Women’s empowerment and child stunting in Peru: a nationally representative analysis

BACKGROUND: Child stunting remains a persistent public health challenge in Peru. Although women's empowerment has been linked to improved child health, evidence on its domain-specific relationship with stunting remains limited. The objective of this study was to assess the association between women's empowerment, across attitudes towards violence, social independence, and decision-making, and child stunting in Peru. METHODS: We conducted an analytical cross-sectional study using nationally representative data from the 2021 Demographic and Family Health Survey (ENDES), including 16,650 mother-child pairs. Analyses of women's empowerment were conducted in a sub-sample with complete SWPER data (n = 12,696). Stunting was defined as height-for-age below - 2 standard deviations of WHO standards. Women's empowerment was measured using the SWPER Global index and categorised into tertiles. All analyses accounted for the complex survey design, including sampling weights. Crude and adjusted logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The overall prevalence of child stunting was 11.3%. Stunting disproportionately affected disadvantaged groups, particularly children living in rural areas and from lower wealth quintiles. In adjusted analyses, higher maternal decision-making was associated with lower odds of stunting (medium vs. low: aOR 0.65; 95% CI 0.46-0.92; high vs. low: aOR 0.48; 95% CI 0.34-0.69). No significant associations were found for attitudes towards violence or social independence after adjustment. CONCLUSIONS: Maternal decision-making empowerment is associated with lower odds of child stunting in Peru. These findings suggest that strategies aimed at improving child nutrition may benefit from incorporating interventions that strengthen women's agency within household decision-making.