scholarly journals Does gender inequality matter for access to and utilization of maternal healthcare services in Bangladesh?

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257388
Author(s):  
Firoz Ahmed ◽  
Fahmida Akter Oni ◽  
Sk. Sharafat Hossen
Keyword(s):  
Gender Inequality ◽  
Gender Gap ◽  
Partner Violence ◽  
Bargaining Power ◽  
Healthcare Services ◽  
Household Wealth ◽  
Maternal Healthcare ◽  
Intrahousehold Bargaining ◽  
Women’S Autonomy ◽  
Women's Autonomy

There is a high prevalence of gender gap in Bangladesh which might affect women’s likelihood to receive maternal healthcare services. In this backdrop, we aim to investigate how gender inequality measured by intrahousehold bargaining power (or autonomy) of women and their attitudes towards intimate partner violence (IPV) affects accessing and utilizing maternal health care services. We used Bangladesh Demographic and Health Survey (BDHS) data of 2014 covering 5460 women who gave birth at least one child in the last three years preceding the survey. We performed logistic regression to estimate the effect of women’s autonomy and their attitude towards IPV on access to and utilization of maternal healthcare services. Besides, we employed different channels to understand the heterogeneous effect of gender inequality on access to maternal healthcare services. We observed that women having autonomy positively influenced attaining five required antenatal care (ANC) services (AOR: 1.17; 95% CI: 0.98–1.41) and women’s negative attitudes towards IPV were positively associated with five ANC services (AOR: 1.42; 95% CI: 1.02–1.97), sufficient ANC visits (COR: 1.55; CI: 1.19–2.01), skilled birth attendant (SBA) (AOR: 1.43; 95% CI: 1.05–1.94) and postnatal care (PNC) services (AOR: 1.44; 95% CI: 1.12–1.84). Besides, rural residency, religion, household wealth, education of both women and husband were found to have some of the important channels which were making stronger effect of gender inequality on access to maternal healthcare services. The findings of our study indicate a significant association between access to maternal healthcare services and women’s autonomy as well as attitude towards IPV in Bangladesh. We, therefore, recommend to protect women from violence at home and mprove their intrahousehold bargaining power to increase their access to and utilization of required maternal healthcare services.

scholarly journals Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023128 ◽  
Author(s):  
Chol Chol ◽  
Joel Negin ◽  
Kingsley Emwinyore Agho ◽  
Robert Graham Cumming
Keyword(s):  
Decision Making ◽  
Outcome Measures ◽  
Household Income ◽  
Healthcare Services ◽  
Maternal Healthcare ◽  
African Region ◽  
African Countries ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Sub Saharan

ObjectivesTo examine the association between women’s autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries.Design, setting and participantsWe analysed the Demographic and Health Survey (DHS) (2010–2016) data collected from married women aged 15–49 years. We used four DHS measures related to women’s autonomy: attitude towards domestic violence, attitude towards sexual violence, decision making on spending of household income made by the women solely or jointly with husbands and decision making on major household purchases made by the women solely or jointly with husbands. We used multiple logistic regression analyses to examine the association between women’s autonomy and the utilisation of maternal healthcare services adjusted for five potential confounders: place of residence, age at birth of the last child, household wealth, educational attainment and working status. Adjusted ORs (aORs) and 95% CI were used to produce the forest plots.Outcome measuresThe primary outcome measures were the utilisation of ≥4 antenatal care visits and delivery by skilled birth attendants (SBA).ResultsPooled results for all 31 countries (194 883 women) combined showed weak statistically significant associations between all four measures of women’s autonomy and utilisation of maternal healthcare services (aORs ranged from 1.07 to 1.15). The strongest associations were in the Southern African region. For example, the aOR for women who made decisions on household income solely or jointly with husbands in relation to the use of SBAs in the Southern African region was 1.44 (95% CI 1.21 to 1.70). Paradoxically, there were three countries where women with higher autonomy on some measures were less likely to use maternal healthcare services. For example, the aOR in Senegal for women who made decisions on major household purchases solely or jointly with husbands in relation to the use of SBAs (aOR=0.74 95% CI 0.59 to 0.94).ConclusionOur results revealed a weak relationship between women’s autonomy and the utilisation of maternal healthcare services. More research is needed to understand why these associations are not stronger.

scholarly journals Women’s autonomy and utilization of maternal healthcare in India: Evidence from a recent national survey

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243553
Author(s):  
Dinabandhu Mondal ◽  
Suranjana Karmakar ◽  
Anuradha Banerjee
Keyword(s):  
Decision Making ◽  
Family Health ◽  
Healthcare Services ◽  
Married Women ◽  
Maternal Healthcare ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Logistic Regression Models ◽  
High Level ◽  
Women In India

Objective The present study aims to examine the association between women’s decision-making autonomy and utilization of maternal healthcare services among the currently married women in India. Methods A total of 32,698 currently married women aged 15–49 years who had at least one live birth in the past five years preceding the survey and had information regarding autonomy collected by the National Family Health Survey 2015–16 were used for analysis. Bivariate and multivariate logistic regression models were employed for the analyses of this study. Results Utilization of maternal healthcare services was higher among the women having a high level of decision-making autonomy compared to those who had a low autonomy in the household. The regression results indicate that women’s autonomy was significantly associated with increased odds of maternal healthcare services in India. Women with high autonomy had 37% and 33% greater likelihood of receiving ANC (AOR: 1.37, 95% CI: 1.25–1.50) and PNC care (AOR: 1.33, 95% CI: 1.24–1.42) respectively compared to women having low autonomy. However, no significant association was observed between women’s autonomy and institutional delivery in the adjusted analysis. Conclusion This study recommends the need for comprehensive strategies involving improvement of women’s autonomy along with expansion of education, awareness generation regarding the importance of maternity care, and enhancing public health infrastructure to ensure higher utilization of maternal healthcare services that would eventually reduce maternal mortality.

scholarly journals Assessing the role of women’s autonomy and acceptability of intimate-partner violence in maternal health-care utilization in 63 low- and middle-income countries

2019 ◽  
Vol 48 (5) ◽  
pp. 1580-1592 ◽  
Author(s):  
Pooja Sripad ◽  
Charlotte E Warren ◽  
Michelle J Hindin ◽  
Mahesh Karra
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Antenatal Care ◽  
Partner Violence ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Maternal Health Care Utilization ◽  
Care Services

Abstract Background Our study investigates the associations between women’s autonomy and attitudes toward the acceptability of intimate-partner violence against women (IPVAW) and maternal health-care utilization outcomes. Methods We combine data from 113 Demographic and Health Surveys conducted between 2003 and 2016, which give us a pooled sample of 765 169 mothers and 777 352 births from 63 countries. We generate composite scores of women’s autonomy (six-point scale with reference: no contribution) and acceptability of IPVAW (five-point scale with reference: no acceptance) and assess the associations between these measures and women’s use of antenatal care services and facility delivery in pooled and unique country samples. Results A change in a woman’s autonomy score from ‘no contribution to any decision-making domain’ (a composite autonomy score of 0) to ‘contribution to all decision-making domains’ (a score of 6) is associated with a 31.2% increase in her odds of delivering in a facility and a 42.4% increase in her odds of receiving at least eight antenatal care visits over the course of her pregnancy. In contrast, a change in a woman’s attitude towards acceptability of IPVAW from ‘IPVAW is not acceptable under any scenario’ (a score of 0) to ‘IPVAW is acceptable in all scenarios’ (a score of 5) is associated with an 8.9% decrease in her odds of delivering in a facility and a 20.3% decrease in her odds of receiving eight antenatal care visits. Conclusions Our findings suggest that strong and significant associations exist between autonomy, acceptability of IPVAW and utilization of maternal health-care services.

scholarly journals The mediation effect of contraceptive use and women’s autonomy on the relationship between intimate partner violence and unintended pregnancy in Ethiopia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tenaw Yimer Tiruye ◽  
Melissa L. Harris ◽  
Catherine Chojenta ◽  
Elizabeth Holliday ◽  
Deborah Loxton
Keyword(s):  
Unintended Pregnancy ◽  
Partner Violence ◽  
Emotional Abuse ◽  
Contraceptive Use ◽  
Mediation Effect ◽  
Composite Measure ◽  
Multiple Partner ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Controlling Behaviour

Abstract Background Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy. Methods This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects. Results Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively. Conclusion Women’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.

scholarly journals Husband’s international migration

2019 ◽  
Vol 34 (1) ◽  
pp. 56-67
Author(s):  
Win Win Shwe ◽  
Aree Jampaklay ◽  
Aphichat Chamratrithirong ◽  
Suchada Thaweesit
Keyword(s):  
Decision Making ◽  
International Migration ◽  
Economic Status ◽  
Household Wealth ◽  
Cross Sectional ◽  
Women’S Autonomy ◽  
Content Type ◽  
Women's Autonomy ◽  
Left Behind ◽  
Selection Factors

Purpose The purpose of this paper is to understand the effects of the husband’s migration on wives’ decision-making autonomy. Design/methodology/approach The study setting is Magway Region of central Myanmar where poverty has driven adult males to migrate overseas. The study hypothesizes that the absence of husbands due to international migration leads to changes in the roles and decision-making power of left-behind wives. A cross-sectional survey was conducted in 22 villages of Pakkoku district, Magway Region, using the multi-stage random sampling method. The study sample included 205 migrant’s wives and 196 non-migrant’s wives. Findings The international migration of husbands has a strong and positive impact on left-behind wives’ autonomy independent of individual characteristics and household social and economic status. In addition, the findings show that the number of children and household wealth are positively associated with women’s autonomy, whereas household size shows a negative association. Research limitations/implications It is possible that there will be unmeasured selection factors such as unsuccessful migration as it might influence both husbands’ migration status and women’s autonomy. Cross-sectional data also invite a question about the causal relationship. For example, it might be possible that women with high autonomy may be more likely to encourage their husband to work abroad. So, the relationship might be the other way around. A further longitudinal study is also needed to describe detail explanation about the causal influence of left-behind women’s autonomy. Originality/value Successful international migration has a impact not only on women’s autonomy but also on household economic status in central rural Myanmar.

Do women with autonomy in the household experience less intimate partner violence in Malawi? Evidence from the 2015–16 Demographic and Health Survey

2021 ◽  
pp. 1-20
Author(s):  
James Forty
Keyword(s):  
Intimate Partner Violence ◽  
Civic Education ◽  
Health Survey ◽  
Partner Violence ◽  
Secondary Data ◽  
Intimate Partner ◽  
Wife Beating ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Household Decision

Abstract In Malawi, the prevalence of intimate partner violence (IPV), or closely related violence, is estimated at 42% according to the 2015–16 Malawi Demography and Health Survey (MDHS). This study investigated the association between women’s autonomy in household decision-making participation as well as sexual autonomy and IPV among married and cohabiting women aged 15–49 years in Malawi. Secondary data were taken from the 2015–16 MDHS. Multivariate analysis was performed using a stepwise forward logistic (binary) regression model to assess the association of dimensions of women’s autonomy in the household and selected control variables with IPV. No association was found between dimensions of women’s autonomy in the household and IPV. However, other variables did have an association with some form of IPV, namely women justifying wife beating, having a jealous partner, being accused of unfaithfulness by their partner, having a partner who drinks alcohol and having a partner with another woman or more. In addition, religion, ethnicity, women education level and women’s occupation were found to be associated with the risk of experiencing IPV. The study recommends policy interventions aimed at supporting youth, especially girls, to complete secondary education before they marry or cohabit; the development of accessible and affordable psycho-social counselling specialists and platforms for married and cohabiting couples; nationwide rigorous advocacy and civic education on IPV; and enforcement of Malawi’s 2006 domestic violence law.

The Gender System and Class Mobility

2021 ◽  
pp. 1-45
Author(s):  
Ieva Zumbyte
Keyword(s):  
Rural Women ◽  
Fixed Effects ◽  
Driving Forces ◽  
Household Wealth ◽  
Social Force ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Class Mobility ◽  
Nationally Representative ◽  
Gender System

It is often assumed that improvements in household wealth are associated with greater gender equality, including greater women’s autonomy and decision-making power inside the home. Yet, evidence often shows the opposite: greater household wealth often curtails women’s autonomy. Research has yet to reveal the driving forces behind this surprising finding. This paper focuses on one important social force, the community gender system, to show how it shapes the relationship between changing household wealth and women’s autonomy. Drawing on a nationally representative panel of rural women in India and fixed effects models, I find that the prevalence of women’s veiling at the village level, a notable marker of an exclusionary gender system, moderates the effects of increasing household wealth on women’s autonomy. In villages with less veiling, increases in wealth have the perverse effect of suppressing women’s autonomy. The study suggests that in these places, households curtail women’s mobility because such behavior signals rising social status. In contrast, in villages with more veiling increasing household wealth does not reduce women’s autonomy because most households across the class spectrum are already conforming to the norms of seclusion. The findings demonstrate how new wealth interacts with a community gender system which is anchored in gendered notions of family honor to reproduce structures of gender inequality.

scholarly journals Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa

2016 ◽  
Vol 19 (8) ◽  
pp. 1428-1437 ◽  
Author(s):  
Pierre Traissac ◽  
Jalila El Ati ◽  
Agnès Gartner ◽  
Houda Ben Gharbia ◽  
Francis Delpeuch
Keyword(s):  
Gender Equity ◽  
Gender Inequality ◽  
North Africa ◽  
Gender Gap ◽  
Household Wealth ◽  
Professional Activity ◽  
Gender Inequalities ◽  
Double Burden ◽  
Excess Adiposity ◽  
Double Burden Of Malnutrition

AbstractObjectiveThe nutrition transition has exacerbated the gender gap in health in the Middle East and North Africa region as the increase in excess adiposity has been much higher among women than men. This is not exclusive of the persistence of anaemia, generally also more prevalent among women. We assessed the magnitude and sociodemographic factors associated with gender inequality vis-à-vis the double burden of excess adiposity and anaemia.DesignCross-sectional study, stratified two-stage cluster sample. BMI (=weight/height2) ≥25·0 kg/m2 defined overweight and BMI≥30·0 kg/m2 obesity. Anaemia was defined as Hb <120 g/l for women, <130 g/l for men. Gender inequalities vis-à-vis the within-subject coexistence of excess adiposity and anaemia were assessed by women v. men relative prevalence ratios (RPR). Their variation with sociodemographic characteristics used models including gender × covariate interactions.SettingGreater Tunis area in 2009–2010.SubjectsAdults aged 20–49 years (women, n 1689; men, n 930).ResultsGender inequalities in excess adiposity were high (e.g. overweight: women 64·9 % v. men 48·4 %; RPR=2·1; 95 % CI 1·6, 2·7) and much higher for anaemia (women 38·0 % v. men 7·2 %; RPR=8·2; 95 % CI 5·5, 12·4). They were striking for overweight and anaemia (women 24·1 % v. men 3·4 %; RPR=16·2; 95 % CI 10·3, 25·4). Gender inequalities in overweight adjusted for covariates increased with age but decreased with professional activity and household wealth score; gender inequality in anaemia or overweight and anaemia was more uniformly distributed.ConclusionsWomen were much more at risk than men, from both over- and undernutrition perspectives. Both the underlying gender-related and sex-linked biological determinants of this remarkable double burden of malnutrition inequality must be addressed to promote gender equity in health.

scholarly journals Determinants of maternal healthcare service utilisation among Indonesian mothers: A population-based study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1124
Author(s):  
Ridwan Setyo Aji ◽  
Ferry Efendi ◽  
Iqlima Dwi Kurnia ◽  
Santo Imanuel Tonapa ◽  
Chong-Mei Chan
Keyword(s):  
Occupational Status ◽  
Wealth Index ◽  
Healthcare Facility ◽  
Healthcare Services ◽  
Household Wealth ◽  
Population Based ◽  
Maternal Healthcare ◽  
Determinant Factors ◽  
Number Of Children ◽  
Mother’S Age

Background: In Indonesia, maternal health care services are widely available, aiming to improve health and survival among mothers. However, these services remain underutilised, and its determining factor was unknown. This study sought to identify determinant factors of maternal healthcare services utilisation among Indonesian mothers. Methods: This population-based cross-sectional study leveraged the 2017 Indonesia Demographic and Health Survey data. A total of 12,033 mothers aged from 15 to 49 years who had a live birth in the five years preceding the survey were included in the analysis. Multivariable logistic regressions were used to identify the determinant factors. Results: Approximately 93.44% of the mothers had adequate antenatal care, 83.73% had a delivery at the healthcare facility, and 71.46% received postnatal care. The mother’s age and household wealth index were the typical determinants of all maternal healthcare services. Determinants of antenatal care visits were husband’s occupational status, the number of children, and access to the healthcare facility. Next, factors that drive mothers’ delivery at the healthcare facility were the mother’s education level, husband’s educational level, and residential area. The use of postnatal care was determined by the mother’s occupational status, husband’s educational level, number of children, wealth index, access to the healthcare facility, and residential area. Conclusions: Although there were differences in the determinant factors of three key maternal healthcare services, the mother’s age and household wealth index were the typical determinants of all maternal healthcare services utilisation. Providing a tailored programme aligned with these determinant factors may ensure that mothers can access and adequately utilise maternal healthcare services.

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