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Owoputi I, Kayanda R, Bezner Kerr R, Dismas J, Ganyara P, Hoddinott J, Dickin K. Gender differences in perceptions of "joint" decision-making about spending money among couples in rural Tanzania. PLoS One 2024; 19:e0302071. [PMID: 38865315 PMCID: PMC11168642 DOI: 10.1371/journal.pone.0302071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/27/2024] [Indexed: 06/14/2024] Open
Abstract
Family and cultural contexts can constrain the effectiveness of evidence-based interventions designed to improve the health and wellbeing of women and their children. Unequal power relationships within the household may underlie the failure of many programs targeting women to achieve their intended impact. To reduce these unequal power dynamics within the households, many programs or interventions aim to both assess and improve the gender dynamics between husbands and wives within the household. Decision-making is one important facet of these dynamics and has been linked to health outcomes for women and children. However, household decision-making is rarely observed and often difficult to capture. This study aimed to use qualitative research to further understand one aspect of decision-making, namely on how to spend money. In two regions of Tanzania, we used surveys and interviews to explore different perspectives on spending and allocation of resources among 58 couples in rural farming households. While many men and women initially reported that they made decisions jointly, most women stated they would often concede if there was a disagreement or argument around spending. These results highlight the different perceptions of joint decision-making between men and women. We compared these results to survey responses on decision-making and found differences within and between couples across interview and survey responses. Based on the differences in qualitative and survey responses within couples and how they reported dealing with disagreement, our study found households were on a spectrum from no cooperation in decision-making to full cooperation. Our results highlight challenges for assessing decision-making on spending and ultimately improving these decision-making dynamics within the household. These challenges are especially important for maternal and child behavioral change and provide insights on why many interventions aimed at improving women's decision- making power on money may not reach their full potential.
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Affiliation(s)
- Ibukun Owoputi
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
| | | | - Rachel Bezner Kerr
- Cornell University, Department of Global Development, Ithaca, NY, United States of America
| | | | | | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America
- Cornell University, Department of Global Development, Ithaca, NY, United States of America
- Charles H. Dyson School of Applied Economics and Management. Cornell University, Ithaca, NY, United States of America
| | - Katherine Dickin
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, United States of America
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Euler M, Jaleta M, Gartaula H. Associations between women's bargaining power and the adoption of rust-resistant wheat varieties in Ethiopia. WORLD DEVELOPMENT 2024; 178:106567. [PMID: 38826843 PMCID: PMC11004725 DOI: 10.1016/j.worlddev.2024.106567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 06/04/2024]
Abstract
The dynamics in intra-household decision-making are often neglected in literature on the adoption of agricultural innovations. However, households' farm management decisions are often made following negotiations between female and male farmers. These may differ in terms of individual bargaining power and personal preferences. A better understanding of the links between gender roles in household decision-making and the adoption of technologies is postulated to enhance the uptake of innovations in smallholder farming systems. In this study, we use survey data from 1,088 wheat-producing households in Ethiopia to analyze the links between women's role in household decisions concerning crop production and the adoption and turnover rates of rust-resistant wheat varieties. We interviewed female and male respondents from the same households, but separately, which facilitated capturing individual perceptions and the intra-household dynamics in decision-making. To account for observed heterogeneity that may simultaneously determine the level of women's agency and varietal adoption by households, we employed Inverse Probability-Weighted Regression Adjustment (IPWRA). A positive association was found between women's role in decision-making concerning choice of wheat seed and household adoption of rust-resistant wheat varieties and wheat varietal turnover. Spouses may be in agreement or have different opinions regarding their decision-making roles. The disagreement scenario in which the wife claims to have a role in decision-making is associated with lower adoption rates of rust-resistant wheat varieties and less frequent testing of new varties in recent growing seasons, compared to a scenario where both spouses agree that wives do not have a role. We conclude that gender-disaggregated data and the examination of intra-household decision-making can offer novel and valuable insights for designing and implementing strategies to enhance the uptake of agricultural technologies among smallholders. The results emphasize the need to include complementary perspectives on the intra-household decision-making process.
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Affiliation(s)
- Michael Euler
- International Maize and Wheat Improvement Center (CIMMYT), ILRI Sholla Campus, P.O. Box 5689, Addis Ababa, Ethiopia
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Diamond-Smith N, Gopalakrishnan L, Leslie H, Katz E, Harper C, Weiser S, Patil SR. Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: protocol for the TARANG cluster randomised controlled trial. BMJ Open 2024; 14:e086778. [PMID: 38688674 PMCID: PMC11086273 DOI: 10.1136/bmjopen-2024-086778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION In South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of these interventions in reproductive and sexual autonomy and contraception has not been examined. METHODS AND ANALYSIS A two-arm, parallel, cluster randomised controlled trial will evaluate the impact of TARANG (Transforming Actions for Reaching and Nurturing Gender Equity and Empowerment), a life skills and reproductive health empowerment group-based intervention for newly married women, compared with usual services in the community in rural and tribal Rajasthan, India. TARANG will also provide light-touch sessions to husbands and mothers-in-law of newly married women. We will test the impact of TARANG in 80 village clusters among 800 eligible households comprising newly married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy within 1 year at the time of enrolment, their husbands and mothers-in-law who consent to participate. Women in the intervention villages will receive 14 sessions over a 6-month period, while husbands and mothers-in-law will receive 1 and 4 sessions (respectively) each. Three rounds of surveys will be collected over 18 months. Control villages will receive the intervention after the endline surveys. Primary outcomes include rate of unintended pregnancy and modern contraceptive use. We plan to start recruitment of participants and data collection in April 2024. We will estimate unadjusted and adjusted intention-to-treat effects using survival analysis and mixed models. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by the human subjects review boards at the University of California, San Francisco, and the Centre for Media Studies, India (IRB00006230) and ACE Independent Ethics Committee, Bangalore (NET0062022). Results will be disseminated in international peer-reviewed journals and conferences, to stakeholders including local government and non-governmental organisations, and directly to the communities and individuals that participated in the intervention. TRIAL REGISTRATION NUMBER NCT06024616.
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Affiliation(s)
| | | | - Hannah Leslie
- Global Health and Population, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Katz
- Global Center for Gender Equality, San Francisco, California, USA
| | - Cynthia Harper
- University of California San Francisco, San Francisco, California, USA
| | - Sheri Weiser
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sumeet R Patil
- Center for Causal Research and Impact Evaluation, NEERMAN, Mumbai, India
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Sedlander E, Dahal M, Bingenheimer JB, Puri MC, Rimal RN, Granovsky R, Diamond-Smith NG. Adapting and Validating the G-NORM (Gender Norms Scale) in Nepal: An Examination of How Gender Norms Are Associated with Agency and Reproductive Health Outcomes. Stud Fam Plann 2023; 54:181-200. [PMID: 36715570 DOI: 10.1111/sifp.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Research calls for the sexual and reproductive rights field to prioritize gender norms to ensure that women can act on their reproductive rights. However, there is a gap in accepted measures. We addressed this by including important theoretical components of gender norms: differentiating between descriptive and injunctive norms and adding a referent group. Our team originally developed and validated the G-NORM, a gender norms scale, in India. In this paper, we describe how we subsequently adapted and validated it in Nepal. We administered items to women of reproductive age, conducted exploratory and confirmatory factor analysis, and examined associations between the subscales and reproductive health outcomes. Like the original G-NORM, our factor analyses showed that descriptive norms and injunctive norms comprise two distinct scales which fit the data well and had Cronbach alphas of 0.92 and 0.89. More equitable descriptive gender norms were associated with higher decision-making scores, increased odds of intending to use family planning, disagreeing that it is wrong to use family planning, and older ideal age at marriage. Injunctive gender norms were only associated with disagreeing that it is wrong to use family planning. Findings offer an improved measure of gender norms in Nepal and provide evidence that gender norms are critical for agency and reproductive health outcomes.
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Affiliation(s)
- Erica Sedlander
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Minakshi Dahal
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | | | - Mahesh C Puri
- Center for Research on Environment, Health & Population Activities, Kathmandu, Nepal
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Granovsky
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nadia G Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Tesema GA, Wolde M, Tamirat KS, Worku MG, Fente BM, Tsega SS, Tadesse A, Teshale AB. Factors associated with short birth interval among reproductive-age women in East Africa. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231209879. [PMID: 37955253 PMCID: PMC10644753 DOI: 10.1177/17455057231209879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/26/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Child and maternal mortality continue as a major public health concern in East African countries. Optimal birth interval is a key strategy to curve the huge burden of maternal, neonatal, infant, and child mortality. To reduce the incidence of adverse pregnancy outcomes, the World Health Organization recommends a minimum of 33 months between two consecutive births. Even though short birth interval is most common in many East African countries, as to our search of literature there is limited study published on factors associated with short birth interval. Therefore, this study investigated factors associated with short birth intervals among women in East Africa. OBJECTIVE To identify factors associated with short birth intervals among reproductive-age women in East Africa based on the most recent demographic and health survey data. DESIGN A community-based cross-sectional study was conducted based on the most recent demographic and health survey data of 12 East African countries. A two-stage stratified cluster sampling technique was employed to recruit the study participants. METHODS AND ANALYSIS A total weighted sample of 105,782 reproductive-age women who had two or more births were included. A multilevel binary logistic regression model was fitted to identify factors associated with short birth interval. Four nested models were fitted and a model with the lowest deviance value (-2log-likelihood ratio) was chosen. In the multivariable multilevel binary logistic regression analysis, the adjusted odds ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association between short birth interval and independent variables. RESULTS The prevalence of short birth interval in East Africa was 16.99% (95% confidence interval: 16.76%, 17.21%). Women aged 25-34 years, who completed their primary education, and did not perceive the distance to the health facility as a major problem had lower odds of short birth interval. On the contrary, women who belonged to the poorest household, made their own decisions with their husbands/partners or by their husbands or parents alone, lived in households headed by men, had unmet family planning needs, and were multiparous had higher odds of having short birth interval. CONCLUSION Nearly one-fifth of births in East Africa had short birth interval. Therefore, it is essential to promote family planning coverage, improve maternal education, and empower women to decrease the incidence of short birth intervals and their effects.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Maereg Wolde
- Department of Health Education and Behavioral Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aster Tadesse
- Department of Nursing, College of Health Sciences, Debre Markos University, Markos, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mangimela-Mulundano A, Black KI, Cheney K. A cross-sectional study of women's autonomy and modern contraception use in Zambia. BMC Womens Health 2022; 22:550. [PMID: 36575426 PMCID: PMC9793589 DOI: 10.1186/s12905-022-02101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/30/2022] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Abigail Mangimela-Mulundano
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Kirsten I. Black
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Kate Cheney
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Ameyaw EK, Seidu AA, Ahinkorah BO. Women’s healthcare decision-making and unmet need for contraception in Mali. Reprod Health 2022; 19:183. [PMID: 35987680 PMCID: PMC9392281 DOI: 10.1186/s12978-022-01484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Contraception plays a significant role in fertility regulation. Evidence suggests that reproductive health rights influence contraception use. Women of Mali are noted to have limited control over their healthcare decisions. As a result, this study aimed at investigating the association between women’s healthcare decision-making capacity and unmet need for contraception in Mali. Methods This study comprised 6593 women who participated in the 2018 Mali Demographic and Health Survey. Two binary logistic regression models were built. Whilst the first model (crude) involved healthcare decision-making capacity and unmet need for contraception, the second one was a complete model which controlled for all the socio-demographic characteristics. Sample weight was applied and Stata version 13.0 was used for all analyses. Results Most of the women were not taking their healthcare decisions alone (92.8%). Nearly four out of ten of them indicated that they had unmet need for contraception (35.7%). Unmet need for contraception was high among women aged 45–49 (50.9%) and low among those aged 15–19 (19.2%). Unmet need for contraception was more probable among women who took their healthcare decisions alone compared to those who did not take their healthcare decisions alone [AOR = 1.35; CI = 1.08–1.70]. Compared with women aged 15–19, unmet need was higher among women aged 45–49 [AOR = 4.58, CI = 3.05–6.86]. Richer women had lower odds of unmet need for contraception compared with poorest women [AOR = 0.77, CI = 0.61–0.97]. Conclusion Women who took their healthcare decisions alone had higher odds of unmet need for contraception. To increase contraceptive use in Mali, it is imperative to take women’s healthcare decisions into consideration to strengthen existing policies geared towards fertility control and improvement in maternal health to achieve Sustainable Development Goals 3 and 5. Sustainable Development Goal 3 seeks to ensure healthy lives and promote well-being for all at all ages whilst Goal 5 aims at achieving gender equality and empower all women and girls. Evidence suggests that reproductive health rights influence contraception use. In Mali, women are noted to have limited control over their healthcare decisions. Due to that, this current study explored the relationship between women’s healthcare decision-making capacity and unmet need for contraception in Mali. The sample was 6593 women aged 15–49. About nine out of ten of the women were not taking their healthcare decisions alone and 35.7% indicated that they had unmet need for contraception. Unmet need for contraception dominated among those aged 45–49 (50.9%) but was low among those aged 15–19 (19.2%). Women who took their healthcare decisions alone had high odds of unmet need for contraception. Compared with women aged 15–19, unmet need was nearly five times likely among women aged 45–49. Richer women had lower odds of unmet need for contraception compared with poorest women. To increase contraceptive use in Mali, it is important to take into consideration the variations revealed in this study. This will help to strengthen existing policies geared towards fertility control and improvement in maternal health.
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Litorp H, Kågesten A, Båge K, Uthman O, Nordenstedt H, Fagbemi M, Puranen B, Ekström AM. Gender norms and women’s empowerment as barriers to facility birth: A population-based cross-sectional study in 26 Nigerian states using the World Values Survey. PLoS One 2022; 17:e0272708. [PMID: 35980968 PMCID: PMC9387800 DOI: 10.1371/journal.pone.0272708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Central and western Africa struggle with the world’s lowest regional proportion of facility birth at 57%. The aim of the current study was to compare beliefs related to maternal health care services, science/technology, gender norms, and empowerment in states with high vs. low proportions of facility birth in Nigeria. Methods Face-to-face interviews were performed as part of a nationally representative survey in Nigeria using a new module to measure values and beliefs related to gender and sexual and reproductive health and rights collected as part the 2018 World Values Survey. We compared beliefs related to maternal health care services, science/technology, gender norms, and empowerment between Nigerian states with facility birth proportions > 50% vs. < 25% as presented in the 2018 Nigerian Demographic Health Survey report. Pearson’s chi-squared test, the independent t-test, and univariable and multivariable logistic and linear regression were used for analyses. Results were also stratified by gender. Results Among the 1,273 participants interviewed, 653 resided in states with high and 360 resided in states with low proportions of facility birth. There were no significant differences between the groups in perceived safety of facility birth (96% vs. 94%) and confidence in antenatal care (91% vs 94%). However, in states with low proportions of facility birth, participants had higher confidence in traditional birth attendants (61% vs. 39%, adjusted odds ratio [aOR] 2.1, [1.5–2.8]), men were more often perceived as the ones deciding whether a woman should give birth at a clinic (56% vs. 29%, aOR 2.4 [1.8–3.3]), and participants experienced less freedom over their own lives (56% vs. 72%, aOR 0.56 [0.41–0.76]). Most differences in responses between men and women were not statistically significant. Conclusions In order to increase facility births in Nigeria and other similar contexts, transforming gender norms and increasing women’s empowerment is key.
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Affiliation(s)
- Helena Litorp
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Anna Kågesten
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Båge
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Olalekan Uthman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Bi Puranen
- World Values Survey, Stockholm, Sweden
- Institute for Future Studies, Stockholm, Sweden
| | - Anna-Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Kassahun A, Zewdie A. Decision-making autonomy in maternal health service use and associated factors among women in Mettu District, Southwest Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e059307. [PMID: 35501088 PMCID: PMC9062806 DOI: 10.1136/bmjopen-2021-059307] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/19/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Women's autonomy is valued in a range of healthcare settings, from seeking and receiving care to deciding between treatment options. This study aimed to assess the level of decision-making autonomy women have and associated factors when it comes to using maternal healthcare services. DESIGN A community-based cross-sectional study was conducted. SETTING The study was conducted in Mettu Rural District, Iluababor Zone, Southwest Ethiopia. METHODS Data were collected using a pretested interviewer-administered questionnaire from 541 women selected by a multistage sampling technique. The collected data were entered into EpiData V.3.1 and exported to SPSS V.22 for analysis. Bivariable and multivariable binary logistic regression were used to identify factors associated with women's decision-making autonomy on maternal health service use. Variables with a p value less than 0.05 at 95% CI were declared significant, and the strength of the association was measured by an adjusted OR (AOR). PRIMARY OUTCOME Level of women's decision-making autonomy on maternal health service use. RESULTS It was found that 60.5% of women were autonomous in maternal health service use (95% CI 56.2% to 64.7%). The older age group (AOR=4.27, 95% CI 1.6 to 11.4, p=0.034), higher educational level (AOR=3.8, 95% CI 2.2 to 6.7, p=0.042), small family size (AOR=2.5, 95% CI 1.5 to 4.1, p=0.01) and proximity to health facilities (AOR=5.3, 95% CI 2.5 to 11.3, p=0.004) were all associated factors with healthcare decision-making autonomy. CONCLUSION Two-fifths of women have diminished autonomy in decision making on healthcare service use. Age, level of education, family size and accessibility of health services were found to influence women's autonomy. Special attention should be given to education and access to health services to improve women's autonomy.
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Affiliation(s)
- Asmamaw Kassahun
- Prisoner Health Center, Iluababor Zone Prison Administration, Mettu, Oromia, Ethiopia
| | - Asrat Zewdie
- Department of Public Health, Mettu University, Mettu, Ethiopia
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Sunmola AM, Sambo MN, Mayungbo OA, Morakinyo LA. Moderating Effect of Husband's Controlling Attitudes on the Relation Between Women's Household Decision-Making Autonomy and Intimate Partner Violence Experience in Nigeria. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12125-NP12154. [PMID: 31789086 DOI: 10.1177/0886260519888534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Existing studies show a consensus on the importance of women's household decision-making autonomy. However, the studies also show mixed findings of the association between the variable and intimate partner violence (IPV). In this study, moderating effects of husband's controlling and domineering attitudes on the association between women's household decision-making autonomy and husband-perpetrated physical, sexual, and emotional violence were investigated. Data used in the study were drawn from an existing database of a 2013 cross-sectional Demographic and Health Survey (DHS) of nationally representative sample (N = 19,360) of Nigerian married women. Participants were interviewed on measures of women's autonomy, husband's attitudes, and husband-perpetrated violence. Results revealed that women who exercised high household decision-making autonomy significantly experienced more physical (b = .31, t = 11.78, p < .001), sexual (b = .05, t = 3.59, p < .01), and emotional (b = .17, t = 9.76, p < .001) violence if they reported relationship with husbands who endorsed high controlling and domineering attitudes. The results represent an extension over existing research and have implications on how husband's attitudes could improve women's autonomy and reduce their IPV experience in various intervention settings.
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Two decades of theorising and measuring women's empowerment: Literature review and future research agenda. WOMENS STUDIES INTERNATIONAL FORUM 2021. [DOI: 10.1016/j.wsif.2021.102495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dixit A, Johns NE, Ghule M, Battala M, Begum S, Yore J, Saggurti N, Silverman JG, Reed E, Benmarhnia T, Averbach S, Raj A. Male-female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India. Reprod Health 2021; 18:139. [PMID: 34193214 PMCID: PMC8244175 DOI: 10.1186/s12978-021-01187-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Women's involvement in contraceptive decision-making increases contraceptive use and reduces unmet need, but study of this has been limited to women's self-reports. Less research is available examining couple concordance and women's involvement in contraceptive decision-making as reported by both men and women. STUDY DESIGN We carried out a cross-sectional study using data from rural India (N = 961 young married couples). Using multivariable regression we examined the association between concordance or discordance in spousal reports of wife's involvement in contraceptive decision-making and modern contraceptive use, adjusting for demographics, intimate partner violence, and contraceptive use discussion. RESULTS More than one third (38.3%) of women reported current modern contraceptive use. Report of women's involvement in contraceptive decision-making showed 70.3% of couples agreed that women were involved, jointly or alone (categorized as Concordant 1), 4.2% agreed women were not involved (categorized at Concordant 2), 13.2% had women report involvement but men report women were uninvolved (categorized as Discordant 1), and 12.2% had women report uninvolvement but men report that women were involved (categorized as Discordant 2). Discordant 2 couples had lower odds of modern contraceptive use relative to Concordant 1 couples (adjusted RR = 0.61, 95% CI 0.45-0.83). No other significant differences between Concordant 1 couples and other categories were observed. CONCLUSION One in four couples indicated discordance on women's involvement in contraceptive decision making, with Discordant 2 category having lower odds of contraceptive use. Couples' concordance in women's involvement in contraceptive decision-making offers a target for family planning research and interventions to better meet their needs. Trial registration ClinicalTrial.gov, NCT03514914. https://clinicaltrials.gov/ct2/show/NCT03514914.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA. .,Joint Doctoral Program in Public Health (Global Health Track), University of California San Diego/San Diego State University, San Diego, USA.
| | - Nicole E Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | | | - Jay G Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA
| | - Elizabeth Reed
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA.,Division of Health Promotion and Behavior, San Diego State University, San Diego, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, USA.,Scripps Institution of Oceanography, University of California, San Diego, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, La Jolla, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, USA.,Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
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Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal. J Nutr 2021; 151:1018-1024. [PMID: 33693922 DOI: 10.1093/jn/nxaa399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. OBJECTIVES We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). METHODS We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. RESULTS Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (β: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (β: 0.233, P < 0.001) and the model with women's and men's domains (β: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (β: -0.0503, P = 0.014) and in the model with women's and men's domains (β: -0.056, P = 0.008). Household decision making for women (β: -0.0631, P = 0.007) and for men (β: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. CONCLUSIONS Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.
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Affiliation(s)
- Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kenda Cunningham
- Hellen Keller International, Kathmandu, Nepal.,London School of Hygiene and Tropical Medicine, Department of Population Health, Faculty of Epidemiology, London, United Kingdom
| | - Spencer Moore
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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14
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Behrman J, Gonalons-Pons P. Women's employment and fertility in a global perspective (1960-2015). DEMOGRAPHIC RESEARCH 2020; 43:707-744. [PMID: 34305448 PMCID: PMC8295801 DOI: 10.4054/demres.2020.43.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Scant research explores the association between women's employment and fertility on a truly global scale due to limited cross-national comparative standardized information across contexts. METHODS This paper compiles a unique dataset that combines nationally representative country-level data on women's wage employment from the International Labor Organization with fertility and reproductive health measures from the United Nations and additional information from UNESCO, OECD, and the World Bank. This dataset is used to explore the linear association between women's employment and fertility/reproductive health around the world between 1960 and 2015. RESULTS Women's wage employment is negatively correlated with total fertility rates and unmet need for family planning and positively correlated with modern contraceptive use in every major world region. Nonetheless, evidence suggests that these findings hold for nonagricultural employment only. CONTRIBUTION Our analysis documents the linear association between women's employment and fertility on a global scale and widens the discussion to include reproductive health outcomes as well. Better understanding of these empirical associations on a global scale is important for understanding the mechanisms behind global fertility change.
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Affiliation(s)
- Julia Behrman
- Equal authorship, authors in alphabetical order. Northwestern University, USA
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15
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Pierce H, Heaton TB. Cohabitation or Marriage? How Relationship Status and Community Context Influence the Well-being of Children in Developing Nations. POPULATION RESEARCH AND POLICY REVIEW 2019. [DOI: 10.1007/s11113-019-09549-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Gautam S, Jeong HS. The Role of Women's Autonomy and Experience of Intimate Partner Violence as a Predictor of Maternal Healthcare Service Utilization in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050895. [PMID: 30871081 PMCID: PMC6427435 DOI: 10.3390/ijerph16050895] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
Abstract
This study aims to identify the relationship of women’s autonomy and intimate partner violence (IPV) with maternal healthcare service utilization among married women of reproductive age in Nepal. This study used data from the 2016 Nepal Demographic and Health Survey (NDHS), which is a nationally representative sample survey. The association between outcome variables with selected factors were examined by using the Chi-square test (χ2), followed by multiple logistic regression. The sample was adjusted for multi-stage sampling design, cluster weight, and sample weight. Of the total sample, 68.4% reported attending sufficient Antenatal care (ANC) visits throughout their pregnancy, while 59.9% reported having a health facility delivery. The factors associated with both, sufficient ANC visits and institutional delivery includes ethnicity, place of residence, household wealth status, and the number of living children. Women who have access to media, and who have intended pregnancy were more likely to have sufficient ANC visits. Exposure to some forms of violence was found to be the barrier for maternal health service utilization. Attending ANC visits enables mothers to make the decision regarding skilled attendance or health facility delivery. Preventing any forms of violence need to be considered as a vital element in interventions aimed at increasing maternal health service utilization.
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Affiliation(s)
- Sujan Gautam
- Department of Health Administration, Graduate School, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do 26493, Korea.
| | - Hyoung-Sun Jeong
- Department of Health Administration, Graduate School, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwon-do 26493, Korea.
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17
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Intimate Partner Violence in Relation to Husband Characteristics and Women Empowerment: Evidence from Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050709. [PMID: 30818838 PMCID: PMC6427227 DOI: 10.3390/ijerph16050709] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to assess the magnitude of intimate partner violence (IPV) and associated factors among women in Nepal. The secondary data from the Nepal Demographic and Health Survey (NDHS) 2016 was used. This study was confined to the respondents selected for the domestic violence module. The association between experience of IPV 'ever' and 'in the past year' with selected factors were examined by using Chi-square test, followed by multivariate logistic regression. Complex sample analysis procedure was adopted to adjust for multi-stage sampling design, cluster weight, and sample weight. The result revealed that 26.3% of ever-married women experienced any form of IPV at some point in their lives, while only 13.7% has experienced any form of IPV in the past year. The factors associated with both 'lifetime' and 'past year' experience of IPV includes women witnessing parental violence during their childhood, the husband being drunk frequently, women being afraid of their husband most of the times, and women whose husbands shows marital control behavior. Women's experiencing IPV was associated more with husband related factors than with women's empowerment indicators. Reducing IPV requires a commitment to changing the norms that promote the husband's behavior of controlling his wives and beating her.
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18
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Vallely LM, Emori R, Gouda H, Phuanukoonnon S, Homer C, Vallely AJ. Women's knowledge of maternal danger signs during pregnancy: Findings from a cross-sectional survey in Papua New Guinea. Midwifery 2019; 72:7-13. [PMID: 30739884 DOI: 10.1016/j.midw.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To explore knowledge of pregnancy related danger signs among women attending antenatal clinics in Papua New Guinea. DESIGN Cross-sectional survey undertaken as part of a wider integrated health and demographic survey. SETTING Three sites in Papua New Guinea: Hiri District (Central Province), Karkar (Madang Province) and Asaro (Eastern Highlands Province). PARTICIPANTS 482 women aged 15-44 years. FINDINGS Almost all (95.2%; 459/482) women attended for antenatal care at least once; 68.2% attended four or more times. Among women who attended the antenatal clinic, 53.6% (246/459) reported receiving information about danger signs in pregnancy from a health worker. Of these 60.2% (148/246) could recall at least one danger sign. In addition, 16.4% (35/213) of women who did not receive information from the antenatal clinic reported pregnancy related danger signs. Among the 183 women who reported danger signs, 47.5% (87/183) reported fever; 39.3% (72/183) reported vaginal bleeding and 36.6% (67/183) reported swelling of the face, legs and arms. Women who reported receiving information at the antenatal clinic were significantly more likely know any danger signs, compared with women who did not receive information at the antenatal clinic (OR 7.68 (95%CI: 4.93, 11.96); p = <0.001). Knowledge of danger signs was significantly associated with secondary school education, compared with none or only primary education (OR 3.08 (95% CI: 2.06, 4.61); p = <0.001). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Every antenatal clinic visit should be used opportunistically to provide women with information about key danger signs during pregnancy and childbirth. Recognising maternal danger signs, together with the importance of seeking early transfer to the health facility and the importance of attending for a health facility birth are critical to improving outcomes for mothers and babies especially in low income settings such as Papua New Guinea.
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Affiliation(s)
- L M Vallely
- Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney 2052, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - R Emori
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - H Gouda
- School of Public Health, University of Queensland, Brisbane, Australia.
| | - S Phuanukoonnon
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Cse Homer
- Burnet Institute, Melbourne, Victoria, Australia; Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, Australia.
| | - A J Vallely
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Kirby Institute, University of New South Wales, Sydney, Australia.
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Gram L, Morrison J, Skordis-Worrall J. Organising Concepts of 'Women's Empowerment' for Measurement: A Typology. SOCIAL INDICATORS RESEARCH 2018; 143:1349-1376. [PMID: 31231148 PMCID: PMC6548747 DOI: 10.1007/s11205-018-2012-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 06/01/2023]
Abstract
Improving the conceptualisation and measurement of women's empowerment has been repeatedly identified as a research priority for global development policy. We apply arguments from feminist and political philosophy to develop a unified typology of empowerment concepts to guide measurement and evaluation. In this typology, empowerment (1) may be a property of individuals or collectives (2) may involve removing internal psychological barriers or external interpersonal barriers (3) may be defined on each agent's own terms or by external agents in advance (4) may require agents to acquire a degree of independence or require others to 'empower' them through social support (5) may either concern the number of present options or the motivations behind past choices. We argue a careful examination of arguments for and against each notion of empowerment reveal fundamental fact-, theory- and value-based incompatibilities between contrasting notions. Thus, empowerment is an essentially contested concept that cannot be captured by simply averaging a large number of contrasting measures. We argue that researchers and practitioners measuring this concept may benefit from making explicit their theory-, fact- and value-based assumptions about women's empowerment before settling on a single primary measure for their particularly context. Alternative indicators can subsequently be used as sensitivity measures that not only measure sensitivity to assumptions about women's social reality, but also to investigators' own values.
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Affiliation(s)
- Lu Gram
- Institute of Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Joanna Morrison
- Institute of Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Jolene Skordis-Worrall
- Institute of Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
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20
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Shakya HB, Dasgupta A, Ghule M, Battala M, Saggurti N, Donta B, Nair S, Silverman J, Raj A. Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study. BMC WOMENS HEALTH 2018; 18:147. [PMID: 30180845 PMCID: PMC6123913 DOI: 10.1186/s12905-018-0636-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022]
Abstract
Background Persistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting. Methods Using data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men’s and women’s reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women’s empowerment (household and fertility decision-making, women’s education, and women’s knowledge of contraception). Results When individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women’s empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband’s education, husband’s familiarity with contraception, and number of children. Conclusions Overall there were clear patterns to differential reporting. Associations with women’s empowerment and contraceptive communication and use suggest a strategy of women’s empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences. Trial registration Clinical Trials Number: NCT01593943, registered May 4, 2012 at clinicaltrials.gov.
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Affiliation(s)
- Holly B Shakya
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Center on Gender Equity and Health (GEH), University of California, San Diego, CA, USA.
| | - Anindita Dasgupta
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Mohan Ghule
- National Institute for Research in Reproductive Health (NIRRH), Mumbai, India
| | | | | | - Balaiah Donta
- National Institute for Research in Reproductive Health (NIRRH), Mumbai, India
| | - Saritha Nair
- National Institute of Medical Statistics, New Delhi, India
| | - Jay Silverman
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.,Center on Gender Equity and Health (GEH), University of California, San Diego, CA, USA
| | - Anita Raj
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.,Center on Gender Equity and Health (GEH), University of California, San Diego, CA, USA
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Becker S, Kalamar A. Sampling Weights for Analyses of Couple Data: Example of the Demographic and Health Surveys. Demography 2018; 55:1447-1473. [DOI: 10.1007/s13524-018-0688-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abstract
In some surveys, women and men are interviewed separately in selected households, allowing matching of partner information and analyses of couples. Although individual sampling weights exist for men and women, sampling weights specific for couples are rarely derived. We present a method of estimating appropriate weights for couples that extends methods currently used in the Demographic and Health Surveys (DHS) for individual weights. To see how results vary, we analyze 1912 estimates (means; proportions; linear regression; and simple and multinomial logistic regression coefficients, and their standard errors) with couple data in each of 11 DHS surveys in which the couple weight could be derived. We used two measures of bias: absolute percentage difference from the value estimated with the couple weight and ratio of the absolute difference to the standard error using the couple weight. The latter shows greater bias for means and proportions, whereas the former and a combination of both measures show greater bias for regression coefficients. Comparing results using couple weights with published results using women’s weights for a logistic regression of couple contraceptive use in Turkey, we found that 6 of 27 coefficients had a bias above 5 %. On the other hand, a simulation of varying response rates (27 simulations) showed that median percentage bias in a logistic regression was less than 3 % for 17 of 18 coefficients. Two proxy couple weights that can be calculated in all DHS surveys perform considerably better than either male or female weights. We recommend that a couple weight be calculated and made available with couple data from such surveys.
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Affiliation(s)
- Stan Becker
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, USA
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22
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Islam AZ. Factors affecting modern contraceptive use among fecund young women in Bangladesh: does couples' joint participation in household decision making matter? Reprod Health 2018; 15:112. [PMID: 29929526 PMCID: PMC6013886 DOI: 10.1186/s12978-018-0558-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/15/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The purpose of the study was to explore the association between couples' joint participation in household decision making and modern contraceptive use (MCU) among fecund (physically able to bear child) young women in Bangladesh. METHODS This study utilized a cross-sectional data (n = 3507) extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. Differences in the utilization of modern contraceptives (MC) by socio-demographic characteristics were assessed by χ2 analyses. Binary logistic regression was used to identify the associated factors of usingMC, and the odds ratio with a 95% CI was computed to assess the strength of association. Multicollinearity was also checked by examining the standard errors in the fitted model. RESULTS Desire for a child after two years go by and no child at all contributed the most to increasing MCU followed by receiving family planning (FP) methods from FP workers. Couples' joint decision making power on women's health care, child's health care and visiting family members or relatives emerged as the third most influential factor that might be associated with MCU. CONCLUSIONS Since spousal joint decision making increases the likelihood of using MC, government should include strategic interventions in FP programs to elevate women's status through creating educational and employment opportunities and encouraging more visible involvement in household decision making.
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Affiliation(s)
- Ahmed Zohirul Islam
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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23
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Uddin J, Hossin MZ, Pulok MH. Couple's concordance and discordance in household decision-making and married women's use of modern contraceptives in Bangladesh. BMC WOMENS HEALTH 2017; 17:107. [PMID: 29121901 PMCID: PMC5680601 DOI: 10.1186/s12905-017-0462-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
Background Although a large body of studies documents that women’s autonomy in the household is associated with better reproductive health outcomes, these studies typically examined autonomy only from women’s point of view. The current study employs husband’s and wife’s perspectives together to examine the relationship between the decision-making arrangements in the household and the women’s use of modern contraceptives in Bangladesh. Methods The study used the couple dataset of 2007 Bangladesh Demographic and Health Survey. The sample was comprised of 3336 married couples. Binary logistic regression models were used to examine the associations between the selected items on household decision-making and the use of modern contraceptives. Results Our results indicate that the couples disagree considerably as to who in the household exercises the decision-making power. The pattern of decision-making regarding visiting family and relatives emerged as an important predictor of use of modern contraceptives in the multivariate regression analysis. The results suggest that compared to the couple’s concordant joint decision-making, the husband-only decision-making is associated with lower odds of contraceptives use (OR 0.49; 95% CI 0.28–0.85). Only a small part of this association is explained by spousal communication about family planning issues while the socio-demographic correlates hardly affected the association. On the contrary, the wife-only decision-making did not result in increased contraceptives use (OR 0.71; 95% CI 0.45–1.13). Conclusions The study findings imply that women’s greater autonomy may not necessarily result in improved reproductive health behavior, and therefore, a balance of power in the spousal relationship is warranted.
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Affiliation(s)
- Jalal Uddin
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | | | - Mohammad Habibullah Pulok
- Department of Economics, Southeast University, Dhaka, Bangladesh. .,Center for Health Economics Research and Evaluation (CHERE), UTS Business School, University of Technology Sydney (UTS), Sydney, Australia. .,CMCRC Health Market Quality Research Program, Sydney, Australia.
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Allendorf K, Thornton A, Mitchell C, Young-DeMarco L, Ghimire DJ. Early Women, Late Men: Timing Attitudes and Gender Differences in Marriage. JOURNAL OF MARRIAGE AND THE FAMILY 2017; 79:1478-1496. [PMID: 29129940 PMCID: PMC5679473 DOI: 10.1111/jomf.12426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 05/18/2017] [Indexed: 05/30/2023]
Abstract
Around the world, women marry earlier than men, but it is not well understood why this gender gap exists. Using panel data collected in Nepal, the authors investigate whether attitudes about marital timing held by unmarried youth and their parents account for women marrying earlier than men. They also examine whether the influence of timing attitudes differs by gender. On average, unmarried youth and their parents viewed 20 to 25 as acceptable ages for women to marry, while ages 23 to 30 were appropriate for men. In turn, women entering the acceptable marriage age range earlier than men accounted for a third of the gender gap in marital timing. The influence of youth and parents' timing attitudes did differ by gender, but only at the extreme. When they were much too young for marriage, both genders were less likely to marry, but this dampening effect was substantially larger for women.
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Affiliation(s)
- Keera Allendorf
- Indiana University, 1020 E. Kirkwood Ave., Bloomington, IN 47405
| | - Arland Thornton
- University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, Tel: (734)-763-1543
| | - Colter Mitchell
- University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, Tel: (734)-936-2267
| | - Linda Young-DeMarco
- University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, Tel: (734)-615-3540
| | - Dirgha J Ghimire
- University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, Tel: (734)-936-3125
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Ghose B, Feng D, Tang S, Yaya S, He Z, Udenigwe O, Ghosh S, Feng Z. Women's decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey. BMJ Open 2017; 7:e017142. [PMID: 28882921 PMCID: PMC5595179 DOI: 10.1136/bmjopen-2017-017142] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the association between women's decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women. SETTINGS This is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully. PARTICIPANTS Cross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent's own healthcare, large household purchases, having a say on child's healthcare and visiting to family or relatives were included in the analysis. RESULTS Prevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner. CONCLUSION Neither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services.
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Affiliation(s)
- Bishwajit Ghose
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Da Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Zhifei He
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | | | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bhandari TR, Kutty VR, Sarma PS, Dangal G. Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth? PLoS One 2017; 12:e0182485. [PMID: 28771579 PMCID: PMC5542628 DOI: 10.1371/journal.pone.0182485] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/19/2017] [Indexed: 12/04/2022] Open
Abstract
Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway.
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Affiliation(s)
- Tulsi Ram Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
- AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
- * E-mail:
| | - V. Raman Kutty
- AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. Sankara Sarma
- AchuthaMenon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ganesh Dangal
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Bagbazaar, Kathmandu, Nepal
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Bonilla J, Zarzur RC, Handa S, Nowlin C, Peterman A, Ring H, Seidenfeld D. Cash for Women's Empowerment? A Mixed-Methods Evaluation of the Government of Zambia's Child Grant Program. WORLD DEVELOPMENT 2017; 95:55-72. [PMID: 31363300 PMCID: PMC6667169 DOI: 10.1016/j.worlddev.2017.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The empowerment of women, broadly defined, is an often-cited objective and benefit of social cash transfer programs in developing countries. Despite the promise and potential of cash transfers to empower women, the evidence supporting this outcome is mixed. In addition, there is little evidence from programs at scale in sub-Saharan Africa. We conducted a mixed-methods evaluation of the Government of Zambia's Child Grant Program, a poverty-targeted, unconditional transfer given to mothers or primary caregivers of young children aged zero to five. The quantitative component was a four-year longitudinal clustered-randomized control trial in three rural districts, and the qualitative component was a one-time data collection involving in-depth interviews with women and their partners stratified on marital status and program participation. Our study found that women in beneficiary households were making more sole or joint decisions (across five out of nine domains); however, impacts translated into relatively modest increases in the number of decision domains a woman is involved in, on average by 0.34 (or a 6% increase over a baseline mean of 5.3). Qualitatively, we found that changes in intrahousehold relationships were limited by entrenched gender norms, which indicate men as heads of household and primary decision makers. However, women's narratives showed the transfer increased financial empowerment as they were able to retain control over transfers for household investment and savings for emergencies. We highlight methodological challenges in using intrahousehold decision making as the primary indicator to measure empowerment. Results show potential for unconditional cash transfer programs to improve the financial and intrahousehold status of female beneficiaries, however it is likely additional design components are need for transformational change.
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Diamond-Smith N, Raj A, Prata N, Weiser SD. Associations of women's position in the household and food insecurity with family planning use in Nepal. PLoS One 2017; 12:e0176127. [PMID: 28453562 PMCID: PMC5409177 DOI: 10.1371/journal.pone.0176127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/05/2017] [Indexed: 12/21/2022] Open
Abstract
Background Women in Nepal have low status, especially younger women in co-resident households. Nepal also faces high levels of household food insecurity and malnutrition, and stagnation in uptake of modern family planning methods. Objective This study aims to understand if household structure and food insecurity interact to influence family planning use in Nepal. Methods Using data on married, non-pregnant women aged 15–49 with at least one child from the Nepal 2011 Demographic and Health Survey (N = 7,460), we explore the relationship between women’s position in the household, food insecurity as a moderator, and family planning use, using multi-variable logistic regressions. We adjust for household and individual factors, including other status-related variables. Results In adjusted models, living in a food insecure household and co-residing with in-laws either with no other daughter-in-laws or as the eldest or youngest daughter-in-law (compared to not-co-residing with in-laws) are all associated with lower odds of family planning use. In the interaction model, younger-sisters-in-law and women co-residing with no sisters-in-law in food insecure households have the lowest odds of family planning use. Conclusion This study shows that household position is associated with family planning use in Nepal, and that food insecurity modifies these associations–highlighting the importance of considering both factors in understanding reproductive health care use in Nepal. Policies and programs should focus on the multiple pathways through which food insecurity impacts women’s reproductive health, including focusing on women with the lowest status in households.
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Affiliation(s)
- Nadia Diamond-Smith
- University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Anita Raj
- University of California San Diego, San Diego, California, United States of America
| | - Ndola Prata
- University of California, Berkeley, California, United States of America
| | - Sheri D. Weiser
- University of California San Francisco, San Francisco, California, United States of America
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Budhathoki SS, Pokharel PK, Good S, Limbu S, Bhattachan M, Osborne RH. The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review. BMC Health Serv Res 2017; 17:237. [PMID: 28347355 PMCID: PMC5369219 DOI: 10.1186/s12913-017-2183-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/23/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health literacy has been linked to health outcomes across population groups around the world. Nepal, a low income country, experiences the double burden of highly prevalent communicable as well as non-communicable diseases. The World Health Organization (WHO) has positioned health literacy as a key mechanism to meet the health-related Sustainable Development Goal (SDG3). However, there is little known about the status of health literacy in developing countries such as Nepal. This paper aims to review the potential of health literacy to address SDG3 in Nepal. METHODS A rapid review was conducted using the knowledge to action evidence summary approach. Articles included in the review were those reporting on barriers to health care engagements in Nepal published in English language between January 2000 and December 2015. RESULTS Barriers for healthcare engagement included knowledge and education as strong factors, followed by culture, gender roles, quality of service and cost of services. These barriers influence the Nepalese community to access and engage with services, and make and enact healthcare decisions, not only at the individual level but at the family level. These factors are directly linked to health literacy. Health literacy is a pivotal determinant of understanding, accessing and using health information and health services, it is important that the health literacy needs of the people be addressed. CONCLUSION Locally identified and developed health literacy interventions may provide opportunities for systematic improvements in health to address impediments to healthcare in Nepal. Further research on health literacy and implementation of health literacy interventions may help reduce inequalities and increase the responsiveness of health systems which could potentially facilitate Nepal to meet the sustainable development goals. While there is currently little in place for health literacy to impact on the SDG3, this paper generates insights into health literacy's potential role.
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Affiliation(s)
- Shyam Sundar Budhathoki
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, 56700 Nepal
| | - Paras K. Pokharel
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, 56700 Nepal
| | - Suvajee Good
- World Health Organization, South-East Asia Regional Office, New Delhi, India
| | - Sajani Limbu
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, 56700 Nepal
| | - Meika Bhattachan
- School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, 56700 Nepal
| | - Richard H. Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Australia
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Gram L, Morrison J, Sharma N, Shrestha B, Manandhar D, Costello A, Saville N, Skordis-Worrall J. Validating an Agency-based Tool for Measuring Women's Empowerment in a Complex Public Health Trial in Rural Nepal. JOURNAL OF HUMAN DEVELOPMENT AND CAPABILITIES 2017; 18:107-135. [PMID: 28303173 PMCID: PMC5327873 DOI: 10.1080/19452829.2016.1251403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Despite the rising popularity of indicators of women's empowerment in global development programmes, little work has been done on the validity of existing measures of such a complex concept. We present a mixed methods validation of the use of the Relative Autonomy Index for measuring Amartya Sen's notion of agency freedom in rural Nepal. Analysis of think-aloud interviews (n = 7) indicated adequate respondent understanding of questionnaire items, but multiple problems of interpretation including difficulties with the four-point Likert scale, questionnaire item ambiguity and difficulties with translation. Exploratory Factor Analysis of a calibration sample (n = 511) suggested two positively correlated factors (r = 0.64) loading on internally and externally motivated behaviour. Both factors increased with decreasing education and decision-making power on large expenditures and food preparation. Confirmatory Factor Analysis on a validation sample (n = 509) revealed good fit (Root Mean Square Error of Approximation 0.05-0.08, Comparative Fit Index 0.91-0.99). In conclusion, we caution against uncritical use of agency-based quantification of women's empowerment. While qualitative and quantitative analysis revealed overall satisfactory construct and content validity, the positive correlation between external and internal motivations suggests the existence of adaptive preferences. High scores on internally motivated behaviour may reflect internalized oppression rather than agency freedom.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, University College London, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Neha Sharma
- Mother Infant Research Activities, Kathmandu, Nepal
| | | | | | - Anthony Costello
- Institute for Global Health, University College London, London, UK
- Mother Infant Research Activities, Kathmandu, Nepal
- World Health Organization, Geneva, Switzerland
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
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Osamor PE, Grady C. Women's autonomy in health care decision-making in developing countries: a synthesis of the literature. Int J Womens Health 2016; 8:191-202. [PMID: 27354830 PMCID: PMC4908934 DOI: 10.2147/ijwh.s105483] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women’s decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance.
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Affiliation(s)
- Pauline E Osamor
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Christine Grady
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Jennings EA, Pierotti RS. The influence of wives' and husbands' fertility preferences on progression to a third birth in Nepal, 1997-2009. Population Studies 2016; 70:115-33. [PMID: 26938445 DOI: 10.1080/00324728.2016.1140806] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
As couples across the globe increasingly exercise conscious control over their reproduction, both spouses' family-size preferences have the opportunity to influence their fertility. Using couple-level measures of rural Nepalese spouses' family-size preferences and more than a decade of monthly panel data collected subsequently on fertility outcomes, we investigate how both spouses' preferences influence progression to a third birth in a country where the widely professed ideal family size is two children. Contrary to expectations based on women's relative disadvantage, we find that it is wives' preferences that drive couples' progression to a third birth. We find also that the influence of wives' preferences is not explained by contraceptive use but that this influence is moderated by couple communication about family planning. Wives' preferences drive progression to a third birth among couples who had discussed how many children to have.
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Correlates of unmet need for contraception in Bangladesh: does couples' concordance in household decision making matter? Contraception 2016; 94:18-26. [PMID: 26921638 DOI: 10.1016/j.contraception.2016.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 02/12/2016] [Accepted: 02/21/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION A large body of literature has highlighted that women's household decision-making power is associated with better reproductive health outcomes, while most of the studies tend to measure such power from only women's point of view. Using both husband's and wife's matched responses to decision-making questions, this study examined the association between couples' concordant and discordant decision makings, and wife's unmet need for contraception in Bangladesh. METHODS This study used couple's data set (n=3336) from Bangladesh Demographic and Health Survey of 2007. Multivariate logistic regression was used to examine the likelihood of unmet need for contraception among married women of reproductive age. FINDINGS Study results suggested that couples who support the equalitarian power structure seemed to be more powerful in meeting the unmet demand for contraception. Logistic regression analysis revealed that compared to couple's concordant joint decision making, concordance in husband-only or other's involvement in decision making was associated with higher odds of unmet need for contraception. Wives exposed to family planning information discussed family planning more often with husbands, and those from richest households were less likely to have unmet need for contraception. CONCLUSION Couple's concordant joint decision making, reflecting the concept of equalitarian power structure, appeared to be a significant analytic category. Policy makers in the field of family planning may promote community-based outreach programs and communication campaigns for family planning focusing on egalitarian gender roles in the household.
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Bhandari TR, Kutty VR, Ravindran TKS. Women's Autonomy and Its Correlates in Western Nepal: A Demographic Study. PLoS One 2016; 11:e0147473. [PMID: 26799217 PMCID: PMC4723155 DOI: 10.1371/journal.pone.0147473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022] Open
Abstract
Despite various efforts for enhancing women's autonomy in developing countries, many women are deprived of their capacity in decision-making on their household affairs as well as social issues. This paper aimed to examine women's autonomy and its associated factors in the Kapilvastu district of Nepal. We measured women's autonomy using a recently developed women's autonomy measurement scale from June to October 2014. Descriptive statistics, chi-square test and logistic multivariate modeling technique were applied for assessing the association of demographic and socio-economic characteristics of women and their autonomy. Mean score for women's autonomy was 23.34 ± 8.06 out of the possible maximum 48. It was found to be positively associated with higher age difference at marriage, advantaged caste/ethnicity, better employment for the husband, couple's education more than 10 years schooling, and higher economic status of the household. We found strong direct effect of women's education (OR = 8.14, CI = 3.77-17.57), husband's education (OR = 2.63, CI = 1.69-4.10) and economic status of household (OR = 1.42, CI = 1.01-2.03) on women's autonomy. When we adjusted women's education for husband's education, the odds ratio decreased by around 22% {from (OR = 8.14, CI = 3.77-17.57) to (OR = 6.32, CI = 2.77-14.46)} and was a mediator effect. The economic status of household also had mediator effect on women's autonomy through their education. Education status of women is a key predictor of women's autonomy in Kapilvastu district. Husband's education and economic status of the household are other important predictors of women's autonomy which have a mediator effect on women's autonomy. Improving educational status and economic conditions of both women and their husbands may be the best solution to promote women's autonomy.
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Affiliation(s)
- Tulsi Ram Bhandari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Lekhnath-12, Kaski, Nepal
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram – 695011, Kerala, India
| | - V. Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram – 695011, Kerala, India
| | - T. K. Sundari Ravindran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Thiruvananthapuram – 695011, Kerala, India
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Viens LJ, Clouston S, Messina CR. Women's autonomy and cervical cancer screening in the Lesotho Demographic and Health Survey 2009. Soc Sci Med 2015; 150:23-30. [PMID: 26722985 DOI: 10.1016/j.socscimed.2015.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/09/2015] [Accepted: 12/03/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE There are vast global disparities in the burden of cervical cancer; 85% of incident cases and 87% of deaths occur in the developing world. There is a growing body of literature asserting that women's autonomy is associated with a broad range of health outcomes. OBJECTIVE This study examined the relationship between women's autonomy and cervical cancer screening to inform interventions in global cervical cancer care. METHODS A generalized estimating equation approach to logistic regression was used to analyze associations between women's autonomy indicators and both cervical cancer screening knowledge and personal history in a cross sectional sample of 4049 married women in Lesotho. RESULTS More than half of the women surveyed (65.2%) had never heard of a pap smear, and only 7.2% had ever had one. Women who participated in all types of household decision-making were 1.4 times more likely to have heard of a pap smear (estimated risk ratio = 1.4, 95% confidence interval: 1.0, 1.8) compared to women with lower participation levels (p = 0.032). CONCLUSIONS This study extends earlier research demonstrating that women's autonomy predicts improved health outcomes, to include cervical cancer screening awareness, but not action. This finding, that augmenting women's autonomy improves cervical cancer screening awareness, adds yet another to the myriad reasons for focusing global attention on issues of gender equity.
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Affiliation(s)
- Laura J Viens
- Stony Brook University, Department of Preventive Medicine, Stony Brook, NY, USA.
| | - Sean Clouston
- Stony Brook University, Department of Preventive Medicine, Stony Brook, NY, USA
| | - Catherine R Messina
- Stony Brook University, Department of Preventive Medicine, Stony Brook, NY, USA
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Preciado MA, Krull JL, Hicks A, Gipson JD. Using a dyadic logistic multilevel model to analyze couple data. Contraception 2015; 93:113-8. [PMID: 26363432 DOI: 10.1016/j.contraception.2015.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/16/2015] [Accepted: 09/06/2015] [Indexed: 11/19/2022]
Abstract
There is growing recognition within the sexual and reproductive health field of the importance of incorporating both partners' perspectives when examining sexual and reproductive health behaviors. Yet, the analytical approaches to address couple data have not been readily integrated and utilized within the demographic and public health literature. This paper seeks to provide readers unfamiliar with analytical approaches to couple data an applied example of the use of dyadic logistic multilevel modeling, a useful approach to analyzing couple data to assess the individual, partner and couple characteristics that are related to individuals' reproductively relevant beliefs, attitudes and behaviors. The use of multilevel models in reproductive health research can help researchers develop a more comprehensive picture of the way in which individuals' reproductive health outcomes are situated in a larger relationship and cultural context.
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Affiliation(s)
- Mariana A Preciado
- Research and Evaluation, CollegeSpring, 800S. Figueroa Street, Suite 760 Los Angeles, CA 90017.
| | - Jennifer L Krull
- UCLA Department of Psychology, 4643 Franz Hall Los Angeles, CA 90095-1563.
| | - Andrew Hicks
- Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115.
| | - Jessica D Gipson
- UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, CHS 46-071B, Los Angeles, CA 90095-1772.
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Ghimire DJ. Wives' and Husbands' Nonfamily Experiences and First-Birth Timing. INTERNATIONAL JOURNAL OF SOCIOLOGY 2015; 45:4-23. [PMID: 26435547 PMCID: PMC4587386 DOI: 10.1080/00207659.2015.1004974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Dirgha J Ghimire
- Institute for Social Research, Population studies Center, University of Michigan
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Vallely LM, Homiehombo P, Kelly-Hanku A, Vallely A, Homer CS, Whittaker A. Childbirth in a rural highlands community in Papua New Guinea: A descriptive study. Midwifery 2015; 31:380-7. [DOI: 10.1016/j.midw.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/13/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
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Speizer IS, Story WT, Singh K. Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms. BMC Pregnancy Childbirth 2014; 14:398. [PMID: 25427853 PMCID: PMC4247879 DOI: 10.1186/s12884-014-0398-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women's decision-making autonomy and their perceptions about social support for institutional delivery in their community. METHODS This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers-women's decision-making autonomy and community perceptions of institutional delivery-we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. RESULTS The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. CONCLUSIONS This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women's decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors.
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Affiliation(s)
- Ilene S Speizer
- />Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- />Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - William T Story
- />Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Kavita Singh
- />Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- />Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Mishra A, Nanda P, Speizer IS, Calhoun LM, Zimmerman A, Bhardwaj R. Men's attitudes on gender equality and their contraceptive use in Uttar Pradesh India. Reprod Health 2014; 11:41. [PMID: 24894376 PMCID: PMC4051668 DOI: 10.1186/1742-4755-11-41] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 05/20/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Men play crucial role in contraceptive decision-making, particularly in highly gender-stratified populations. Past research examined men's attitudes toward fertility and contraception and the association with actual contraceptive practices. More research is needed on whether men's attitudes on gender equality are associated with contraceptive behaviors; this is the objective of this study. METHODS This study uses baseline data of the Measurement, Learning, and Evaluation (MLE) Project for the Urban Health Initiative in Uttar Pradesh, India. Data were collected from a representative sample of 6,431 currently married men in four cities of the state. Outcomes are current use of contraception and contraceptive method choice. Key independent variables are three gender measures: men's attitudes toward gender equality, gender sensitive decision making, and restrictions on wife's mobility. Multivariate analyses are used to identify the association between the gender measures and contraceptive use. RESULTS Most men have high or moderate levels of gender sensitive decision-making, have low to moderate levels of restrictions on wife's mobility, and have moderate to high levels of gender equitable attitudes in all four cities. Gender sensitive decision making and equitable attitudes show significant positive association and restrictions on wife's mobility showed significant negative relationship with current contraceptive use. CONCLUSION The study demonstrates that contraceptive programs need to engage men and address gender equitable attitudes; this can be done through peer outreach (interpersonal communication) or via mass media. Engaging men to be more gender equal may have an influence beyond contraceptive use in contexts where men play a crucial role in household decision-making.
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Affiliation(s)
- Anurag Mishra
- International Center for Research on Women (ICRW), New Delhi, India
| | - Priya Nanda
- International Center for Research on Women (ICRW), New Delhi, India
| | - Ilene S Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa M Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Atteraya MS, Kimm H, Song IH. Women's autonomy in negotiating safer sex to prevent HIV: findings from the 2011 Nepal Demographic and Health Survey. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:1-12. [PMID: 24450274 DOI: 10.1521/aeap.2014.26.1.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Women with greater autonomy have higher HIV-related knowledge and condom use. Inability to negotiate safer sex in high-risk situations might increase HIV infection. This study examined the relationship between women's autonomy and ability to negotiate safer sex practices among married women. The 2011 Nepal Demographic and Health Survey data were used. The data were collected by two-stage stratified cluster sampling and face-to-face interviews. Autonomy was measured in Decision-Making Participation and Assets Ownership, while ability to negotiate safer sex consists of Refusal of Sex and Ask for Condom Use. Among 12,674 women of 15-49 years, married women were analyzed (n = 8,896). Women with greater autonomy in decision-making participation were more likely to negotiate safer sex. After controlling for socio-demographic factors, odds ratios (OR) for refusal of sex was 2.70 (95% CI [2.14, 3.40]) in women with the highest decision-making participation. These women showed higher OR for 'ask for condom use' in high risk situations (2.10, 95% CI [1.81, 2.44]). Assets ownership also demonstrated a positive statistical relationship with asking for a condom use (OR 1.31, 95% CI [1.10, 1.56]). The results point to the importance of women's autonomy on sexual health. It emphasizes women's empowerment-based approach to curbing HIV/AIDS in developing countries.
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Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People's democratic republic: a qualitative study. BMC Pregnancy Childbirth 2013; 13:243. [PMID: 24373604 PMCID: PMC3879427 DOI: 10.1186/1471-2393-13-243] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 12/22/2013] [Indexed: 11/21/2022] Open
Abstract
Background To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national ‘Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services’. This paper reports on implementation constraints identified in three demonstration sites. Methods The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al’s health system constraint framework. Results In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women’s position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. Conclusion The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the initiative. To achieve effective implementation and scale-up a number of concurrent interventions are needed to address identified constraints. More research is needed to identify the optimal combination of interventions to improve these constraints. The broader contextual characteristics require longer-term, cross-sectoral action.
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Correlates of and barriers to the utilization of health services for delivery in South Asia and Sub-Saharan Africa. ScientificWorldJournal 2013; 2013:423403. [PMID: 24288482 PMCID: PMC3830882 DOI: 10.1155/2013/423403] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/13/2013] [Indexed: 11/17/2022] Open
Abstract
The high maternal and neonatal mortality rates in South Asia and Sub-Saharan Africa can be attributed to the lack of access and utilization of health services for delivery. Data from the Demographic and Health Surveys conducted in Bangladesh, India, Pakistan, Kenya, Nigeria, and Tanzania show that more than half of the births in these countries were delivered outside a health facility. Institutional delivery was closely associated with educational level, family wealth, place of residence, and women's media exposure status, but it was not influenced by women's work status and their roles in decision-making (with the exception of Nigeria). Controlling for other variables, higher parity and younger women were less likely to use a health facility for delivery. Within each country, the poorer, less educated and rural women had higher unmet need for maternal care services. Service related factors (accessibility in terms of cost and distance) and sociocultural factors (e.g., did not perceive the need for the services and objections from husband and family) also posed as barriers to institutional delivery. The paper concludes with some suggestions to increase institutional delivery.
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Exploring women's perspectives of access to care during pregnancy and childbirth: a qualitative study from rural Papua New Guinea. Midwifery 2013; 29:1222-9. [PMID: 23684099 DOI: 10.1016/j.midw.2013.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/11/2013] [Accepted: 03/16/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES to explore women's perceptions and experiences of pregnancy and childbirth in a rural community in PNG. DESIGN a qualitative, descriptive study comprising focus group discussions (FGDs) and in depth interviews. SETTING this study took place in a rural community in Eastern Highlands Province, PNG. PARTICIPANTS 51 women participated in seven focus group discussions. In depth interviews were undertaken with 21 women, including women recruited at the antenatal clinic, women purposively selected in the community and three key informants in the community. FINDINGS the majority of women mentioned the benefits of receiving antenatal care at the health facility and the importance of a supervised, facility birth. Women faced numerous challenges with regards to accessing these services, including geographical, financial and language barriers. Cultural and customary beliefs surrounding childbirth and lack of decision making powers also impacted on whether women had a supervised birth. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE distance, terrain and transport as well as decision making processes and customary beliefs influenced whether a woman did or did not reach a health facility to give birth. While the wider issue of availability and location of health services and health system strengthening is addressed shorter term, community based interventions could be of benefit. These interventions should include safe motherhood and birth preparedness messages disseminated to women, men and key family and community members.
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The influence of gender attitudes on contraceptive use in Tanzania: new evidence using husbands' and wives' survey data. J Biosoc Sci 2013; 45:331-44. [PMID: 23312349 PMCID: PMC3607277 DOI: 10.1017/s0021932012000855] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper explores the hypothesis that gender attitude scales (which measure the degree of equity in gender attitudes) are associated with contraceptive use. Four hundred male and female respondents (200 couples) were interviewed using a pre-tested, structured questionnaire. Analyses included comparisons of means and prevalence rates on gender equity indicators, other related factors and socio-demographic characteristics; t-tests to compare mean scores on each gender scale for wives and husbands to identify any significant differences; chi-squared tests to compare associations between individual attributes, attitudes and contraceptive use; and multivariate logistic regression to examine associations between each gender scale and contraceptive use. The findings revealed that, on average, wives endorsed more inequitable gender attitudes compared with husbands on all gender attitude scales. For wives, more equitable gender attitudes were positively associated with contraceptive use. For husbands, the role of gender attitudes had no significant association with wives' reported contraceptive use. Family planning programmes that aim to challenge inegalitarian gender norms should not overlook women in their efforts since both men and women often accept and support inequality in a social system and, in some cases, it may be women's gender attitudes that most influence family planning decisions.
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Abstract
Abstract
Scholars traditionally argued that industrialization, urbanization, and educational expansion lead to a decline in extended families and complementary rise in nuclear families. Some have suggested that such transitions are good for young married women because living in nuclear families benefits their health. However, extended families may also present advantages for young women’s health that outweigh any disadvantages. Using the Indian National Family Health Survey, this article examines whether young married women living in nuclear families have better health than those in patrilocal extended families. It also examines whether young married women’s living arrangements are changing over time and, if so, how such changes will affect their health. Results show that young married women living in nuclear families do not have better health than those in patrilocal extended families. Of eight health outcomes examined, only five differ significantly by family structure. Further, of the five outcomes that differ, four are patrilocal extended-family advantages and only one is a nuclear-family advantage. From 1992 to 2006, the percentage of young married women residing in nuclear families increased, although the majority remained in patrilocal extended families. This trend toward nuclear families will not benefit young women’s health.
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Affiliation(s)
- Keera Allendorf
- Department of Sociology, University of Illinois at Urbana-Champaign, 702 S. Wright St., Urbana, IL 61801, USA
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Story WT, Burgard SA. Couples' reports of household decision-making and the utilization of maternal health services in Bangladesh. Soc Sci Med 2012; 75:2403-11. [PMID: 23068556 DOI: 10.1016/j.socscimed.2012.09.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/17/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service utilization focus on women's reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands' involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized.
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Affiliation(s)
- William T Story
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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Sychareun V, Hansana V, Somphet V, Xayavong S, Phengsavanh A, Popenoe R. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study. BMC Pregnancy Childbirth 2012; 12:86. [PMID: 22925107 PMCID: PMC3449206 DOI: 10.1186/1471-2393-12-86] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/23/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Maternal mortality among poor rural women in the Lao People's Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. METHODS A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. RESULTS Obstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a "hot bed" after delivery. The decision about where to give birth was commonly made by the woman's husband, mother, mother-in-law or other relatives in consultation with the woman herself. CONCLUSION This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR's high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be taught and encouraged to recognize the signs of at-risk pregnancies so as to be able to reach health facilities on time.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
- Dean of the Faculty of Postgraduate Studies, University of Health Sciences, Vientiane City, Lao PDR
| | - Visanou Hansana
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | - Vatsana Somphet
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | - Sisouvanh Xayavong
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | | | - Rebecca Popenoe
- Department of Public Health, Global Health Division and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Abstract
The role of family context in determining women's agency has been addressed through kinship patterns, household structure, and domestic violence. This study suggests that another aspect of family context - family relationship quality - can also influence women's agency. Data from the Women's Reproductive Histories Survey, collected in Madhya Pradesh, India, are used to examine whether family relationship quality is a determinant of women's agency. Results show that women with higher quality relationships with husbands and parents-in-law do have greater agency. Further, family relationship quality is just as influential as other well known determinants of agency, including education and employment.
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Kamiya Y. Women's autonomy and reproductive health care utilisation: empirical evidence from Tajikistan. Health Policy 2011; 102:304-13. [PMID: 21592608 DOI: 10.1016/j.healthpol.2011.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 03/30/2011] [Accepted: 04/05/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Women's autonomy is widely considered to be a key to improving maternal health in developing countries, whereas there is no consistent empirical evidence to support this claim. This paper examines whether or not and how women's autonomy within the household affects the use of reproductive health care, using a household survey data from Tajikistan. METHODS Estimation is performed by the bivariate probit model whereby woman's use of health services and the level of women's autonomy are recursively and simultaneously determined. The data is from a sample of women aged 15-49 from the Tajikistan Living Standard Measurement Survey 2007. RESULTS Women's autonomy as measured by women's decision-making on household financial matters increase the likelihood that a woman receives antenatal and delivery care, whilst it has a negative effect on the probability of attending to four or more antenatal consultations. The hypothesis that women's autonomy and reproductive health care utilisation are independently determined is rejected for most of the estimation specifications, indicating the importance of taking into account the endogenous nature of women's autonomy when assessing its effect on health care use. CONCLUSIONS The empirical results reconfirm the assertion that women's status within the household is closely linked to reproductive health care utilisation in developing countries. Policymakers therefore need not only to implement not only direct health interventions but also to focus on broader social policies which address women's empowerment.
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Affiliation(s)
- Yusuke Kamiya
- Human Development Department, Japan International Cooperation Agency, 3rd floor, Nibancho Center Building 5-25, Niban-cho, Chiyoda-ku, Tokyo 102-8012, Japan.
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