Skip to main content Accessibility help

Maternal employment and childhood overweight in low- and middle-income countries

  • Vanessa M Oddo (a1), Noel T Mueller (a2), Keshia M Pollack (a3), Pamela J Surkan (a4), Sara N Bleich (a5) and Jessica C Jones-Smith (a1) (a6)...



To investigate the association between maternal employment and childhood overweight in low- and middle-income countries (LMIC).


We utilized cross-sectional data from forty-five Demographic and Health Surveys from 2010 to 2016 (n 268 763). Mothers were categorized as formally employed, informally employed or non-employed. We used country-specific logistic regression models to investigate the association between maternal employment and childhood overweight (BMI Z-score>2) and assessed heterogeneity in the association by maternal education with the inclusion of an interaction term. We used meta-analysis to pool the associations across countries. Sensitivity analyses included modelling BMI Z-score and normal weight (weight-for-age Z-score≥−2 to <2) as outcomes.


Participants included children 0–5 years old and their mothers (aged 18–49 years).


In most countries, neither formal nor informal employment was associated with childhood overweight. However, children of employed mothers, compared with children of non-employed mothers, had higher BMI Z-score and higher odds of normal weight. In countries where the association varied by education, children of formally employed women with high education, compared with children of non-employed women with high education, had higher odds of overweight (pooled OR=1·2; 95 % CI 1·0, 1·4).


We find no clear association between employment and child overweight. However, maternal employment is associated with a modestly higher BMI Z-score and normal weight, suggesting that employment is currently associated with beneficial effects on children’s weight status in most LMIC.


Corresponding author

* Corresponding author: Email


Hide All
1. Anderson, PM, Butcher, KF & Levine, PB (2003) Maternal employment and overweight children. J Health Econ 22, 477504.
2. Phipps, SA, Lethbridge, L & Burton, P (2006) Long-run consequences of parental paid work hours for child overweight status in Canada. Soc Sci Med 62, 977986.
3. Chia, YF (2008) Maternal labour supply and childhood obesity in Canada: evidence from the NLSCY. Can J Econ 41, 217242.
4. Fertig, A, Glomm, G & Tchernis, R (2009) The connection between maternal employment and childhood obesity: inspecting the mechanisms. Rev Econ Househ 7, 227255.
5. Courtemanche, C (2014) Longer hours and larger waistlines? The relationship between work hours and obesity. (accessed May 2016).
6. Standing, G (1996) Global feminization through flexible labor: a theme revisited. World Dev 27, 583602.
7. Head, S, Zweimueller, S, Marchena, C et al. (2014) Women’s Lives and Challenges: Equality and Empowerment Since 2000. Rockville, MD: ICF International.
8. Adair, L, Guilkey, D, Bisgrove, E et al. (2002) Effect of childbearing on Filipino women’s work hours and earnings. J Popul Econ 15, 625645.
9. de Onis, M, Blossner, M & Borghi, E (2010) Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 92, 12571264.
10. Engle, PL (1993) Influences of mothers’ and fathers’ income on children’s nutritional status in Guatemala. Soc Sci Med 37, 13031312.
11. Popkin, BM (1980) Time allocation of the mother and child nutrition. Ecol Food Nutr 9, 113.
12. Popkin, BM & Du, S (2003) Dynamics of the nutrition transition toward the animal foods sector in China and its implications: a worried perspective. J Nutr 133, 11 Suppl. 2, 3898S3906S.
13. Drewnowski, A (2000) Nutrition transition and global dietary trends. Nutrition 16, 486487.
14. Du, S, Mroz, TA, Zhai, F et al. (2004) Rapid income growth adversely affects diet quality in China – particularly for the poor! Soc Sci Med 59, 15051515.
15. Monteiro, CA, Levy, RB, Claro, RM et al. (2011) Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr 14, 513.
16. Bamji, MS & Thimayamma, BVS (2000) Impact of women’s work on maternal and child nutrition. Ecol Food Nutr 39, 1331.
17. Nair, M, Ariana, P & Webster, P (2014) Impact of mothers’ employment on infant feeding and care: a qualitative study of the experiences of mothers employed through the Mahatma Gandhi National Rural Employment Guarantee Act. BMJ Open 4, e004434.
18. Mamabolo, RL, Alberts, M, Steyn, NP et al. (2005) Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa. Public Health Nutr 8, 501508.
19. Moss, BG & Yeaton, WH (2011) Young children’s weight trajectories and associated risk factors: results from the Early Childhood Longitudinal Study-Birth Cohort. Am J Health Promot 25, 190198.
20. Dubois, L & Girard, M (2006) Early determinants of overweight at 4.5 years in a population-based longitudinal study. Int J Obes (Lond) 30, 610617.
21. Pryor, LE, Tremblay, RE, Boivin, M et al. (2011) Developmental trajectories of body mass index in early childhood and their risk factors: an 8-year longitudinal study. Arch Pediatr Adolesc Med 165, 906912.
22. Lourenço, BH, Villamor, E, Augusto, RA et al. (2015) Influence of early life factors on body mass index trajectory during childhood: a population‐based longitudinal analysis in the Western Brazilian Amazon. Matern Child Nutr 11, 240252.
23. Baird, J, Fisher, D, Lucas, P et al. (2005) Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 331, 929.
24. Binkin, NJ, Yip, R, Fleshood, L et al. (1988) Birth weight and childhood growth. Pediatrics 82, 828834.
25. Skilton, MR, Siitonen, N, Wurtz, P et al. (2014) High birth weight is associated with obesity and increased carotid wall thickness in young adults: the cardiovascular risk in young Finns study. Arterioscler Thromb Vasc Biol 34, 10641068.
26. Eyzaguirre, F, Bancalari, R, Román, R et al. (2012) Prevalence of components of the metabolic syndrome according to birthweight among overweight and obese children and adolescents. J Pediatr Endocrinol 25, 5156.
27. Mehta, SH, Kruger, M & Sokol, RJ (2011) Being too large for gestational age precedes childhood obesity in African Americans. Am J Obstet Gynecol 204, e261e265.
28. Reilly, JJ & Kelly, J (2011) Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond) 35, 891898.
29. Günther, I & Launov, A (2012) Informal employment in developing countries: opportunity or last resort? J Dev Econ 97, 8898.
30. Fields, G (2005) A guide to multisector labor market models. Paper prepared for the World Bank Labor Market Conference. (accessed May 2016).
31. ICF Macro (2008) Demographic and Health Surveys: DHS Model Questionnaires. Calverton, MD: ICF Macro.
32. De Onis, M & Lobstein, T (2010) Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes 5, 458460.
33. WHO Multicentre Growth Standards Working Group (2006) WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr 450, 7685.
34. ICF Macro (2009) Training Field Staff for DHS Surveys. Calverton, MD: ICF Macro.
35. Chen, MA (2012) The Informal Economy: Definitions, Theories and Policies. Manchester: Women in Informal Economy Globalizing and Organizing.
36. Murphy, KM & Topel, R (1997) Unemployment and nonemployment. Am Econ Rev 87, 295300.
37. Textor, J, Hardt, J & Knuppel, S (2011) DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology 22, 745.
38. Galobardes, B, Morabia, A & Bernstein, MS (2000) The differential effect of education and occupation on body mass and overweight in a sample of working people of the general population. Ann Epidemiol 10, 532537.
39. Glewwe, P (1999) Why does mother’s schooling raise child health in developing countries? Evidence from Morocco. J Hum Resour 34, 124159.
40. Wachs, TD (2008) Mechanisms linking parental education and stunting. Lancet 371, 280281.
41. Goldin, C (1995) The U-shaped female labor force function in economic development and economic history. In Investment in Women’s Human Capital and Economic Development, pp. 6190 [TP Schultz, editor]. Chicago, IL: University of Chicago Press.
42. Jones-Smith, JC, Gordon-Larsen, P, Siddiqi, A et al. (2011) Cross-national comparisons of time trends in overweight inequality by socioeconomic status among women using repeated cross-sectional surveys from 37 developing countries, 1989–2007. Am J Epidemiol 173, 667675.
43. The World Bank Group (2016) World Development Indicators. (accessed May 2016).
44. Thompson, SG & Higgins, J (2002) How should meta‐regression analyses be undertaken and interpreted? Stat Med 21, 15591573.
45. Sterne, JA, Cox, D & Smith, GD (2001) Sifting the evidence – what’s wrong with significance tests? Another comment on the role of statistical methods. BMJ 322, 226231.
46. Jewell, N (2004) Statistics for Epidemiology. Boca Raton, FL: Chapman & Hall/CRC.
47. Dewey, K & Brown, K (2003) Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs. Food Nutr Bull 24, 528.
48. Gomez, LF, Parra, DC, Lobelo, F et al. (2007) Television viewing and its association with overweight in Colombian children: results from the 2005 National Nutrition Survey: a cross sectional study. Int J Behav Nutr Phys Act 4, 1.
49. Popkin, BM & Slining, M (2013) New dynamics in global obesity facing low‐and middle‐income countries. Obes Rev 14, 1120.
50. Klesges, RC, Stein, RJ, Eck, LH et al. (1991) Parental influence on food selection in young children and its relationships to childhood obesity. Am J Clin Nutr 53, 859864.
51. Reardon, T & Berdegue, JA (2002) The rapid rise of supermarkets in Latin America: challenges and opportunities for development. Dev Policy Rev 20, 371388.
52. Reardon, T, Timmer, CP, Barrett, CB et al. (2003) The rise of supermarkets in Africa, Asia, and Latin America. Am J Agric Econ 85, 11401146.
53. Monteiro, CA, Moubarac, JC, Cannon, G et al. (2013) Ultra‐processed products are becoming dominant in the global food system. Obes Rev 14, 2128.
54. Lin, B-H & Guthrie, JF (2012) Nutritional Quality of Food Prepared at Home and Away from Home, 19772008 . Washington, DC: US Department of Agriculture, Economic Research Service.
55. Lumeng, JC, Kaciroti, N, Sturza, J et al. (2015) Changes in body mass index associated with Head Start participation. Pediatrics 135, e449e456.


Type Description Title
Supplementary materials

Oddo supplementary material
Oddo supplementary material

 Word (295 KB)
295 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed