What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries

Michael Nnachebe Onah; Sue Horton; John Hoddinott

doi:10.1371/journal.pone.0250014

Peer Review History

Original SubmissionAugust 9, 2020
11 Sep 2020 Decision Letter - Yacob Zereyesus, Editor PONE-D-20-24920 What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries PLOS ONE Dear Dr. Onah, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 26 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No ****** 3. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Comments: The paper covers an interesting area, and it is well-written. My comments below are intended to improve the paper. 1. It would be helpful to have a discussion about social norms and nutritional status in each of the five countries in the study, especially since the study recommends to tailor empowerment strategies around contextual factors. What are the contextual factors around gender norms and nutrition in each country? 2. There is now a body of literature that links women’s empowerment to women’s nutritional status. I recommend to have a summary of the literature on what they say in the introduction, highlighting which aspects of empowerment have been associated with improved nutrition. That should set up the paper in stating how the paper motivates and contributes to existing literature. 3. The regression results (marginal effects from the Poisson regression) are not in the body of the paper, but are attached as supplemental material. I recommend that these results be included in the body of the paper because these results should form the core of the paper. 4. The household hunger score is likely an outcome variable and not an independent variable for women’s dietary diversity. The argument to include the household hunger score as an independent variable as it is written in the paper is not convincing as it is likely endogenous. 5. The variables “Study location” and “Study month” are included in the regressions as continuous variables in pooled and country level regressions. Usually, these variables are included in the regressions as dummy variables because, for example, study locations do not affect the outcome variable in a continuous manner. 6. For the pooled regressions, I recommend that dummy variables for each country be included because they are likely to have country level differences that affect the outcome variable. However, I am personally not in favor of pooled regressions with different countries because they assume that the independent variables have the same effects on the outcome variable across five countries. That is a very strong assumption to make. 7. The asset index has a negative relationship with women’s dietary diversity in Malawi, Zambia, and Mozambique (though not significant for the latter two). I would check what variables are contained in the asset index to make sure that they are positively correlated with each other. There might be some variables that have negative relationship with socio-economic status. Also, please consider using a nonlinear approach for the asset index by including the index and index squared. 8. There are some variables, such as number of children or land size, that could affect WDD. I would consider adding some socio-demographic variables in the regressions. 9. The workload variable in the WEAI is complicated because the time spent in at three broad areas conflict with each other, and with women’s empowerment. The variable includes time spent in domestic work, which relates to access to water and household fuel; agricultural work, which also relates to access to agricultural technology; and paid work. Spending time in paid work could actually increase women’s empowerment and WDD because they earn income. Therefore, being overworked could increase women’s empowerment. Time spent in agricultural work could increase income and empowerment, or it could lead to disempowerment. It might be worth breaking the variable down to look at which aspects of time spent affect WDD. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0250014.r001
Revision 1
18 Nov 2020 Author Response Thank you for the careful appraisal and detailed comments from both editor and reviewers. We value the opportunity to revise and improve this paper. Find below our point by point response to reviewer comments. Where appropriate, changes have been made in track changes. Reviewer #1: Comments: The paper covers an interesting area, and it is well-written. My comments below are intended to improve the paper. 1. It would be helpful to have a discussion about social norms and nutritional status in each of the five countries in the study, especially since the study recommends to tailor empowerment strategies around contextual factors. What are the contextual factors around gender norms and nutrition in each country? Response: Many thanks for this suggestion. We have included a brief summary discussion of the relationship between social norms and contextual factors and women’s nutrition. 2. There is now a body of literature that links women’s empowerment to women’s nutritional status. I recommend to have a summary of the literature on what they say in the introduction, highlighting which aspects of empowerment have been associated with improved nutrition. That should set up the paper in stating how the paper motivates and contributes to existing literature. Response: We have followed this suggestion and have now included a paragraph on the links between women’s empowerment and women’s nutrition. 3. The regression results (marginal effects from the Poisson regression) are not in the body of the paper, but are attached as supplemental material. I recommend that these results be included in the body of the paper because these results should form the core of the paper. Response: We thank you for this suggestion. The Poisson and logistic regression analyses were performed as confirmatory tests of the OLS and LPM models and produced similar results. The OLS and LPMs are reported in the manuscript and we stated that the Poisson and logistic regressions confirm the study findings and placed the outputs in the supplementary files. If the referee feels strongly about this point, we could include them in the main part of the paper but our preference – in the interests of keeping the paper short – is to leave them as part of the supplementary material. We have also replaced the graphical illustration of the OLS and LPM results with Tables for easier interpretation. 4. The household hunger score is likely an outcome variable and not an independent variable for women’s dietary diversity. The argument to include the household hunger score as an independent variable as it is written in the paper is not convincing as it is likely endogenous. Response: You are correct. We performed an endogeneity test (Durbin–Wu–Hausman test) and indeed hunger scale is endogenous hence we excluded it from the updated analyses. 5. The variables “Study location” and “Study month” are included in the regressions as continuous variables in pooled and country level regressions. Usually, these variables are included in the regressions as dummy variables because, for example, study locations do not affect the outcome variable in a continuous manner. Response: We have updated the regression analyses by treating study month as a dummy variable. However, for illustrative purposes, study location was presented as continuous since there were about 38 study locations in the pooled data (Mozambique; 22, Malawi; 7, Rwanda; 27, Uganda; 37, and Zambia; 6). In addition, since the focus of the study was not the interpretation of the effect of covariates, we focused on the interpretation of core independent variables. 6. For the pooled regressions, I recommend that dummy variables for each country be included because they are likely to have country level differences that affect the outcome variable. However, I am personally not in favor of pooled regressions with different countries because they assume that the independent variables have the same effects on the outcome variable across five countries. That is a very strong assumption to make. Response: We have included a dummy variable for each country in the updated pooled analyses 7. The asset index has a negative relationship with women’s dietary diversity in Malawi, Zambia, and Mozambique (though not significant for the latter two). I would check what variables are contained in the asset index to make sure that they are positively correlated with each other. There might be some variables that have negative relationship with socio-economic status. Also, please consider using a nonlinear approach for the asset index by including the index and index squared. Response: We performed a correlation analyses on the pooled data (Suppl Table 21) and retained only variables (listed in methods section) with moderate to high correlation in the principal component analyses. Indeed, in some countries, the asset index score is negatively associated with WDDS. In such cases, asset index appears to be more positively and significantly associated with the consumption of different food groups. This suggests that perhaps SES index is a better predictor of the consumption of different food groups and not WDDS. The consumption of some of these food groups are also associated with higher SES in literature. We also used a nonlinear approach by developing and including an asset index squared variable in the models. Further, we did not focus on the interpretation of the association coefficients since this was not the focus of the present study. 8. There are some variables, such as number of children or land size, that could affect WDD. I would consider adding some socio-demographic variables in the regressions. Response: We agree that there are important but missing control variables that are potentially associated with WDDS. However, we included all available control variables in the data. We have also mentioned this as a study limitation. 9. The workload variable in the WEAI is complicated because the time spent in at three broad areas conflict with each other, and with women’s empowerment. The variable includes time spent in domestic work, which relates to access to water and household fuel; agricultural work, which also relates to access to agricultural technology; and paid work. Spending time in paid work could actually increase women’s empowerment and WDD because they earn income. Therefore, being overworked could increase women’s empowerment. Time spent in agricultural work could increase income and empowerment, or it could lead to disempowerment. It might be worth breaking the variable down to look at which aspects of time spent affect WDD. Response: We agree that the type of work matter however, paid work may not always increase empowerment. For instance, different paid work like exhausting paid work (e.g. weeding other people’s farmers) might have different effects than white collar work. The variable definitions in the baseline data are not ideal to do this more detailed analysis. We have also removed the discussion of workload from the manuscript since the association with WDDS is not significant in the updated analyses. Attachments Attachment Submitted filename: Response letter to reviewers PLOS.docx https://doi.org/10.1371/journal.pone.0250014.r002
8 Feb 2021 Decision Letter - Kannan Navaneetham, Editor PONE-D-20-24920R1 What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries PLOS ONE Dear Dr. Onah, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 25 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Kannan Navaneetham, PhD Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for addressing the comments on empirical strategy. I do not have further comments on this aspect of the paper. However, I feel that my comments 1 (norms and country context on nutrition) and 2 (literature on empowerment and women's nutrition) have not been adequately addressed. The motivation of the paper and the literature on the pathway of linking empowerment to nutrition are missing, so the paper starts with the introduction and goes next to data description. The motivation, the nutrition framework, and how the paper contributes to the literature need greater detail. How different is this paper from the other papers on this topic? The discussion of results and conclusion are also quite generic. I think adding these sections and giving more detail would provide a stronger case for why this paper should be important. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0250014.r003
Revision 2
24 Mar 2021 Author Response Dear Editor, Revisions for manuscript ref: PONE-D-20-24920 “What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries” Thank you for the careful appraisal and detailed comments from both editor and reviewers. We value the opportunity to revise and improve this paper. Find below our point by point response to reviewer comments. Where appropriate, changes have been made in track changes. Reviewer #1: Thank you for addressing the comments on empirical strategy. I do not have further comments on this aspect of the paper. However, I feel that my comments 1 (norms and country context on nutrition) and 2 (literature on empowerment and women's nutrition) have not been adequately addressed. The motivation of the paper and the literature on the pathway of linking empowerment to nutrition are missing, so the paper starts with the introduction and goes next to data description. The motivation, the nutrition framework, and how the paper contributes to the literature need greater detail. How different is this paper from the other papers on this topic? The discussion of results and conclusion are also quite generic. I think adding these sections and giving more detail would provide a stronger case for why this paper should be important. Response: Many thanks for your comments. We have updated the introduction and discussion sections to include more details on the link between context and nutrition and have also made a better motivation for the study. Attachments Attachment Submitted filename: Response letter to reviewers PLOS 2.docx https://doi.org/10.1371/journal.pone.0250014.r004
30 Mar 2021 Decision Letter - Kannan Navaneetham, Editor What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries PONE-D-20-24920R2 Dear Dr. Onah, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Kannan Navaneetham, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0250014.r005
Formally Accepted
5 Apr 2021 Acceptance Letter - Kannan Navaneetham, Editor PONE-D-20-24920R2 What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries Dear Dr. Onah: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Kannan Navaneetham Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0250014.r006

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