Structural determinants of child undernutrition: contribution of women’s empowerment in India’s nutritional transition

Objective: This study aims to investigate the impact of women’s empowerment on child undernutrition from 2006 to 2021 in India at the state, primary sampling unit and household levels. Design: This study uses repeated cross-sectional data from three rounds of the National Family Health Survey (NFHS). Child undernutrition is assessed using stunting, wasting and underweight indicators, with women’s empowerment as a key predictor. Kernel density and linear polynomial plots depict the progression of anthropometric indicators over time, while multilevel regression identifies correlates and clustering in the undernutrition outcome. Participants: Children under 5 years of age from all twenty-eight states and nine union territories of India living with their biological mothers, who are currently married or in union and not pregnant, were included in the study. Results: Findings indicate that NFHS-5 reports the lowest prevalence of stunting and underweight, while severe wasting persists across all survey rounds. Women’s empowerment was not significant in NFHS-3, emerged as a significant determinant by NFHS-5 (NFHS-3 β = -0·08 (-0·26, 0·11); NFHS-5 β = -0·29** (-0·51, -0·07)). Among covariates, wealth quintile showed the strongest influence on child undernutrition from 2006 to 2021, with children from the richest households having the lowest risk of being underweight. Clustering remained higher at the household level in all survey rounds, reflected through the intra-class correlation. Conclusions: Higher women’s empowerment is significantly associated with reduced child undernutrition, where higher clustering persists at the household level. These findings highlight the need for targeted policies promoting women’s empowerment through community platforms and convergence with self-help groups to strengthen household-level health and nutrition outcomes.