Adolescent Girls' Empowerment and Nutrition in Low- and Middle-Income Countries

Background: Adolescent girls in low- and middle-income countries (LMICs) are disproportionately affected by malnutrition due to biological and social factors, including gender inequities. Empowering adolescent girls may contribute to improving their nutritional status in settings where gender inequality persists, but the causal pathways through which empowerment contributes to improved nutrition for adolescent girls are not fully understood. Thesis objectives: (1) To assess the effects of empowerment-based nutrition interventions on adolescent girls' nutritional status in LMICs and (2) To identify the dimensions of empowerment significantly associated with adolescent girls' nutritional status in LMICs. Methods: A theoretically informed model of the empowerment–nutrition relationship was developed to inform this thesis. To answer objective 1, a Campbell systematic review of the effects of empowerment-based nutrition interventions on the nutritional status of adolescent girls in LMICs was conducted. To answer objective 2, a series of exploratory structural equation models of the relationship between dimensions of empowerment and measures of adolescent girls' nutritional status were developed and tested using cross-sectional Demographic and Health Survey data for adolescent girls in East Africa. Results: The current evidence base on the empowerment–nutrition relationship for adolescent girls in LMICs is limited. This thesis found that there is a statistically significant relationship between empowerment and nutrition for adolescent girls that varies according to individual and contextual characteristics. It further found that there is limited, low-quality evidence that empowerment-based nutrition interventions contribute to improved nutritional status among adolescent girls in LMICs, though the evidence base is scarce, heterogenous, and lacking in methodological quality. A model of the causal pathways from empowerment-based nutrition interventions to improved nutritional status was developed. Conclusion: This thesis provides a comprehensive examination of existing evidence of the relationship between adolescent girls' empowerment and nutrition in LMICs. This relationship is significant and complex, requiring careful consideration when designing interventions. The models that were developed, tested, and refined through this research are important contributions to the literature that can guide further research to improve measurement of the empowerment–nutrition relationship and the design and evaluation of interventions to empower adolescent girls for improved nutrition.