The Impact of Infrastructure on Low-Income Consumers' Nutritious Diet, Women's Economic Empowerment, and Gender Equality in Low- and Middle-Income Countries: An Evidence and Gap Map

Abstract

Physical infrastructure, such as market centers and roads, can foster women's economic empowerment and gender equality and mitigate adverse effects of seasonality on availability and prices of nutritious foods. The lack of infrastructure is therefore a major challenge for agricultural development in Sub-Saharan Africa and South Asia—the regional focus of this study. It threatens food and nutrition security, depriving low-income consumers' access to healthy, affordable food and quality nutrition. Interestingly, previous studies show that physical infrastructure promotes inclusive growth and maximizes positive impacts such as improved well-being and sustainable development, and can contribute to the empowerment of women and girls. When infrastructural investments are planned, delivered, and managed using nutrition-sensitive, gender-inclusive, and responsive approaches, it can help to address barriers that impede access to nutritious diets, nutrition security, and structural inequities militating against women and girls at the household and market levels. Hence, investments in physical infrastructure could be a useful pathway for meeting various Sustainable Development Goals (SDGs 1–No Poverty, 2–Zero Hunger, 3–Good Health and Wellbeing, 5–Gender Equality, 6–Clean water and sanitation, 7–Affordable and Clean Energy, and 8–Decent Work and Economic Growth). However, few studies have examined the evidence and gaps on infrastructure's impact on nutritious diet, women's economic empowerment, and gender equality in low- and middle-income countries (LMICs) in Sub-Saharan Africa and South Asia. Evidence and gap maps are useful tools for promoting evidence-informed decision-making by making evidence and research gaps accessible to policymakers, development practitioners, and researchers. This EGM was conducted in the consultations with stakeholders. This study seeks to identify, map, and provide an overview of the existing evidence and gaps on the impact of physical infrastructure on nutritious diets, women's economic empowerment, and gender equality among low-income consumers in LMICs in sub-Saharan Africa and South Asia regions. A standardized search strategy was adapted for searching published and unpublished studies in 3 academic databases, 33 institutional websites, Google, Google Scholar, 3 existing EGMs, and 8 registries of randomized control trials and pre-analysis plans from June 2022 to September 2022. Additional papers were identified through OpenAlex in EPPI-Reviewer. We supplemented the database searches by conducting hand searches and backward citation searches in identified reviews for relevant studies. We also contacted five prominent authors in the literature for relevant completed and on-going studies for the EGM. The selection criteria adapted the PICOS (population, intervention, comparison, outcomes, and study design) approach. The intervention was defined as those related to establishing or upgrading physical infrastructure for the agricultural sector and local economic development, such as production, post-production, distribution, and information. Furthermore, the outcomes were nutritious diets, women's economic empowerment, and gender equality. This EGM does not specify a comparison group. Two other eligibility criteria for including studies were publication in the Year 2000 and onwards, and those studies written in the English language. A total of 17,102 studies were uploaded and screened in EPPI-Reviewer data management software for titles and abstracts. About 969 studies were screened for full-text, and 342 eligible studies were included in the map based on a pre-defined code. The unit of analysis was a study. Therefore, each item presented in the EGM is a study. Studies reporting multiple interventions, outcomes, or study designs were coded multiple times per the appropriate coding category, but counted as one entry in the EGM. All outliers and out-of-range frequency values of assigned codes were identified and cleaned. Data was analyzed using descriptive statistics in Microsoft Excel and STATA version 16. The EGM was generated using EPPI-Mapper. A total of 342 studies (337 completed and 5 ongoing studies) from 54 countries across the sub-Saharan Africa and South Asia regions were included in the EGM. The EGM shows a steady growth in evidence over the last two decades. Most of the studies were impact evaluations (n = 178), followed by summative evaluations (n = 101). Non-experimental evaluation (n = 255) was the most common study design employed, followed by qualitative studies (n = 94), systematic review (n = 9), and scoping and other reviews (n = 48). This EGM did not find any studies using randomized controlled trials. The few systematic reviews included in the EGM had no accompanying meta-analysis. The most studied regions were Eastern Africa (n = 133), followed by West Africa (n = 100) and South Asia (n = 93). Production infrastructure (n = 202) had most of the evidence, compared with post-production infrastructure (n = 125), distribution infrastructure (n = 41), and information infrastructure (n = 2). Nutritious diets outcomes (n = 274) were the most reported indicators, compared with women's economic empowerment (n = 89) and gender equality (n = 53) outcomes. The aggregate map showed that production infrastructure and nutritious diets had the most cluster of evidence (n = 188) and this suggest a potential area for future evidence synthesis. This EGM presents evidence and research gaps around infrastructural interventions related to nutritious diets, women's economic empowerment, and gender equality, with specific references to the continents of Sub-Saharan Africa and South Asia. Most of the evidence is based on non-experimental impact evaluations, and we could not find any randomized controlled trials—a critical gap for future research. The majority of evidence was gathered in Eastern Africa, whereas Central Africa was the least documented. The most studied intervention was irrigation, and more evidence was found on nutritious diets than on women's empowerment and gender equality. This is important at the academic level and at the policy level to assist resource allocation and to support evidence-based policy tools such as systematic reviews and policy briefs.