Background Female-headed households (FHHs) are often viewed as vulnerable and over-represented among the poorest of the poor, which further translates to poor child health outcomes. Nevertheless, there are counterarguments stating that FHHs are heterogeneous. While some may indeed be vulnerable, other FHHs may be of comparable status to male-headed households (MHHs) or better off. This study aimed to assess the relationship between household deprivation and headship while considering effect modification by subnational average levels of women’s empowerment.

Methods We used Demographic Health Surveys (DHS) from 48 low- and middle-income countries. The study explored the relationship between household deprivation using the Multidimensional Poverty Index (MPI) and household headship categorized as MHH, FHH with husband; with adult women; with adult men (excluding husbands); with women and men; with children only; and women heads alone. Households were classified as ‘most deprived’ if in the top 25% of the MPI score and as ‘less deprived’ otherwise. The Survey-based Women’s Empowerment Index (SWPER) was used to measure empowerment. The multilevel logistic model used included household, sub-national regions, and country-level confounders.

Results In the crude analysis, FHHs with children only had the highest proportion being among the most deprived (40.8%, 95% CI: 40.5%-41.1%). FHHs with men and women and FHHs with men recorded lower proportions of being most deprived, 11.6% (95% CI: 11.3%-31.8%) and 15.1% (95% CI: 14.8%-15.5%), respectively, compared to MHHs, at20.5% (95% CI: 20.4%-20.5%). The adjusted multilevel model showed that FHHs with men and with men and women had significantly lower odds, 0.61 (95% CI: 0.57–0.65) and 0.60 (95% CI: 0.55–0.67), respectively, of being among the most deprived households compared to MHHs. FHHs with children alone and FHHs where the woman heads were alone had significantly higher odds of being among the most deprived than MHHs, 1.97 (95% CI: 1.80–2.15) and 2.82 (95% CI: 2.53–3.14) respectively. Women’s empowerment significantly modified the effect between household deprivation and headship. The predicted proportions showed that households were more deprived when sub-national average empowerment scores were low. As empowerment increased, the proportions of households among the most deprived decreased consistently across MHHs and FHH types.

Conclusion Women-led households are not always the most deprived households. Moreover, women’s empowerment, which may be a proxy for contextual social norms, is essential in alleviating household deprivation. More emphasis on the intersection between headship, deprivation, and women’s empowerment is needed to understand better how household and individual characteristics impact child health.