To what extent does the adapted Women's empowerment in nutrition index demonstrate psychometric validity and determine the nutritional empowerment among pregnant women in southern Ethiopia?

BackgroundWomen's empowerment plays a crucial role in the wellbeing of families by affecting nutrition and health. Women's Empowerment in Nutrition Index (WENI) was recently developed in rural South Asia, but requires validation in new contexts.ObjectiveThe study aimed to evaluate the psychometric validation of the WENI, the level of nutritional empowerment and factors associated with nutritional empowerment among pregnant women in Southern Ethiopia.DesignA facility-based cross-sectional study design was employed.MethodsThe study was conducted among 392 pregnant women from March 10 to May 30, 2025. The structural validity of the WENI was assessed using Exploratory and Confirmatory Factor Analysis (EFA/CFA) to identify latent constructs of empowerment. Kaiser-Meyer-Olkin (≥ 0.60) and significant results in Bartlett's Test (p < 0.05) were used for confirming sampling adequacy. Independent factors were identified using a hierarchical negative binomial multiple regression with adjusted incidence rate ratios (aIRRs) calculated, considering statistical significance at p < 0.05.ResultsFactor analysis revealed a six-factor structure with an internal consistency (Cronbach's alpha = 0.86), and convergent and discriminant validities (AVE=0.50, CR=0.70). The model demonstrated strong fit indices (CFI= 0.94; RMSEA<0.06). A significant relationship was found between WENI scores and maternal and child nutrition outcomes (p<0.001), with 51.5% of women being nutritionally empowered. Empowerment was higher in women free from intimate partner violence (aIRR = 1.12), those receiving nutritional counseling (aIRR = 1.33). Conversely, empowerment rates were lower in women with no formal education (aIRR = 0.76) and those in the lowest wealth quintile (aIRR = 0.82).ConclusionThis study confirmed that nutritional empowerment, measured via a 21-item tool, improves maternal health and food security. However, social norms and a "knowledge-agency gap" persist. Interventions must shift from basic education to actively promoting women's control over resources, gender equality, and stronger community-based support systems to be truly effective.