Women’s empowerment and fertility decision-making in 53 low and middle resource countries: a pooled analysis of demographic and health surveys

ObjectiveWomen’s empowerment and its association with fertility preference are vital for central-level promotional health policy strategies. This study examines the association between women’s empowerment and fertility decision-making in low and middle resource countries (LMRCs).DesignThis cross-sectional study uses the Demographic and Health Survey database.Settings53 LMRCs from six different regions for the period ranging from 2006 to 2018.ParticipantsThe data of women-only aged 35 years and above is used as a unit of analysis. The final sample consists of 91 070 married women.MethodsWe considered two outcome variables: women’s perceived ideal number of children and their ability to achieve preferred fertility desire and the association with women empowerment. Women empowerment was measured by their participation in household decision-making and attitude towards wife-beating. The negative binomial regression model was used to assess women’s perceived ideal number of children, and multivariable logistic regression was used to evaluate women’s ability to achieve their preferred fertility desire.ResultsOur study found that empowered women have a relatively low ideal number of children irrespective of the measures used to assess women empowerment. In this study, the measures were participation in household decision-making (incidence rate ratio (IRR): 0.92, 95% CI: 0.91 to 0.93) and attitude towards wife-beating (IRR: 0.96, 95% CI: 0.95 to 0.97). In the LMRCs, household decision-making and negative attitude towards wife-beating have been found associated with 1.12 and 1.08 times greater odds of having more than their ideal number of children.ConclusionOur findings suggest that women’s perceived fertility desire can be achieved by enhancing their empowerment. Therefore, a modified community-based family planning programme at the national level is required, highlighting the importance of women’s empowerment on reproductive healthcare as a part of the mission to assist women and couples to have only the number of children they desire.

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Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

PLoS ONE ◽

10.1371/journal.pone.0262323 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262323

Author(s):

Muhammad Asim ◽

Waqas Hameed ◽

Sarah Saleem

Keyword(s):

Decision Making ◽

Antenatal Care ◽

Health Survey ◽

Women's Empowerment ◽

Women’S Empowerment ◽

Women Empowerment ◽

Household Decision ◽

Household Decision Making ◽

To Receive

Introduction Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women’s empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. Methods We used Pakistan Demographic and Health Survey 2017–18 (PDHS) data which comprises of 6,602 currently married women aged between 15–49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. Results We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women’s empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30–2.10) and 1.45 (95% CI 1.19–1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44–2.43) and 2.78 (95% CI 2.04–3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60–2.44) and 1.56 (95% CI 2.17–1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. Conclusion The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women’s empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.

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Effect of BISP’S Unconditional Cash Transfer Program on Women Empowerment in Gilgit Baltistan

Review of Applied Management and Social Sciences ◽

10.47067/ramss.v4i1.106 ◽

2021 ◽

Vol 4 (1) ◽

pp. 131-144

Author(s):

Fatima Ghazi ◽

Muhammad Abo ul Hassan Rashid ◽

Saif Ur Rehman Saif Abbasi ◽

Hassan Raza

Keyword(s):

Decision Making ◽

Domestic Violence ◽

Women's Empowerment ◽

Cash Transfer ◽

Women’S Empowerment ◽

Transfer Program ◽

Snowball Sampling ◽

Household Decision ◽

Household Decision Making ◽

Unconditional Cash Transfer

Benazir Income Support Program (BISP) is a targeted unconditional cash transfer program initiated to provide financial support to poor and vulnerable women for smoothing and cushioning the negative effects of slow economic growth. The present study aims to find out the effect of unconditional cash transfer BISP on women’s empowerment. We analyze women’s empowerment through exploring the effect of unconditional cash transfer on household decision making, their independence, status of women in the community and their freedom from domestic violence. We interviewed 20 beneficiaries among which 10 respondents belonged to district Gilgit whereas the remaining 10 were the residents of district Nagar the data was analyzed using thematic analysis. Purposive sampling was used for data collection and respondents were traced through snowball sampling technique. The findings aver that BISP has improved the household decision making of women, increased women independence at limited level and decreased domestic violence, however, minimal effect was observed on women’s status in society.

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The Effect of Women’s Empowerment in the Utilisation of Family Planning in Western Ethiopia: A Structural Equation Modelling Approach

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126550 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6550

Author(s):

Muluken Dessalegn Muluneh ◽

Lyn Francis ◽

Mhiret Ayele ◽

Sintayehu Abebe ◽

Misrak Makonnen ◽

...

Keyword(s):

Decision Making ◽

Family Planning ◽

Structural Equation ◽

Contraceptive Use ◽

Women's Empowerment ◽

Women’S Empowerment ◽

Household Decision ◽

Planning Methods ◽

Western Ethiopia ◽

Family Planning Methods

This study examines the associations between women’s empowerment and family planning use in Jimma Zone, Western Ethiopia. A total of 746 randomly selected married women of reproductive age were interviewed. The data were employed by structural equation modelling (SEM) to investigate the complex and multidimensional pathways to show women’s empowerment domains in family planning utilisation. Results of the study revealed that 72% of married women had used family planning. Younger women, having access to information, having access to health facilities and being aware about family planning methods, living in a rural area, having an older partner and increased household decision-making power were associated with using family planning methods. Women’s empowerment is an important determinant of contraceptive use. Women’s empowerment dimensions included increased household decision-making power, socio-demographic variables and having access to information about family planning and accessible health facilities. These were found to be important determinants of contraceptive use. Future interventions should focus on integrating women’s empowerment into family planning programming, particularly in enhancing women’s autonomy in decision making. Further research is warranted on the socio-cultural context of women that influences women’s empowerment and family planning use to establish an in-depth understanding and equity of women in society.

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Women’s empowerment and female genital mutilation intention for daughters in Sierra Leone: a multilevel analysis

BMC Women s Health ◽

10.1186/s12905-021-01340-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Edward Kwabena Ameyaw ◽

Seun Anjorin ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Olalekan A. Uthman ◽

...

Keyword(s):

Decision Making ◽

Sierra Leone ◽

Psychological Health ◽

Female Genital Mutilation ◽

Labour Force ◽

Women's Empowerment ◽

Wife Beating ◽

Women’S Empowerment ◽

Genital Mutilation ◽

Female Genital

Abstract Background Female genital mutilation is common in Sierra Leone. Evidence indicates that empowering women provides protective benefits against female genital mutilation/cutting (FGM/C). Yet, the relationship between women’s empowerment and their intention to cut their daughters has not been explored in Sierra Leone. The aim of this study was to assess the association between women’s empowerment and their intention to have their daughters undergo FGM/C in the country. Methods Data for this study are from the 2013 Sierra Leone Demographic and Health Survey. A total of 7,706 women between the ages of 15 and 49 were included in the analysis. Analysis entailed generation of descriptive statistics (frequencies and percentages), and estimation of multi-level logistic regression models to examine the association between women’s empowerment, contextual factors and their intentions to cut their daughters. Results A significantly higher proportion of women who participated in labour force reported that they intended to cut their daughters compared to those who did not (91.2%, CI = 90.4–91.9 and 86.0%, CI = 84.1–87.8, respectively). Similarly, the proportion intending to cut their daughters was significantly higher among women who accepted wife beating than among those who rejected the practice (94.9%, CI = 93.8–95.8 and 86.4% CI = 84.9–87.8, respectively). A significantly higher proportion of women with low decision-making power intended to cut their daughters compared to those with high decision-making power (91.0%, CI = 89.0–92.8 and 85.0% CI = 82.2–87.4, respectively). Results from multivariate regression analysis showed that the odds of intending to cut daughters were significantly higher among women who participated in labour force (aOR = 2.5, CI = 1.3–4.7) and those who accepted wife beating than among those who did not (aOR = 2.7, CI = 1.7–4.5). In contrast, the likelihood of intending to cut daughters was significantly lower among women with high than low knowledge (aOR = 0.4, CI = 0.3–0.7), and among those aged 45–49 than among those aged 15–19 (aOR = 0.2, CI = 0.0–0.6). Conclusion The findings underscore the need to align anti-FGM/C policies and programmes to women who have undergone FGM/C, those with low knowledge, women who support wife beating and young women. Such interventions could highlight the adverse implications of the practice by stressing the psychological, health and social implications of FGM/C on its survivors.

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WOMEN’S EMPOWERMENT, HOUSEHOLD STATUS AND CONTRACEPTION USE IN GHANA

Journal of Biosocial Science ◽

10.1017/s0021932016000377 ◽

2016 ◽

Vol 49 (4) ◽

pp. 423-434 ◽

Cited By ~ 14

Author(s):

Sarah R. Blackstone

Keyword(s):

Decision Making ◽

Contraceptive Use ◽

Household Head ◽

Unmet Need ◽

Women's Empowerment ◽

Sub Saharan Africa ◽

Wife Beating ◽

Women’S Empowerment ◽

Contraception Use ◽

Unmet Need For Contraception

SummaryGender inequality is often cited as a barrier to improving women’s sexual and reproductive health outcomes, including contraceptive use, in low- and middle-income countries such as those in sub-Saharan Africa. To date there is limited, recent, evidence available regarding women’s empowerment, household status and contraceptive use in Ghana. The objective of this study was to investigate whether women’s empowerment and status in the household were associated with contraceptive use and unmet need for contraception using the 2014 Ghana Demographic and Health Survey. The study sample consisted of 1828 women aged 15–49. Women’s empowerment was measured based on two composite indexes created by the DHS: attitudes towards intimate partner violence and decision-making. Women’s status in the home was measured using indicators of work status, relationship to household head, control over monetary earnings and land ownership. Decision-making was found to be positively associated with contraceptive use and not having unmet need for contraception. Women who justified wife beating in one or more instances were less likely to use contraception, and more likely to have unmet need for contraception. Current or past employment and higher levels of male partner education were associated with contraceptive use. This study indicates that women’s empowerment and household status are influential for contraceptive indicators. Future interventions aimed at improving contraceptive uptake and use should promote women’s empowerment, i.e. decision-making, self-worth and education.

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Women’s Empowerment and HIV Testing Uptake: A Meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African Countries

International Journal of MCH and AIDS (IJMA) ◽

10.21106/ijma.372 ◽

2020 ◽

Vol 9 (3) ◽

pp. 274-286

Author(s):

Sanni Yaya ◽

Gebretsadik Shibre ◽

Dina Idriss-Wheeler ◽

Olalekan A Uthman

Keyword(s):

Global Health ◽

Hiv Testing ◽

Women's Empowerment ◽

Sub Saharan Africa ◽

Wife Beating ◽

Women’S Empowerment ◽

Demographic And Health Surveys ◽

Women Empowerment ◽

Testing Uptake ◽

Sub Saharan

Background: There is a growing body of evidence suggesting that women’s empowerment can help achieve better health behaviours and outcomes. However, few have looked at the impact of women’s empowerment on HIV testing in Sub-Saharan Africa (SSA). This study investigated the association between women’s empowerment and HIV testing among women in 33 countries across SSA. Methods: Cross-sectional data from the most recent Demographic and Health Surveys (2005-2018) of 33 countries in SSA were used. Confounder adjusted logistic regression analysis was completed separately for each of the 33 DHS datasets to produce the adjusted Odds Ratio (OR) for the association between women empowerment and HIV testing. The regression analysis strictly accounted for the three design elements (weight, cluster and strata) to produce an estimate representative of the respective countries. Finally, an Individual Participant Data (IPD) meta-analysis approach was used to statistically pool the effect of women empowerment on HIV testing. Results: There was a wide variation in the percentage of women who were empowered among the countries studied, with only a few countries such as South Africa, Angola and Ghana having a high prevalence of negative attitudes toward wife beating. HIV testing was higher in Angola, Lesotho, Uganda and South Africa. While participation in one or two of the three decisions had been marginally associated with lower odds of HIV testing across the SSA regions (0.89; 95%CI: 0.83, 0.97); the corresponding prediction interval crossed the null. Being involved in the three decisions (0.92; 95%CI: 0.84, 1.00) and disagreement to wife-beating (0.99; 95%CI: 0.94, 1.05) had no statistical relationship with HIV testing uptake. Conclusion and Global Health Implications: The two indirect indicators of women empowerment could not predict HIV testing uptake. Further studies are recommended to establish the nature of the relationship between HIV testing and women’s empowerment that is measured through standard tools. Key words: • HIV/AIDS prevention • Women • Empowerment • Gender equality • Global health • Sub-Saharan Africa Copyright © 2020 Yaya et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Intra-household decision-making among smallholder agroforestry farmers in the eastern highlands of Uganda

International Journal of Agricultural Extension ◽

10.33687/ijae.008.02.3251 ◽

2020 ◽

Vol 8 (2) ◽

pp. 97-111

Author(s):

Fred Kalanzi ◽

Prossy Isubikalu ◽

Florence B. Kyazze ◽

Lawrence J. B. Orikiriza ◽

Isaac Kiyingi ◽

...

Keyword(s):

Decision Making ◽

Qualitative Data ◽

Critical Factor ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Household Decision ◽

Roles And Responsibilities ◽

Number Of Children ◽

Household Decision Making ◽

Eastern Highlands

This paper examines the intra-household decision-making patterns among spouses regarding agroforestry decisions in the eastern highlands of Uganda. The study uses both quantitative and qualitative data to examine spousal differences in the allocation of decision-making power over eight agroforestry decisions in dual-headed households. Quantitative data were collected through a cross-sectional survey in which both husbands and wives were interviewed separately and used to determine the decision-making power of spouses as well as the influence of individual and household characteristics on decision-making. Qualitative data from focus group discussions were collected to validate the quantitative findings. The study found that there were agreements and disagreements among spouses on how decision-making power is exercised over a range of agroforestry decisions. Wives allocated themselves more decision-making power than was assigned to them by their husbands. The higher allocation of decision-making power for wives tended to be in decisions linked to their roles and responsibilities in the household. The most critical factor influencing accord in decision-making was the number of years spent together by the couple while the number of children shared between the couple and farm-labour difference between husband and wife was the most significant for discord. Findings imply that most agroforestry interventions where wives participate without their spouses are bound to fail in dual-headed households because they wives limited decision-making power. It's desirable for programmes promoting agroforestry to integrate both husbands and wives in their interventions, for agroforestry to be more meaningful in meeting their divergent interests. This paper examines the intra-household decision-making patterns among spouses regarding agroforestry decisions in the eastern highlands of Uganda. The study uses both quantitative and qualitative data to examine spousal differences in the allocation of decision-making power over eight agroforestry decisions in dual-headed households. Quantitative data were collected through a cross-sectional survey in which both husbands and wives were interviewed separately and used to determine the decision-making power of spouses as well as the influence of individual and household characteristics on decision-making. Qualitative data from focus group discussions were collected to validate the quantitative findings. The study found that there were agreements and disagreements among spouses on how decision-making power is exercised over a range of agroforestry decisions. Wives allocated themselves more decision-making power than was assigned to them by their husbands. The higher allocation of decision-making power for wives tended to be in decisions linked to their roles and responsibilities in the household. The most critical factor influencing accord in decision-making was the number of years spent together by the couple while the number of children shared between the couple and farm-labour difference between husband and wife was the most significant for discord. Findings imply that most agroforestry interventions where wives participate without their spouses are bound to fail in dual-headed households because they wives limited decision-making power. It's desirable for programmes promoting agroforestry to integrate both husbands and wives in their interventions, for agroforestry to be more meaningful in meeting their divergent interests.

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Women's empowerment and fertility preferences of married women: analysis of demographic and health survey’2016 in Timor-Leste

AIMS Public Health ◽

10.3934/publichealth.2022017 ◽

2022 ◽

Vol 9 (2) ◽

pp. 237-261

Author(s):

Nandeeta Samad ◽

◽

Pranta Das ◽

Segufta Dilshad ◽

Hasan Al Banna ◽

...

Keyword(s):

Decision Making ◽

Health Survey ◽

Women's Empowerment ◽

Married Women ◽

Fertility Rate ◽

Demographic And Health Survey ◽

Women’S Empowerment ◽

Women Empowerment ◽

Fertility Preferences ◽

Timor Leste

<abstract> <p>A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.</p> </abstract>

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22A Survey-Based Women's Empowerment Index for Low- and Middle-Income Countries: The SWPER Goes Global

International Journal of Epidemiology ◽

10.1093/ije/dyab168.193 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Fernanda Ewerling ◽

Anita Raj ◽

Cesar G Victora ◽

Franciele Hellwig ◽

Carolina VN Coll ◽

...

Keyword(s):

Decision Making ◽

Women's Empowerment ◽

Women’S Empowerment ◽

African Countries ◽

Middle Income ◽

Household Decision ◽

Middle Income Countries ◽

World Regions ◽

Country Rankings ◽

Low And Middle Income

Abstract Background In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. We explored the applicability of the SWPER in national health surveys from countries in other world regions. Methods We used data from the latest Demographic and Health Survey for 62 low- and middle-income countries (LMICs) since 2000, and adapted the indicator so that it could be used for any LMIC. Adaptations included the exclusion of women's working status and recategorization of the household decision-making related items. We compared the loading patterns obtained from principal components analysis for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII). Results Most countries presented similar patterns regarding item loadings for the three SWPER empowerment domains. Correlations between the country-specific and global individual-level scores were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.71 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.82, 0.67, and 0.44, respectively, with GDI. Conclusions The SWPER global is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women's empowerment and allowing wider comparisons across countries and world regions.

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Association between women’s empowerment and diarrhoea in children under five years: evidence from the 2017/18 Benin Demographic and Health Survey

Journal of Biosocial Science ◽

10.1017/s002193202100064x ◽

2021 ◽

pp. 1-20

Author(s):

Betregiorgis Zegeye ◽

Dina Idriss-Wheeler ◽

Sanni Yaya

Keyword(s):

Decision Making ◽

Health Survey ◽

Women's Empowerment ◽

Married Women ◽

Demographic And Health Survey ◽

Wife Beating ◽

Women’S Empowerment ◽

Children Under Five ◽

Under Five ◽

Childhood Diarrhoea

Abstract Globally, diarrhoea is the third leading cause of death for under five-children. Women’s empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women’s empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57–0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65–0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women’s age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women’s empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women’s empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women’s education and decision-making power and enhancing awareness of women’s human and democratic rights.

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