A Women's Rights-Based Approach to Reducing Child Mortality: Data from 193 Countries Show that Gender Equality does Affect Under-five Child Mortality

The Role of Community Health Agents in Promoting Social Change in Peru

BACKGROUND

Community health agents (CHAs) provide basic health services and increase health care access thereby improving health outcomes for peri-urban regions in Peru. Few studies analyze the effect that becoming a CHA has on women's interpersonal interactions. We aim to explore the impact CHAs may have on gender and social norms through their roles as trusted leaders in male-dominated communities.

METHODS

We conducted six 90-minute group discussions with CHAs working in Huancayo and Trujillo, Peru. We designed the discussions to extract data about family and community norms that changed as a result of working as a CHA.

RESULTS

A total of 53 female CHAs participated in six discussion groups. CHAs reported shifting family support (a change in how their family supported them in their role as a CHA), gaining status within their family (feeling more valued for their knowledge and experience), and shifting family gender roles (men and boys taking on more household responsibilities) as a result of their work. CHAs also reported a change in community norms and felt they were more valued and respected within their communities as women leaders.

CONCLUSIONS

Working as a CHA creates an opportunity to enact social change through altering family dynamics and community perceptions. Moreover, empowering women to become CHAs not only generates tangible benefits in community health, but can help create social change that ultimately improves the lives of women and realize their human rights.

Integrating the rights-based and capability approaches in the analysis of maternal healthcare utilization in sub-Saharan Africa: A multilevel modelling study

The rights-based and capability approaches received increased attention relative to maternal health in the aftermath of the 2015 Millennium Development Goals (MDGs). This may be in view of the sub-optimal progress gained in reducing maternal and child mortality, especially in developing countries. Despite the combined potential of these approaches, there are limited empirical studies testing their viability in aiding our understanding of maternal healthcare utilization in developing countries. This is what this study sought to accomplish. We combined several datasets, including the Demographic Health Surveys (DHS), World Development Indicators, the World Governance Indicators and Freedom House. Bayesian multilevel logistic regression models were applied on three indicators of maternal healthcare utilization (antenatal care visits, institutional delivery, and postnatal check-ups) in relation to selected variables representing right-based and capability approaches. After controlling for relevant individual and community-level factors, the results show that living in countries with high freedom status (POR = 1.19) and higher female secondary school enrolments (POR = 1.54) increases the odds of adequate antenatal care. Residence in countries with high freedom status (POR = 1.33) and higher voice and accountability (POR = 1.72) has a positive influence on institutional delivery. Similar results are reported for postnatal care where country freedom status (POR = 1.89), voice and accountability (POR = 1.25) and female school enrolment (POR = 1.41) are significant predictors. The results imply that the rights-based and capability approaches have the potential to enhance maternal healthcare utilization in sub-Saharan Africa. Therefore, policy strategies emphasizing on freedoms, accountability, and individual capability functionings should be encouraged in the pursuit of partly achieving Sustainable Development Goals (SDG) number 3.

A cross-sectional study of women's autonomy and modern contraception use in Zambia

BACKGROUND

Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women's autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women's autonomy and modern contraception use among partnered women in Zambia.

METHODS

This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women's autonomy using three indices: women's participation in decision-making, women's attitude towards wife-beating and women's household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR).

RESULTS

The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women's autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048-1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013-1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091-1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105-1.766) and age, 15-24 (AOR = 1.266, P value = 0.007, 95% CI 1.182-2.113,) and 25-34 (AOR = 1.163, P value = 0.002, 95% CI 1.052-1.273).

CONCLUSION

This study argues that increasing women's assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women's autonomy, which in turn would support gender equality and reproductive health.

The human right to safely give birth: data from 193 countries show that gender equality does affect maternal mortality

BACKGROUND

While a reduction in the global maternal mortality ratio (MMR) has slowed, newer strategies are needed to achieve an ongoing and sustainable reduction of the MMR. Previous studies have investigated the association between health system-related factors such as wealth inequalities, healthcare access and use on maternal mortality. However, a women's rights-based approach to address MMR has not been studied, excluding the health system-related factors. This study aimed to analyse the association between gender equality and MMR globally.

METHODS

Using structural equation modelling (SEM), secondary and open access data from the United Nations and other international agencies from 193 countries were analysed using structural equation modelling (SEM). Gender-sensitive variables that represented the theoretical, conceptual framework of the study were selected. The association between latent variable gender equality and the outcome, MMR, was examined in the SEM. A second SEM model (n = 158) was designed to include two variables related to gender-based violence.

FINDINGS

The latent variable, gender equality, was negatively associated with MMR (p < 0‧001, Z = -6‧96, 95% CI: - 6508.98 to - 3141.89 for Model 1 and p < 0‧001, Z = -7‧23, 95% CI: - 6045.356 to - 3467.515 for Model 2).

INTERPRETATION

Gender equality was significantly associated with maternal mortality. Investing in higher education for women, improving their paid employment opportunities, increasing participation in leadership roles and politics, reducing intimate partner violence (IPV) and ending child marriage can significantly reduce maternal mortality.