Objective: To understand the role of women’s input into household decisions as a possible factor contributing to women’s undernutrition in settings where HIV/AIDS and drought have constrained household resources.
Design and setting: Three cross-sectional surveys of non-pregnant women in partnerships without a birth in the last 3 months were analysed. Factors associated with chronic energy deficiency (CED), defined as body mass index of , 18.5 kgm22, were assessed among 1920 women in Zimbabwe, 2870 women in Zambia and 6219 women in Malawi.
Results: Prevalence of CED was 4.2% in Zimbabwe, 13.5% in Zambia and 6.7% in Malawi. In Malawi, women with less input into decisions were more likely to have CED. After multivariable adjustment, each additional decision made by the partner increased the odds of CED in Malawi by 1.08 (95% confidence interval (CI) 1.02–1.15); each additional decision made by the woman decreased the odds of CED by 0.90 (95% CI 0.88–0.97). Malawian women with all the final say or with partners with no final say had significantly more CED than expected (odds ratio (OR) ¼ 2.88, 95% CI 1.42–5.83 and OR ¼ 1.64, 95% CI 1.06–2.52, respectively), and removing these points increased the magnitude and significance of the linear trends. In Zambia, the relationship was found for urban women only and no associations were found in Zimbabwe.
Conclusions: Input into household decisions may be a key factor in the cycle of drought and CED. Women with both low input and CED may lose productive capacity, putting them at greater risk of food insecurity and potentially HIV/AIDS in high prevalence settings.