Household wealth, women's empowerment, and food insecurity in conflict-affected Southeast Myanmar

To quantify inequities in food insecurity and other nutrition outcomes in conflict zones of Southeast Myanmar when women's empowerment, wealth, and educational attainment are considered in concert.

A stratified cluster survey in 74 villages was designed to evaluate a program delivering nutrition-sensitive interventions in areas of armed conflict. Primary outcomes included the Food Insecurity Experience Scale (FIES) and standard indicators of infant and young child feeding (IYCF). We quantified inequities according to several axes of vulnerability including household wealth, maternal education, and women's empowerment, considered individually and in concert, by estimating crude- and multiply adjusted logistic regression models that also account for distance to food markets. Crude and adjusted relative concentration indices were used to summarize inequities in nutrition indicators and program coverage. Analysis accounted for the complex survey design.

Among 801 respondents 32% are illiterate and 59% reported household wealth in the poorest national quintile. One quarter (25.3%) of households reported moderate or severe food insecurity overall, with moderate to large inequities related to wealth (crude rCI -0.19) and education (-0.17), though only education inequities remained significant in adjusted models. Inequities for child and maternal nutrition outcomes except for minimum meal frequency were larger for household wealth (range in rCI, 0.14 to 0.34) and smaller for education (0.07 to 0.22). Women in wealthier households were more likely to report high empowerment, though women's empowerment was not associated with nutrition outcomes. Project coverage was concentrated among wealthier households.

Large inequities in food insecurity, dietary intake and women's empowerment exist in remote areas of Myanmar experiencing active armed conflict. Nutrition-sensitive intervention coverage also was inequitably distributed, suggesting that it is unlikely the nutrition project could reduce inequities in food and nutrition outcomes. Humanitarian agencies should routinely measure health inequities and identify delivery models that ameliorate them.