PROJECT DESCRIPTION

Childhood malnutrition remains an issue of public health concern in developing countries. Such problems mainly arise due to inappropriate child-feeding practices. Improving women 's decision-making autonomy holds promising solutions. However, there is limited evidence on the barriers to women's decision-making practices.

Objective: To explore the barriers of women engagement in intra-household decision making experiences on child feeding at rural districts of south Ethiopia from primary caregivers and key individuals' perspective.

Methods: A mixed-methods study was carried out in rural districts of Southern Ethiopia. We conducted a cross-sectional with women having children aged 6 23 months from July 15 to September 15, 2023 (N = 1479). Quantitative data were collected on women participation on household decision making. The women who were living in the rural districts were selected using the simple random sampling technique. Trained health professional collected the data by interview, using a structured and pre-tested questioner. Bivariable and multivariable binary logistic regression analysis was used to identify the associated factors, and the odds ratio with a 95 % CI was computed to assess the strength of the association. Qualitative data were from 51 focus group discussants and 12 key informants. The data were collected till saturation, and finally thematic analysis was carried out.

Results: A total of 1479 women in the quantitative section and 51 discussants and 12 key informants were participated in the study. Overall, more than two-thirds of the married women were found to be more autonomous to decide on child feeding. Education (AOR=1.84, 95% CI: 1.37, 2.46), Husband involvement in child feeding (AOR=2.23, 95%CI: 1.70, 2.92), having limited number of children (AOR=1.51, 95%CI: 1.11-2.04), and being in the older age (AOR=2.14, 95%CI: 1.38, 3.33) were significantly associated with women s decision-making participation on child feeding practice. Moreover, large family sizes, polygamy, large age gap between husband and wife, limited freedom of partner choice, and gender inequalities were barriers to women engagement in intra-household decision making.

Conclusion: Women participation in household decision making was satisfactory. However, had it been the socio-cultural barriers such as lack of property ownership, income, polygamy, limited freedom of parent choice, extreme age difference between couples, and large family size, higher participation could have been achieved. This also reflected as maternal education, husband involvement in child feeding, and mothers age, and number of children significantly determine women participation in household decision. Therefore, strategies to improve women engagement in intra-household decision making should consider those influencing factors.