8 Poverty causes malnutrition in countries where inequalities regarding health, education and economic resource between men and women exist.9 Gender inequality is also a major cause of hunger and malnutrition in women.10 A woman’s freedom of movement and mobility, her paid work and access to resources play an important role not only in improving her own nutritional status but also of her children.11-13 Women’s participation in decision-making is positively associated with their good nutritional outcomes.5,11,12,14-16

This paper attempts to investigate the impact of biological, demographic, and socioeconomic determinants of nutritional status of mothers in developing countries.


Subjects and Methods


Taken from nationally representative Demographic and Health Surveys of 38 developing countries, secondary data (215,940 respondents) has been used for this study. Mother’s nutritional status was proxied through her BMI. The value of BMI below 18.5 kg2 was classified as undernourished whereas BMI value above or equal to 18.5 kg2 was classified as not malnourished. The explanatory variables such as mother’s age, education, age at first marriage, husband’s education and employment status, number of children ever born, number of children alive, household wealth and locality are self-explanatory and given by the data set. However, women’s empowerment was measured through constructing an index capturing the information on 17 indicators relating to five dimensions of women empowerment. The index was generated through principal component analysis (PCA) by using SPSS. Due to the dichotomous nature of the dependent variable, binary logistic regression was applied as the estimation technique. The Study was conducted in the Islamia University of Bahawalpur, Pakistan.




The results of the study are the outcomes of two types of analyses.

Column A (Table) presents the descriptive statistics (in the form of frequency distribution) and column B presents the probability of malnutrition. Here, we present the findings of binary logistic regression. According to the logistic regression results, women between the age of 15 and 19 years have more chances of being undernourished (OR=1.158, 95% CI=1.056-1.270) as compared to reference category of women above 35 years.

The probability of mother’s BMI (<18.5 kg/m2) or malnutrition was negatively related to the level of education as compared to the reference category of no education. The probability of not been malnourished was the lowest (OR=0.655, 95% CI=0.607-0.708) among the women with secondary level education and the highest (OR=0.397, 95% CI=0.341-0.462) among the mothers with higher education. The literature shows the positive impact of education on women’s health.17 The probability of malnourishment was the highest (OR=1.112, 95% CI=1.043-1.186) among women who had their first child between 15-19 years of age. Women empowerment indicates women’s awareness, decision making, self-esteem and self-confidence. There is an evidence of such type of relationship in the literature.18-20 Highly empowered women were least likely to be malnourished and moderately empowered women are less likely to be malnourished against the reference category of least empowerment. Except for mothers whose husbands had secondary level of education, women were less likely to be malnourished if their husbands had a high level of education as compared to the reference category of no education. Similarly mothers whose hubands were employed were less malnourished and less likely to be malnourished. Women who had given birth to more than four children were 31.7 percent more likely to be malnourished. In comparison with the women of the reference category, the probability of being undernourished was high (OR=1.724, 95% CI=1.669-1.782) among women who had not seen a doctor for antenatal care during pregnancy. The probability of being malnourished was (OR=1.003, 95% CI=.848-1.188) high among the women who had given birth at an interval of one year.

Wealth status of the household — to which a mother belonged — showed an inverse relationship with the prevalence of malnutrition among mothers. The probability of being malnourished for women belonging to the poorest households as compared to the women belonging to relatively well-off households reduced as the wealth status of the household improves. More rural mothers were suffering from malnutrition than the urban ones, i.e., the probability of malnutrition was high in rural women as compared to urban ones. It was noted that women with fewer children and living in the urban areas are healthier.21 Similar kind of explanatory variables have been embraced in the studies — on sufficient maternal iron supplementation22 and tetanus toxoid vaccination23 as the components of maternal healthcare — and for better maternal healthcare, the awareness and education of a woman, her husband’s participation, and cash transfer programmes have been proposed as the strategies to target mothers from the marginalised households of India.




The nutritional status of mothers is one of the prime concerns of the nations as healthy mothers give birth to healthy nations. To evaluate the nutritional status of mothers, it is proposed from the analysis that laws regarding the minimum age for marriage should be strictly implemented. Early marriages needs to be discouraged through campaigns. Women empowerment and education should be a part of policy formulation for the long run and sustainable nutritional status of the mothers. The fertility behaviour needs improvement for mothers’ nutritional status.


Disclaimer: None.

Conflict of Interest: None.

Funding sources: None.




1.      Thiele DK, Erickson EN, Snowden JM. High Prevalence of Maternal Serum 25-Hydroxyvitamin D Deficiency Is Not Associated With Poor Birth Outcomes Among Healthy White Women in the Pacific Northwest. J Obstet Gynecol Neonatal Nurs 2019; 48: 163-75.

2.      Ringel JB, Jannat-Khah D, Chambers R, Russo E, Merriman L, Gupta R. Impact of gaps in care for malnourished patients on length of stay and hospital readmission. BMC Health Serv Res 2019; 19: 87.

3.      Dalle Carbonare L, Valenti MT, Del Forno F, Piacentini G, Pietrobelli A. Vitamin D Daily versus Monthly Administration: Bone Turnover and Adipose Tissue Influences. Nutrients 2018; 10: 1934.

4.      Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. J Adolesc Health 2006; 39: 244-51.

5.      Stevens SD, Herbozo S, Morrell HE, Schaefer LM, Thompson JK. Adult and childhood weight influence body image and depression through weight stigmatization. J Health Psychol 2017; 22: 1084-93.

6.      Zhang L, Qian H, Fu H. To be thin but not healthy - The body-image dilemma may affect health among female university students in China. PLoS One 2018; 13: e0205282.

7.      Hernández-Yumar A, Wemrell M, Abásolo Alessón I, González López-Valcárcel B, Leckie G, Merlo J. Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. PLoS One 2018; 13: e0208624.

8.      Robert KW, Parris TM,  Leiserowitz A. What is sustainable development? Goals, indicators, values, and practice. Environment Science and Policy for Sustainable Development 2005; 47: 8-21.

9.      Delisle HF. Poverty: the double burden of malnutrition in mothers and the intergenerational impact. Ann N Y Acad Sci 2008; 1136: 172-84.

10.    The state of food insecurity in the world. [Online] 2012 [Cited 2020 May 20]. Available from: URL:

11.    Bose S. The effect of women's status and community on the gender differential in children's nutrition in India. J Biosoc Sci 2011; 43: 513-33.

12.    Shroff M, Griffiths P, Adair L, Suchindran C, Bentley M. Maternal autonomy is inversely related to child stunting in Andhra Pradesh, India. Matern Child Nutr 2009; 5: 64-74.

13.    Bhagowalia P, Menon P, Quisumbing AR, Soundararajan V. What Dimensions of Women’s Empowerment Matter Most for Child Nutrition? Evidence Using Nationally Representative Data from Bangladesh. IFPRI Discussion Paper 1192. Washington, D.C.: International Food Policy Research Institute (IFPRI). [Online] [Cited 2020 May 20] Avaialble from: URL:

14.    Brunson EK, Shell‐Duncan B, Steele M. Women's autonomy and its relationship to children's nutrition among the Rendille of northern Kenya. J Hum Biol Assoc 2009; 21: 55-64.

15.    Pryer JA, Rogers S, Rahman A. Factors affecting nutritional status in female adults in Dhaka slums, Bangladesh. J Soc Biol 2003; 50: 259-69.

16.    Smith LC, Haddad LJ.  Explaining child malnutrition in developing countries: A cross-country analysis. Intl Food Policy Res Inst 2000; 111.

17.    Colchero MA, Caballero B, Bishai D. The effect of income and occupation on body mass index among women in the Cebu Longitudinal Health and Nutrition Surveys (1983–2002). Soc Sci Med 2008; 66: 1967-78.

18.    Sharma B, Shekhar C. Association of Women Empowerment with Inter-Spousal Communication on RCH Matters In Selected South Asian Countries. Int J Soc Sci Manag 2015; 2: 197-213.

19.    Ameyaw EK, Kofinti RE, Appiah F. National health insurance subscription and maternal healthcare utilisation across mothers’ wealth status in Ghana. Health Econ Rev 2017; 7: 1-15.

20.    DeWitte SN, Hughes-Morey G, Bekvalac J, Karsten J. Wealth, health and frailty in industrial-era London. Ann Hum Biol 2016; 43: 241-54.

21.    Sattar A, Baig S, Naveed ur Rehman, Bashir B. Factors affecting BMI; Assessment of the effect of sociodemographic factors on BMI In the population of Ghulam Mohammad Abad Faisalabad. Professional Med J 2013; 20: 956-64.

22.    Khan REA, Raza MA. Maternal Health Care: The Case of Iron Supplementation in India. Pak J Commer Soc Sci 2013; 7: 263-75.

23.    Khan R, Raza MA. Maternal health-care in India: the case of tetanus toxoid vaccination. Asian Dev Policy Rev 2013; 1: 1-14.


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