How do gender norms contribute to stunting in Ntchisi District, Malawi? A qualitative study

Background and Aim Despite adequate food production and nutrition intervention coverage, stunting remains an enduring problem in Ntchisi, Malawi. Globally, gender and social norms are known to influence nutritional outcomes in children. This study explores how gender norms contribute to child stunting, in Ntchisi district, Central Malawi. Research Methods Informed by the UNICEF Framework for Malnutrition, nine focus group discussions were conducted with mothers (n=24), fathers (n=23), and members of policy and health treatment committees (n=21), spanning three different areas of Ntchisi district. Data were analysed through inductive thematic analysis, guided by the framework for Research in Gender and Ethics (RinGs). Results Three primary themes were identified: 1) gender unequal decision making on the consumption, sale and distribution of food; 2) enshrined community norms influence feeding practices underpinned by gender-based violence; and 3) policy disconnections and gaps that reinforce gender norms regarding nutrition. Themes encompassed practices across household, health treatment, and policy level. Conclusion Gender norms that underpin inequalities in decision making for production and consumption of food undermine children’s nourishment and contributes towards sustained child malnutrition in Ntchisi. Existing policy documents should revise their guidelines to incorporate gender norms as key determinants of malnutrition. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was granted by the Trinity Health Policy and Management, Centre for Global Health (HP&M/CGH) Research Ethics Committee (REC) and by the Ntchisi District Council Secretariat, including the District Health Office (DHO) and the District Agriculture Office (DAO). Informed consent was sought from participants, who were fully briefed about the study aims and objectives, the voluntary nature of their participation, and that they could opt out at any time without penalty. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The pseudo-anonymised qualitative data is available from the first author, upon reasonable request.