Article

Reproductive Health Care Utilization among Young Mothers in Bangladesh: Does Autonomy Matter?

Authors:
  • Population Science and Human Resource Development, Rajshahi University, Bangladesh
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Abstract

To examine the linkage between the possible influences of the extent of autonomy on young mothers use of reproductive health care services. This paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on responses of 1,778 currently married women aged 15 to 24 years, living with at least one 0- to 35-month-old child. Utilization of antenatal health services (ANC) services by amount and type of provider, and utilization of delivery assistance according to provider type were used as proxy outcome variables of reproductive health care utilization. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Approximately one third (31%) of the currently married young women in Bangladesh had a higher level of overall decision-making autonomy. Only 24.0% of the sampled women received sufficient ANC; 54% and 18% received ANC and assisted deliveries from a medically trained provider. respectively. In adjusted models, young women who had a higher level of overall autonomy were more likely to receive sufficient ANC (adjusted odds ratio [AOR], 1.64; 95% confidence interval [CI], 1.17-2.23) and receiving ANC from medically trained provider (AOR, 1.91; 95% CI, 1.42-2.45). Women who had medium overall autonomy were 1.40 times more likely (95% CI, 1.03-1.98) to have deliveries assisted by a medically trained provider than women who had low autonomy. Association between young mother's autonomy and reproductive health care utilization suggest that maternal autonomy needs to be considered as an important sociocultural determinant for the higher utilization of reproductive health care services for young mothers in Bangladesh.

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... Although the utilization rate has increased in 2017-18 (referred to 2018 onward) compared to 2014, only 47% of mothers in Bangladesh received four or more ANC and 49% of them delivered their last child's birth at a health center in 2018 [29]. Such a pattern of using four or more ANC and health-center-based delivery care in Bangladesh is largely associated with women's lower social position, lower education, poor financial status, and inadequate understanding of their rights [30][31][32][33]. While the unavailability, inaccessibility, and unaffordability are strongly correlated with lower utilization of four or more ANC and health-center-based delivery services among Bangladeshi women, the association of domestic violence with antenatal and delivery care services utilization is less studied in the context of Bangladesh [31,[34][35][36]. ...
... Such a pattern of using four or more ANC and health-center-based delivery care in Bangladesh is largely associated with women's lower social position, lower education, poor financial status, and inadequate understanding of their rights [30][31][32][33]. While the unavailability, inaccessibility, and unaffordability are strongly correlated with lower utilization of four or more ANC and health-center-based delivery services among Bangladeshi women, the association of domestic violence with antenatal and delivery care services utilization is less studied in the context of Bangladesh [31,[34][35][36]. ...
... Geographical variation is also found significant for reducing the use of four or more ANC and health-center-based delivery care. Rural young mothers are less likely to utilize four or more ANC and health-center-based delivery care compared to urban young mothers which is consistent with earlier studies [31,33,35,54]. The utilization of four or more ANC and health-center-based delivery care also significantly vary by division. ...
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Article
This paper examined the association between young mothers’ attitudes towards domestic violence and four or more antenatal care (ANC) and health-center-based delivery service utilization using two cross-sectional waves of the Bangladesh Demographic and Health Surveys (2014 and 2018) data. We carried out a multilevel logistic regression analysis. Findings show that a strong cluster variation exists in four or more ANC and health-center-based delivery service utilization. Although the utilization of four or more ANC and health-center-based delivery services has increased over the years, it is far behind the targets of SDGs, particularly for young mothers with justified attitudes towards domestic violence. Extension of maternity allowance coverage and motivational programs are important policy recommendations.
... Although younger women aged 15-24 years generally have higher odds of using health facilities at childbirth than older women (29), there are notable variations among young women. For instance, older adolescents and youth tend to be more likely to use health facilities at childbirth than very young youth below 17 years [18][19][20], which could be attributed to differences in knowledge and support to access health facilities at childbirth [21]. More importantly, use of health facilities at childbirth was found to be higher among married than unmarried youth due to various societal and health system factors including husband support, shame and discrimination among unmarried youth [22][23][24].Studies have also documented that working away from home [25] and higher parity [25][26][27][28][29][30][31] are associated with reduced chances of use of health facilities at childbirth among youth. ...
... More importantly, use of health facilities at childbirth was found to be higher among married than unmarried youth due to various societal and health system factors including husband support, shame and discrimination among unmarried youth [22][23][24].Studies have also documented that working away from home [25] and higher parity [25][26][27][28][29][30][31] are associated with reduced chances of use of health facilities at childbirth among youth. In addition, higher education level [19,23,[25][26][27][28][29][31][32][33], higher wealth status [18,20,23,25,26,28,29,31,32], urban residence [18-20, 23, 25, 27, 31-33], access to mass media [20,29], and early, frequent and quality antenatal care [23, 25-27, 29, 30, 33] have been associated with increased chances of giving birth from health facilities by youth. Furthermore, good community perspectives about health provider skills were associated with improved use of health facilities at childbirth among married adolescents in India [34]. ...
... This study found that rural areas were associated with lower chances of the use of health facilities at childbirth among both unmarried and married youth. This finding is consistent with previous studies that observed lower odds of the use of health facilities at childbirth in rural areas than urban areas [18,19,[31][32][33]. The observed rural-urban differences could be explained by the long distances, the times, and transport means required to reach the health centres during untimed pre-birth labour pains, which are more unfavourable for rural youth than urban youth. ...
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Background Uganda has a high maternal mortality rate combined with poor use of health facilities at childbirth among youth. Improved use of maternal health services by the youth would help reduce maternal deaths in the country. Predictors of use of health facilities at childbirth among unmarried compared to married youth aged 15–24 years in Uganda between 2006 and 2016 are examined. Methodology Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey. This analysis was among a sample of 764 unmarried, compared to 5,176 married youth aged 15–24 years. Results Overall, unmarried youth were more likely to have a childbirth within the health facilities (79.3%) compared to married youth (67.6%). Higher odds of use of health facilities at childbirth were observed among youth with at least secondary education (OR = 2.915, 95%CI = 1.747–4.865 for unmarried vs OR = 1.633, 95%CI = 1.348–1.979 for married) and frequent antenatal care of at least four visits (OR = 1.758, 95%CI = 1.153–2.681 for unmarried vs OR = 1.792, 95%CI = 1.573–2.042 for married). Results further showed that youth with parity two or more, those that resided in rural areas and those who were engaged in agriculture had reduced odds of the use of health facilities at childbirth. In addition, among married youth, the odds of using health facilities at childbirth were higher among those with at least middle wealth index, and those with frequent access to the newspapers (OR = 1.699, 95%CI = 1.162–2.486), radio (OR = 1.290, 95%CI = 1.091–1.525) and television (OR = 1.568, 95%CI = 1.149–2.138) compared to those with no access to each of the media, yet these were not significant among unmarried youth. Conclusion and recommendations Frequent use of antenatal care and higher education attainment were associated with increased chances of use of health facilities while higher parity, rural residence and being employed in the agriculture sector were negatively associated with use of health facilities at childbirth among both unmarried and married youth. To enhance use of health facilities among youth, there is a need to encourage frequent antenatal care use, especially for higher parity births and for rural residents, and design policies that will improve access to mass media, youth’s education level and their economic status.
... The predictors of antenatal care among the youth include a range of demand-related (e.g., socio-economic and demographic characteristics) and supply-related (e.g., service availability/access and quality) factors. Women's education level has been observed to predict the use of ANC in many settings, and specifically youth with higher education levels are more likely to use ANC early (Ochako et al. 2011) and frequently Haque et al. 2012;Ochako et al. 2011;Singh et al. 2014) than the youth with low educational attainment. However, no difference in ANC numbers in Mali were observed by education level (Singh et al. 2013b). ...
... Higher parity was associated with reduced odds of frequent ANC compared to youth who were pregnant for the first time, especially when they have had no complications for the previous pregnancies (Birungi et al. 2011;Ochako et al. 2011;Magadi et al. 2007;Hueston et al. 2008;Shahabuddin et al. 2015). Urban residence has been observed to be associated with increased odds of early ANC start (Ryan et al. 2009;Rai et al. 2012;Haque et al. 2012;Kumar et al. 2013;Shahabuddin et al. 2015) and frequent use of ANC (Ryan et al. 2009;Rai et al. 2012;Haque et al. 2012;Shahabuddin et al. 2015) than rural areas. Access to information through radios, televisions (TVs), and print media (Singh et al. 2013a(Singh et al. , 2014 and health visitors (Singh et al. 2021) have been observed to be associated with increased chances of adequate ANC and early ANC start (Arthur et al. 2007). ...
... Higher parity was associated with reduced odds of frequent ANC compared to youth who were pregnant for the first time, especially when they have had no complications for the previous pregnancies (Birungi et al. 2011;Ochako et al. 2011;Magadi et al. 2007;Hueston et al. 2008;Shahabuddin et al. 2015). Urban residence has been observed to be associated with increased odds of early ANC start (Ryan et al. 2009;Rai et al. 2012;Haque et al. 2012;Kumar et al. 2013;Shahabuddin et al. 2015) and frequent use of ANC (Ryan et al. 2009;Rai et al. 2012;Haque et al. 2012;Shahabuddin et al. 2015) than rural areas. Access to information through radios, televisions (TVs), and print media (Singh et al. 2013a(Singh et al. , 2014 and health visitors (Singh et al. 2021) have been observed to be associated with increased chances of adequate ANC and early ANC start (Arthur et al. 2007). ...
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Article
Antenatal care is an important determinant of pregnancy and childbirth outcomes. Although the youth disproportionately experience adverse maternal complications and poor pregnancy outcomes, including maternal mortality, timely and frequent use of antenatal care services among unmarried youth in Uganda remains low. This study examines the factors that are important predictors of the use of antenatal health care services among unmarried and married youth. Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey to examine the predictors of ANC use. This analysis was among a sample of 764 unmarried, compared to 5176 married youth aged 15–24 years. Overall, married youth were more likely to have more frequent antenatal care visits (56% versus 53%) and start antenatal care early (27% versus 23%) than unmarried youth. Factors significantly associated with use of antenatal care in the first trimester were education and occupation among unmarried youth, and place of residence and access to the radio among married youth. Key predictors of ANC frequency among unmarried youth were parity, education level, pregnancy desire, age group, sex of head of household and region of residence. Among married youth, significant predictors of ANC frequency were parity, pregnancy desire, occupation, access to the radio and region of residence. These findings will help inform health-care programmers and policy makers in initiating appropriate policies and programs for ensuring optimal ANC use for all that could guarantee universal maternal health-care coverage to enable Uganda to achieve the SDG3.
... Abroad studies identified women's age and educational status as well as household wealth index as a determinant factor for women's health care decisionmaking autonomy [8]. Moreover, studies also identified working status [15], place of residence [17], religion and region [18]. Therefore, based on their possible impacts upon women's autonomy in health care decision-making, this study identified the following independent variables including women's age, education status, working status, place of residence, household wealth index, religion, and region. ...
... In regard to associated factors of women's autonomy in health care decision making, the study's finding revealed that the autonomy of women who resides in urban areas was 98.7% more likely higher than rural residents. Similarly, the other studies conducted in Bangladesh as well as in Nigeria found higher mothers' autonomy of urban women than rural women [17,18,29,30]. The possible justification might be associated with the fact that urban women have better exposer to mass media. ...
... Similar to other researches findings' [15,18,29,30,32] and feminists' assumption [33][34][35], the autonomy of employed women in health care decision making was more likely higher than housewife or unemployed women. Moreover, in consistency with many other related studies [8,17,18,29,30], women with poor household were less like autonomous in health care decision making. The reason might be that the economic dependence of women makes them to develop too low self-confidence to engage in decision making because 'low self-esteem associated with low economic status' [36]. ...
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Background Women's autonomy in health care decision-making is very crucial for the well-being of women themselves, their children, and the entire family members. Although studying the issue is significant to take proper interventions, the issue is not studied at a nationwide level in Ethiopia. Accordingly, this population-based nationwide study was aimed at assessing the trends of women’s autonomy in health care decision-making and its associated factors in Ethiopia. Method The sample was limited to married women of 2005 (n = 8617), 2011 (n = 10,168), and 2016 (n = 9824) Ethiopian Demographic and Health Survey (EDHS) data. Women's autonomy in health care decision-making was measured based on their response to the question ‘person who usually decides on respondent's health care. To examine associated factors, socio-demographic variables were computed using multinomial logistic regression. Result The finding revealed that the trend of women’s autonomy in health care decision-making had declined from 18.7% in 2005 to 17.2% in 2011 albeit it had risen to 19.1% in 2016. The autonomy of women who resides in urban areas was 98.7% higher than rural residents, and those who live in the Tigray region, Somali region, and Addis Ababa are 76.6%, 79.7%, and 95.7% higher than who live in Dire Dawa respectively. Unemployed women, women aged from 15 to 24 years, and uneducated women were 45.1%, 32.4%, and 32.2% less likely autonomous in health care decision making respectively. Conclusion The autonomy of women in health care decision-making had declined from 2005 to 2011. Therefore, the role of stakeholders in taking possible interventions like empowering women shall be strengthened. This is to protect women from certain health problems as well as for the well-being of women themselves, their children, and the entire family members.
... This result is obvious as mothers with higher knowledge know more about maternal and child health and are, therefore, more conscious about the utilization of maternal healthcare facilities. A similar result was reported in previous studies [15][16][17]. ...
... On the other hand, older women become more prominent as a mother and achieve a status in the family and community that may increase the utilization of healthcare facilities [26,27]. Consistent with previous studies, our study also revealed that older mothers were more likely to utilize healthcare facilities than younger mothers [15,21]. ...
... Similar to previous studies, this study also found women from wealthier families and whose partners were more educated had a higher chance of utilizing healthcare facilities [15,21,28,29]. High educated husbands are more aware of their wives' health and child health and influence their wives to get healthcare facilities. ...
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Purpose This study aims to explore whether there is an association between women's empowerment and the utilization of maternal healthcare facilities. Design/methodology/approach This study considered four indices for measuring women's empowerment – labor force participation index (LFPI), decision-making power index (DMPI), attitude toward partner’s violence index (ATPVI) and knowledge level index (KLI) – and three healthcare facilities – number of antenatal visits, delivery with healthcare facilities and postnatal checkup after delivery. Data extracted for this study were from the Bangladesh Demographic and Health Survey 2011 and 2014. A chi-square test was used for bivariate analysis, and a three-level logistic regression model was applied for multivariate analysis. Findings An increment was observed in the practice of all considered healthcare facilities, and the percentage of highly empowered women in DMPI decreased from 2011 to 2014. This study found that higher empowerment of women in DMPI, KLI and ATPVI significantly ( p -value < 0.05) increases the utilization of healthcare facilities. High empowerment of mothers in LFPI was found negatively associated with facility delivery and positively associated with the postnatal checkup. Originality/value Women's empowerment was found significantly associated with the utilization of maternal healthcare facilities. This study is seeking the attention of corresponding authority to come up with a more effective intervention program to empower women to utilize maternal healthcare facilities.
... As this study showed, older women were more likely to decide to use family planning service than the younger ones. This finding is similar to a study conducted in Ethiopia [28], Mozambique [19] and Bangladesh [36]. A possible explanation is that when women get older, they may feel more confident to deal with their husband and to decide on family planning use [37]. ...
... Similarly this study showed that those women who attended ANC visits were more likely to Table 5 Multilevel regression analysis of decision-making power to use family planning among married women in sub-Saharan Africa have decision-making power to use family planning. This finding was also consistent with other studies [24,36]. One explanation is that women go to health facilities for ANC services where they are receiving health information including family planning. ...
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Background In sub-Saharan Africa, there are several socio-economic and cultural factors which affect women’s ability to make decision regarding their own health including the use of contraceptives. Therefore, the main aim of this study was to determine factors associated with decision-making power of married women to use family planning service (contraceptives) in sub-Saharan Africa. Methods The appended, most recent demographic and health survey datasets of 35 sub-Saharan countries were used. A total weighted sample of 83,882 women were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of decision-making power of married women to use family planning service in sub-Saharan countries. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential variables included in the final model. Results Married women with primary education (AOR = 1.24; CI:1.16,1.32), secondary education (AOR = 1.31; CI:1.22,1.41), higher education (AOR = 1.36; CI:1.20,1.53), media exposure (AOR = 1.08; CI: 1.03, 1.13), currently working (AOR = 1.27; CI: 1.20, 1.33), 1–3 antenatal care visits (AOR = 1.12; CI:1.05,1.20), ≥ 4 ANC visits (AOR = 1.14;CI:1.07,1.21), informed about family planning (AOR = 1.09; CI: 1.04, 1.15), having less than 3 children (AOR = 1.12; CI: 1.02, 1.23) and 3–5 children (AOR = 1.08; CI: 1.01, 1.16) had higher odds of decision-making power to use family planning. Mothers who are 15–19 (AOR = 0.61; CI: 0.52, 0.72), 20–24 (AOR = 0.69; CI: 0.60, 0.79), 25–29 (AOR = 0.74; CI: 0.66, 0.84), and 30–34 years of age (AOR = 0.82; CI: 0.73, 0.92) had reduced odds off decision-making power to use family planning as compared to their counterparts. Conclusion Age, women’s level of education, occupation of women and their husbands, wealth index, media exposure, ANC visit, fertility preference, husband’s desire in terms of number of children, region and information about family planning were factors associated with decision-making power to use family planning among married women.
... 4 WHO advocates for increased utilisation of health facilities during pregnancy and delivery, which is of paramount importance in reducing maternal mortality. 5 Extensive research from developing countries has attempted to identify various sociodemographic, geographic and cultural correlates associated with utilisation of MHS from skilled professionals. 3 6-9 A handful of studies from developing countries, [10][11][12][13][14] including Bangladesh, [15][16][17][18][19][20] has documented the relationship between women's empowerment and maternal healthcare utilisation. However, these studies were mainly focused on women's involvement in household decision-making, 10-14 16-18 20 freedom of movement 11 17 18 or attitude towards violence, 12 13 18 19 which provide a narrow scope of women's empowerment for understanding this relationship. ...
... Although this study used a newly developed index (SWPER) to measure women's empowerment status, the relationships between women's empowerment and utilisation of maternal healthcare found in this study are consistent with previous studies around the world which used different measures of women's empowerment. [10][11][12][13][14][15][16][17][18][19] Therefore, the findings of this study reaffirmed the association between women's empowerment and maternal healthcare utilisation in a patriarchal society such as Bangladesh. Imbalances in gender power are high in Bangladesh, and thus women are generally dependent on their husband or male partner. ...
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Objective To examine the relationship between women’s empowerment and maternal healthcare utilisation in Bangladesh. Design This cross-sectional study uses data from the most recent nationally representative Bangladesh Demographic and Health Survey, 2017–2018. Setting Bangladesh. Participants Married women aged 15–49 years who had a live birth within the 3 years preceding the survey (n=4767). Primary and secondary outcome measures Women’s empowerment was measured using the recently developed and validated survey-based Women’s emPowERment (SWPER) index. The index includes three domains: social independence, decision-making and attitude to violence. Outcomes included utilisation of at least one antenatal care from skilled providers (ANC1), at least four antenatal care visits (≥4 ANC), delivery assisted by a skilled birth attendant (SBA) and a postnatal visit within 2 days of delivery (PNC). Logistic regression analyses were used to assess the identified relationships. Results Among participants, 83% received ANC1, 46.3% received ≥4 ANC, 51.9% reported SBA and 50.9% sought PNC. Women with high levels of social empowerment relative to those with low levels were more likely to use ANC1 (adjusted OR (AOR) 1.85; 95% CI 1.40 to 2.45), ≥4 ANC (AOR 1.55; 95% CI 1.27 to 1.90), SBA (AOR 2.12; 95% CI 1.71 to 2.62) and PNC (AOR 1.95; 95% CI 1.56 to 2.44). Compared with women with low levels of decision-making empowerment, women with high levels were more likely to use SBA (AOR 1.49; 95% CI 1.21 to 1.83) and PNC (AOR 1.47; 95% CI 1.19 to 1.81). Additionally, significant inequality was observed among women moving from low to high empowerment in all domains of the empowerment index. Conclusions Higher empowerment levels were positively associated with maternal healthcare utilisation in Bangladesh. Our findings suggest the need to address women’s empowerment in policies aiming to expand health service utilisation.
... The study found that women with higher level of education took less permission from their husbands similar to other studies that examined factors such as age, education and socioeconomic and cultural factors and their influence on women's decision-making autonomy. Studies in Bangladesh, Ethiopia and Nepal found that increased level of education among women is positively associated women's autonomy in decision-making [20,21]. However, a study in Tajikistan reported no statistically significant relationship between women's autonomy and their educational attainment [22]. ...
... The study found no relationship between age of the care giver and seeking permission from husband to visit health facilities similar to the study in Tajikistan [23]. However most other studiesreported that increased age positively associated with women's autonomy in decisionmaking [20][21][22] . ...
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Article
Ethiopia has made great effort in recent years to improve maternal and child health outcomes, however the uptake of services by women in the pastoralist communities of the country is still very low. This study was a cross-sectional study aimed to identify the effect of gender on the utilization of health services among pastoralists women. The study was conducted in Somali Region of Ethiopia between February and March 2020. A mix of qualitative and quantitative methods was used, and study population were married caregivers aged 15years and above. Bivariate analysis was done using t test and chi-square to test association among variables and p value was set at significant level of 5%. Husbands were reported as the main influence of the respondents' decision about almost all the key households' activities including health care seeking and financial decision making. Almost all caregivers (93.6%) who used the health facility took permission from their Original Research Article Oladeji et al.; ACRI, 21(3): 73-81, 2021; Article no.ACRI.70761 74 husbands and the test of association shows significant relationship between level of education and permission from respondents' husbands which decreases with increasing level of education, p<0.05) but not affected by age. The care givers visited the health facilities because of their children more than themselves(58 per cent compared to 49.5 per cent for themselves) due to fear of being attended to by male health work. The study demonstrated the negative effect of gender inequities on health care seeking behaviours with women having limited control over family resources and decision-making over their health or that of their children.
... Alternately, studies have found empowerment to be positively associated with increased pregnancy healthcare seeking [37,38], skilled delivery attendance [37,39] and the use of modern contraceptive methods [5,40], resulting in lower infant mortality [41]. While there are many ways to conceptualize women's empowerment, previous studies have conceptualized empowerment as it relates to pregnancy outcomes, such as via health decision-making [42], attitudes toward intimate partner violence [13], education [13,43], employment [44,45] wealth [22], access to media [22] and contraceptive use [31]. ...
... Alternately, studies have found empowerment to be positively associated with increased pregnancy healthcare seeking [37,38], skilled delivery attendance [37,39] and the use of modern contraceptive methods [5,40], resulting in lower infant mortality [41]. While there are many ways to conceptualize women's empowerment, previous studies have conceptualized empowerment as it relates to pregnancy outcomes, such as via health decision-making [42], attitudes toward intimate partner violence [13], education [13,43], employment [44,45] wealth [22], access to media [22] and contraceptive use [31]. ...
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Article
Improving maternal outcomes and reducing pregnancy morbidity and mortality are critical public health goals. The provision of quality antenatal care (ANC) is one method of doing so. Increasing women’s empowerment is associated with positive women’s health outcomes, including the adequate timing and amount of ANC use. However, little is known about the relationship between women’s empowerment and quality ANC care. Despite a history of political instability, low women’s equality and poor maternal health, the Republic of Guinea has committed to improving the status of women and access to health. However, the 2014 Ebola outbreak may have had a negative impact on achieving these goals. This study sought to examine factors in the relationship between women’s empowerment and the receipt of quality ANC (indicated by the number of health components) within the context of the Ebola outbreak. This study conducted multiple logistic regressions examining associations between covariates and the number of ANC components received using data from the 2012 and 2018 Guinea Demographic Health Surveys. Several aspects of women’s empowerment (healthcare decision-making, literacy/access to magazines, monogamous relationship status, contraceptive use, socio-economic status/employment) were significantly linked with the receipt of a greater number of ANC components, highlighting the importance of women’s empowerment in accessing quality maternity care.
... Women empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality by improving decision-making ability and access to economic resources, hence being in a better position to tackle the barriers to accessing healthcare [5,28]. Empowered women have been shown to have better health-seeking behaviour and decision-making [29,30]. Moreover, with increased access to economic resources, women's empowerment would ease and increase subscription to health insurance schemes, translating into increased access to healthcare. ...
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Background Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among vulnerable groups. Although women’s empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women to tackle the barriers to accessing healthcare, its association with health insurance usage has been barely investigated. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment as well as other socio-demographic factors among Rwandan women. Methods We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15–49 years, who were selected using multistage sampling. Health insurance utilisation, the outcome variable was a binary response (yes/no), while women empowerment was assessed by four composite indicators; exposure to mass media, decision making, economic and sexual empowerment. We conducted multivariable logistic regression to explore its association with socio-demographic factors, using SPSS (version 25). Results Out of the 14,634 women, 12,095 (82.6%) (95% CI 82.0–83.2) had health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators had a negative association with health insurance utilisation; low (AOR = 0.85, 95% CI 0.73–0.98) and high (AOR = 0.66, 95% CI 0.52–0.85) exposure to mass media, high decision making (AOR = 0.78, 95% CI 0.68–0.91) and high economic empowerment (AOR = 0.63, 95% CI 0.51–0.78). Other socio-demographic factors found significant include; educational level, wealth index, and household size which had a negative association, but residence and region with a positive association. Conclusions A high proportion of Rwandan women had health insurance, but it was negatively associated with women’s empowerment. Therefore, tailoring mass-media material considering the specific knowledge gaps to addressing misinformation, as well as addressing regional imbalance by improving women’s access to health facilities/services are key in increasing coverage of health insurance among women in Rwanda.
... At the qualification stage, 70 articles were completely approved and evaluated for eligibility. Finally, this systematic review and meta-analysis included 19 studies 29,[31][32][33]35,37,43,46,[54][55][56][57][58][59][60][61][62][63][64][65] with 103,983 study participants ( Figure 1). All of the included studies were cross-sectional. ...
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Article
Objective: This study was done to determine the overall estimate of decision-making autonomy on maternal health services and associated factors in low- and middle-income countries. Method: PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by country, year, and publication. Joanna Briggs Institute quality assessment tool was used to check the quality of each study. We carried out a leave-one-out sensitivity analysis. Results: Out of 1305 articles retrieved, 19 studies (with 104,871 study participants) met eligibility criteria and were included in this study. The pooled prevalence of women's decision-making autonomy on maternal health services in low- and middle-income countries was 55.15% (95% confidence interval: 44.11-66.19; I2 = 98.6%, P < 0.001). Based on subgroup analysis, decision-making autonomy in maternal health services was the highest in Ethiopia at 61.36% (95% confidence interval: 50.58-72.15) and the lowest in Nigeria at 36.16% (95% confidence interval: 12.99-43.39). It was 32.16% (95% confidence interval: 32.72-39.60) and 60.18% (95% confidence interval: 47.92-72.44) before and after 2016, respectively. It was also 54.64% (95% confidence interval: 42.51-66.78) in published studies and 57.91% (95% confidence interval: 54.80-61.02) in unpublished studies. Age (adjusted odds ratio = 2.67; 95% confidence interval: (1.29-5.55), I2 = 90.1%), primary level of education (adjusted odds ratio = 1.75; 95% confidence interval: (1.39-2.21), I2 = 63.8%), secondary education level (adjusted odds ratio = 2.09; 95% confidence interval: (1.32-3.32), I2 = 87.8%), being urban resident (adjusted odds ratio = 1.80; 95% confidence interval: (1.22-2.66), I2 = 73%), and monthly income (adjusted odds ratio = 3.23; 95% confidence interval: (1.85-5.65), I2 = 97%) were positively associated with decision-making autonomy on maternal health service. Conclusion: Decision-making autonomy on maternal health services in low- and middle-income countries was low. Sociodemographic factors also influenced it. Educational accessibility and income generation should have been recommended, enabling women to decide for themselves.
... 12 Globally, around 40 million mothers give birth at home every year without getting any assistance from skilled birth attendants 13 and most home deliveries take place in developing countries, where traditional practices such as applying unclean substances to the cord increase the risk of tetanus and bacterial infection. 14 Hypothermia is the body temperature below the normal range (36.5-37.5°C) and neonate hypothermia increases mortality and morbidity such as intracranial hemorrhage and sepsis. ...
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Background and aims: Essential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices. Methods: The study used a cross-sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast-feeding), χ 2 test and t-test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design. Results: Only about 24% (95% confidence interval [CI]: 22.95%-25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice. Conclusion: The study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.
... These practices among males may lead to the recurrence of chronic heart diseases like hypertension and trigger more HCU for heart dieseases. Another study in Bangladesh showed that the male-headed family heritage leads to demotivated women's decisions about their healthcare even when there is agreement from senior family members, especially husbands and/or mothers-in-law [40]. This supports the nding of another study [41] that showed that 37% of Bangladesh women had no decision-making power about their healthcare. ...
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Background: Chronic diseases are considered one of the major causes of illness, disability and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) in adult Bangladesh patients with chronic diseases from a gender perspective. Methods: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed using logistic regression to identify the potential factors for higher or lower utilisation of healthcare services after step-by-step adjusting for independent confounding factors. Results: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female (M/F):16.77% / 16.40%), arthritis/rheumatism (M/F:13.70% / 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. Conclusion: Emerging burden of chronic diseases were observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient’s gender for the empolyment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people might enhance their universal health coverage.
... Mothers without exposure to media such as newspapers, radio, television or ownership of mobile phones, will be unaware of the proximal processes such as shared parent-child book activities and its developmental benefits on children (Haque et al., 2012). Education, purchasing capacity and awareness suggest a twofold problem: first, the early linguistic development of children by reading or listening to age-appropriate books may be compromised; and second, lack of shared activities shrinks parent-child interaction time and hampers children's emotional growth and subsequently affects the quality of their life (Aboud et al., 2008;Haider et al., 2001). ...
Article
Two early childhood development aspects: carer involvement with children, and their ownership of age‐appropriate books, were evaluated. Children aged 0–4 years from Bangladesh, extracted from population‐based Multiple Indicator Cluster Survey 2019, were assessed using survey adjusted logistic regression models and district‐wise spatial distribution. Among 13 806 children, 11.2% had no shared activities with carers, and 60.7% had at least four shared activities. Among 22 796 children, 27.4% owned at least one book. Higher carer–child shared activities and more child‐friendly books in households were observed in the Western part of Bangladesh. Children from higher socioeconomic households with educated mothers and greater exposure to media, had higher carer–child interaction and greater availability of books. These findings can aid policies targeting psychological and cognitive development of children in Bangladesh.
... In fact, in such settings, we know that the decision-making autonomy of women plays a crucial role in empowerment and better maternal and child health outcomes (Duflo, 2012;Pratley, 2016). Further, while the socio-cultural context significantly contributes to women's autonomy, some scholars argue that women's autonomy is highly linked to personal capacity rather than their positions in society (Haque et al., 2012;Rahman et al., 2014). This would mean that, even in more patriarchal settings, personal capacities linked to self-esteem and social support can promote women's autonomy and the benefits associated with it. ...
Article
Background Childhood maltreatment (CM) is connected with a large number of maladaptive long-term outcomes. Effective prevention and intervention hinges partly on our understanding of the key mediating mechanisms that help account for the relationship between child maltreatment and its long-term consequences. We know the consequences of CM can extend into adulthood, including the intergenerational transmission of violence, re-victimization, high-risk behavior, and persisting mental health problems. We argue that CM also likely affects decision-making autonomy in adulthood, limiting their independence and exaggerating their risk for other poor outcomes. We suggest that the effects of CM on self-esteem and access to social support mediate this relationship, helping to explain how and why CM impacts autonomy in the long term. Objective This study aimed to examine these relationships using a cross-sectional sample of currently married women of Bangladesh aged 15–49 years (N = 426). Method A multi-stage random sampling technique was employed for data collection and a multivariate logistic regression technique was applied for data analysis. Results Results from the multivariate logistic regression model revealed a direct effect of a history of CM on limited decision-making autonomy in adulthood and a full mediating effect of self-esteem and social support on the associations between CM and decision-making autonomy in women, even after adjusting for theoretically and empirically relevant covariates. Conclusions The study findings provide insight into the mechanisms by which early childhood experiences impact autonomous decision-making. However, causality cannot be determined because of the cross-sectional design. Finally, our findings suggest that the influence of CM on autonomy could be augmented by self-esteem recovery through social support from family, friends, and peers.
... 6 Autonomous women have been shown to have better maternal health-seeking behaviour and better maternal and child health outcomes. 15,16 Decisions regarding access to healthcare may be made exclusively by men and for the women who may access ANC, limited financial and decision making abilities may negatively affect the possibility of implementing the recommended practices at home. In order to ensure proper and effective implementation of the new World Health Organisation (WHO) ANC guidelines aimed at reducing maternal mortality and morbidity, 17 there is need to evaluate access to ANC at a national level with the most recent data. ...
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Background Women empowerment has been viewed as a good strategy in the reduction of global maternal morbidity and mortality. Most of the recent studies in Uganda have focussed on antenatal care (ANC) frequency and the associated factors with no focus on the effect of women empowerment. Our study aims at examining the prevalence of optimal access to ANC by considering the timing of initiation, type of ANC provider and ANC frequency and their association with women empowerment. Methods We used Uganda Demographic and Health Survey 2016 data of 9957 women aged 15–49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and access to ANC using Statistical package for the social sciences version 25. Results Out of 9957 women, 2953 (29.7%: 95% CI: 28.5.0–30.2) had initiated ANC in first trimester, 6080 (61.1%: 95% CI: 60.4–62.3) had 4 or more ANC contacts, and 9880 (99.2%: 95% CI: 99.0–99.3) had received ANC from a skilled provider. Overall, 2399 (24.1%: 95% CI: 23.0–24.6) had optimal access to ANC. Economic empowerment and exposure to media were the only women empowerment indices that were positively associated with optimal access to ANC. Other factors that were significant include; region, wealth index, age, level of education and working status. Conclusion To ensure increased access to ANC, policy-makers and other stakeholders should prioritise the use of mass media in maternal health programs, equitable allocation of the limited financial resources with a focus on older, poor and uneducated women.
... Her involvement in income-generating activities further potentiates her capacity in the household [41]. Women with greater household decision-making powers are more likely to uptake sexual and reproductive health services than those with less power [42][43][44]. In the egalitarian setting of Tamil Nadu in India, women's economic activity positively influenced decision making, an unlikely phenomenon in the gender-conservative context of several locales of India [45]. ...
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Background Sexually transmitted infections (STIs) among women have led to substantial public health and economic burdens in several low-middle-income countries. However, there is a paucity of scientific knowledge about the relationship between empowerment and symptoms of STIs among married Bangladeshi women. This article aimed to examine the association between women empowerment and symptoms of STIs among currently married Bangladeshi women of reproductive age. Materials and methods We extracted data from the Bangladesh Demographic and Health Survey (BDHS), conducted from June 28, 2014, to November 9, 2014. We utilised cross-tabulation, the conceptual framework and multivariable multilevel mixed-effect logistics regression to explore the association between women’s empowerment indicators and women’s self-reported symptoms of genital sore and abnormal genital discharge. All of the analysis was adjusted using cluster weight. Results We found that among 16,858 currently married women, 5.59% and 10.84% experienced genital sores and abnormal genital discharge during the past 12 months, respectively. Women who depended on husbands to make decisions regarding their health care (AOR = 0.75, 95% CI = 0.67–0.84), significant household purchases (AOR = 0.79, 95% CI = 0.71–0.88), and visiting family or relatives (AOR = 0.72, 95% CI = 0.64–0.80) were less likely to report signs of abnormal genital discharge. Women who could make joint healthcare decisions with their husbands were also less likely to report genital sores (AOR = 0.78, 95% CI = 0.67–0.90). Conclusion Genital sores and abnormal genital discharge were prevalent across all parameters of women empowerment among currently married women in Bangladesh. Our estimates show that the husband plays a significant role in decision-making about sexual and reproductive health. Efforts need to be invested in establishing culturally relevant gender policies which facilitate the involvement of women in joint decision-making.
... In Bangladesh, factors affecting adolescents' health and nutrition include family dynamics, social and gender norms, decision-making power, freedom of movement, education level and gender-based violence (Haque et al., 2012;Shahabuddin et al., 2015;Story et al., 2012; WHO & Regional Office for South-East Asia (SEARO), 2014). Married adolescent girls often have minimal decision-making power at the household or community level and are expected to follow the directives of male family members and in-laws (Presler-Marshall & Stavropoulou, 2017 ...
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Adolescent pregnancy can result in serious risks to the mother and her baby; yet, adolescents are among the least likely to access healthcare. Specific nutrition or antenatal care (ANC) guidelines for supporting pregnant adolescents are not available. To understand experiences and decision‐making of pregnant adolescents in Bangladesh related to ANC and nutrition practices, peer interviewers were trained to conduct qualitative interviews in Dhaka and Rangpur with pregnant adolescents (n = 48), adolescent mothers (n = 48), adolescents' family members (n = 64) and health service providers (n = 32). Key themes explored included perception and support of adolescent pregnancy, experiences in seeking ANC, dietary practices, sources of information and roles of male and female family members. Spheres of influence on adolescent pregnancy were identified through analytical framework informed by the socio‐ecological model. Respondents felt that adolescent pregnancy is risky and that adolescents require support and guidance through this experience. Families were highly influential on the care seeking, health and nutrition of pregnant adolescents, and mothers/mothers‐in‐law primarily took on the decision‐making roles, with husbands actively participating. Adolescents valued family support but felt a loss of autonomy and agency upon becoming pregnant. Financial constraints were the greatest perceived barrier to appropriate nutrition and healthcare; yet, both were valued. There is sometimes discord of health and nutrition beliefs between families and health service providers; more research is needed to understand this further. It is essential to engage family members and adolescents in initiatives to increase access to quality ANC for pregnant adolescents, improve dietary practices and support the ability to delay pregnancy.
... While one study conducted in Kenya found that men were reported to be facilitators of positive behaviors by encouraging wives and partners to attend ANC visits and facilitybased delivery services (11); our previous study also identified specific barriers to men's participation in RMNCH including gendered cultural norms such as the belief that pregnancy is the sole responsibility of the woman, negative health care worker attitudes toward male engagement and maternity, and community health services infrastructures that are unsupportive of men's participation (19). As empowered women are more likely to attend facility-based reproductive health services, utilize modern FP methods, and experience fewer pregnancy complications, an increased emphasis on male engagement in women's health will assist in preventing reproductive health issues, increasing acceptance of contraceptive methods, and empowering women's decision making (20)(21)(22). As such, the promotion of FP initiatives that involve men is key to addressing barriers to men's supportive participation in reproductive and maternal health and has been linked to positive health outcomes for women and children (23)(24)(25)(26). ...
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Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced RMNCH in rural Kisii and Kilifi. Methods: The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions (FGDs) with 82 community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews (KIIs) with facility health managers, and sub-county and county officials who were aware of the AQCESS project. Results: Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning (FP), spousal/partner accompaniment to facility care, and defeminization of social and gender roles. Conclusion: This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children's health as well as in improving spousal support for use of FP methods.
... This understanding puts men in a more powerful position than women. Haque's (2012) study in Bangladesh and Widyastuti (2017) in Indonesia show that autonomy affects women's decisions in using ANC. Likewise, research in India shows that there is a link between women's autonomy and the use of health services and the improvement of reproductive health32. ...
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Background: The autonomy associated with the essence of decision-making in the field of reproductive health, including about fertility, pregnancy, and the utilization of health services. The research has shown that autonomy occurred in poor countries and growing. This literature is intended to explore autonomy measures and policies related to reproductive health programs. Methods: Review of the literature search some databases such as the Online Public Access Catalog (OPAC) and Pubmed Medical Center (PMC). Twenty-two articles that met the criteria for discussion included articles dominated by South and Southeast Asia and parts of Africa, as well as one European region. Most of the literature defines women's autonomy using theories from previous literature. Results: the study proves that there is a link between autonomy and utilization of health services, family planning and fertility. Autonomy measurement is done by using direct and indirect dimensions. Dimensions direct connect participation in decision making related to the economy, household and mobility. The other dimension is to assess women's attitudes toward domestic violence. Dimensions are indirectly related to proxies that affect women's status such as employment, education or media exposure. Conclusion: Potential policies and programs related to reproductive health in developing countries basically recommend the integration of women's empowerment in health programs.
... Besides, the study conducted in Bangladesh using DHS data show that empowered women has more likely to believe in gender equality and refuse any violence on women's decision making such as family planning and health care services, and has a great likelihood of attending antenatal care as compared to not empowered women. Recommends women autonomy should be taken into consideration as important factors to have the highest utilization of reproductive health care services (10). ...
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Background Health-care facility delivery was the most critical in ensuring the provision of high-quality care and a distribution location that was ready in the case of an emergency for reproductive women. However, maternal mortality remains high in African nations, and the majority of women were still giving birth at home. This study was aimed to determine whether women's empowerment and community norms, plus other proximate factors, are related to the health facility delivery utilization of women in Ethiopia. Methods The data for this study was taken from the Performance Monitoring for Action (PMA) in Ethiopia of the 2019 cross-sectional survey. A weighted sample of 4864 women with at least one birth history, clustered within 264 clusters was used for this study. The impact of women's empowerment, cultural norms, and other proximate factors on the use of health facility deliveries among reproductive-age women across clusters in Ethiopia was studied using a two-level multilevel logistic regression. Results In Ethiopia, around 51 % of women were delivered their most recent child at the health facility. The use of a health facility delivery was more common among empowered women and those living in where the most people encourage a health facility delivery. Older women were less likely to deliver at a health facility and women from the highest wealth quantile more likely to have a facility delivery. Those women with higher education and living in an urban area were more likely to have a health facility delivery. Women’s chances of giving birth in health facilities vary significantly across the 264 clusters of Ethiopia ( σ_uo^2 =2.49,p.value<0.001). Conclusions This study emphasizes the importance of women's empowerment and cultural norms in enhancing maternal health outcomes of women in Ethiopia. It is more important than ever that the government and development agency should invest more in women's empowerment and raising community consciousness about the benefits of using health facility delivery as part of a strategic intervention to improve maternal health outcomes.
... In reproductive health, women's autonomy was an important socio-cultural factor, which played a role in using of health facilities. 40 This study, consistent with other results, showed that the husband had a role in making decisions in the family, and that women's autonomy in decision-making was very limited, including the basis of the female reproductive health. 41,42 Husbands as the head of households should be motivated by health practitioners on the utilization of the National Health Insurance scheme, as this ensured the achievement of universal medical coverage. ...
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Lack of familiarity among the community, medical workers, and administrative staff regarding reproductive health services covered by Badan Penyelenggara Jaminan Sosial (BPJS) or the National Health Insurance (NHI) in Indonesia, remained a problem. Therefore, this resulted in sub-optimal use of the medical services, as shown by surveys from the Women's Health Foundation for three consecutive years (2015-2017). This qualitative study was conducted with a Rapid Assessment Procedure design in three cities within Indonesia, namely Padang Pariaman, Manado, and Kupang. Data were collected through IDIs (n = 47 informants) and 6 FGDs (7 persons/group). Participants also consisted of NHI RHS users (mothers and young women), administrative officers at health facilities, medical services providers, and officials related to the NHI assistance. Data were managed using NVivo version 2.0 software, accompanied by thematic analysis. The internal barriers in the use of NHI included inadequate knowledge of RHS covered by NHI, and a culture of shame in informants. External barriers included additional costs for medicines not covered by NHI, the dissatisfaction of health services provided by medical workers, busy work and household activities, with the lack of women's role in decision-making within families, which related to reproductive wellness.
... The prevalence varied by socio-demographic, socio-economic, and socio-cultural factors [6]. Previous literatures in various countries have indicated some socio-demographic and socio-economic factors that impact on the use of modern contraceptive such as age and education in Nigeria [7], education and number of children in Cameroon [7,8], women's age, education, region, number of living children, and child preference in Bangladesh [9,10], wealth quantile in Malawi [11], access to media in Cameroon and Bangladesh [8,12], desire for children and visited by health worker in urban Maldives [13] and autonomy on health care in Bangladesh [14]. Moreover, women's empowerment was found to be a key to using modern contraceptives in African countries [15] and women's lack of power restrained themselves from making decision on family planning in Ghana [16,17]. ...
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In Cambodia, modern contraceptive use has increased slightly from 35.0% to 39.0% between 2010 and 2014. However, this proportion remains low in the South-East Asia regions; and more efforts are needed to increase the use of modern contraceptive (MC). Our study aimed to explore the determinants of MC use and to assess whether women’s decision-making power on contraceptive use is more influential determinant. We analyzed data from the Cambodia Demographic Health Survey 2014 in which a total of 611 clusters (urban and rural) from 15,825 households with selected samples of 17,578 women aged 15-49 years old. They were interviewed about sexual, and reproductive health. We restricted our analysis to married women (n=11,668). Bi-variate and multivariate logistic regression were performed using STATA version 14. Sampling weight was taken into account in all analyses. The prevalence of modern contraceptive use in 2014 was 39.0%. Factors independently determining the use of modern contraceptive methods included decision on contraceptive use made by women alone (AOR=5.31, 95% CI=4.01-7.04) and made jointly with husband or partner (AOR=1.59, 95% CI=1.29-1.96) compared with that decision made by husband or partner alone. Women aged ≥ 35 years old was less likely to use MC than those aged 15-34 years old (AOR=0.73, 95% CI= 0.61-0.87). Also, the lower odds of using MC was found among women who completed secondary or higher education (AOR=0.70, 95% CI=0.54-0.90) compared with those who had no education, and women living in the urban area (AOR=0.73, 95% CI= 0.60-0.88) compared to those living in the rural area. Married women’s participation in decision-making on contraceptive use is the influential determinant of modern contraceptive use. Future interventions to improve the use of MC methods should focus on empowerment of women to actively participate in making decision on the use of contraceptive methods and other health services.
... Women empowerment has been viewed as a good strategy in the reduction of global maternal morbidity and mortality 1 . Autonomous women have been shown to have better maternal health seeking behavior and better maternal and child health outcomes 3,4 . Globally, over half of maternal mortalities are due to pregnancy-related complications and over 90% of these deaths are from low and middle income countries 5 . ...
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Background: Women empowerment has been viewed as a good strategy in the reduction of global maternal morbidity and mortality. Most of the recent studies in Uganda have focused on ANC frequency and the associated factors with no focus on the effect of women empowerment. Our study aims at examining the prevalence of optimal access to ANC by considering timing of initiation, type of ANC provider and ANC frequency and their association with women empowerment. Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 9957 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and access to ANC using SPSS version 25. Results: Out of 9,957 women, 2,953 (29.7%: 95% CI: 28.5.0-30.2) had initiated ANC in first trimester, 6,080 (61.1%: 95% CI: 60.4-62.3) had 4 or more ANC contacts, and 9,880 (99.2%: 95% CI: 99.0-99.3) had received ANC from a skilled provider. Overall, 2,399 (24.1%: 95% CI: 23.0-24.6) had optimal access to ANC. Economic empowerment and exposure to media were the only women empowerment indices that were positively associated with optimal access to ANC. Other factors that were significant include; region, wealth index, age, level of education and working status. Women in younger age groups, those with higher wealth quintiles and those from the Northern and Western regions were also more likely to have optimal access to ANC compared to their older, poorest quintile and Eastern region counterparts respectively. Conclusion: To ensure increased access to ANC, policy-makers and other stakeholders should prioritize use of mass media in maternal health programs, equitable allocation of the limited financial resources with a focus on older, poor and uneducated women.
... Therefore, it is important to identify and understand the determinants of women's decision making autonomy. Data from two Asian countries, Bangladesh and Nepal, show that variables such as increased age, higher level of education, residency in urban areas, paid employment, household wealth, and greater number of living children show a positive and significant relationship with greater autonomy (Haque et al., 2012;Acharya et al., 2010). ...
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As many researches on gender and household purchasing decision making are sociological as well as descriptive, this attempt tries to fill the gap with applying of statistical model in to the same context. This is basically an inductive approach that generates data, applies joint modeling and moves forward in sociological interpretation. The data has been generated in an Island-wide survey consisting 28,800 household units in Sri Lanka in 2016. Generalized linear mixed approach was applied to baseline-category logit models to identify the factors associated with women’s autonomy in decision making on daily household purchases and major household purchases. This research comes up to the conclusions that women’s age, education status of the women and spouses, number of children, residence area and economic status in the family emerged as important factors associated with women’s autonomy in decision making. Increased age, well paid employment and having many living children are all positively associated with women’s autonomy in decision making in both daily household purchases and major household purchases. Women from rural and estate areas are less likely be autonomous in decision making than the women from urban areas. Highly educated women are more likely to make decisions jointly while the women who less attended formal education are further likely to make decisions unaccompanied. Keywords: Women’s Autonomy, Baseline Category Logit Model, Generalized Linear Mixed Models, Household Purchases
... As this study showed older women were more likely have decision making power to use FP. This nding is similar to a study conducted in Ethiopia(26), Mozambique (33) and Bangladesh (34). This might be due to if a woman gets more aged, she may feel more self-con dent to decide on family planning use individually and by discussing with her husband (35). ...
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Background: In sub-Saharan Africa there are several socio-economic and cultural factors which affect women’s ability to make decision regarding their own health including contraceptive usage. The main aim of this study was to determine factors associated with decision making power of women to use family planning in sub-Saharan Africa. Methods: The appended, most recent demographic and health survey datasets of 35 sub-Saharan countries were used. A total weighted sample of 83,882 women were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of decision making power of women to use family planning in SSA. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential variables included in the final model. Results: Those married women with primary education (AOR=1.24; CI:1.16,1.32),secondary education (AOR=1.31; CI:1.22,1.41), higher education (AOR=1.36; CI:1.20,1.53),media exposure(AOR=1.08; CI: 1.03, 1.13), currently working (AOR=1.27; CI: 1.20, 1.33), antenatal care visit of 1-3 (AOR=1.12; CI:1.05,1.20) and ≥ 4 ANC visit (AOR=1.14;CI:1.07,1.21), women who were informed about family planning (AOR=1.09; CI: 1.04, 1.15), women who had less than 3 children(AOR=1.12; CI: 1.02, 1.23) and 3-5 children (AOR=1.08; CI: 1.01, 1.16) had higher odds of decision making power to use family planning than their counter parts. Besides, mothers with age of 15-19 (AOR=0.61; CI: 0.52, 0.72), 20-24 (AOR= 0.69; CI: 0.60, 0.79), 25-29 (AOR=0.74; CI: 0.66, 0.84), and 30-34 years (AOR=0.82; CI: 0.73, 0.92) had reduced chance of decision making power of women to use family planning. Conclusion: Age, women’s level of education, occupation of women and their husband, wealth index, media exposure, ANC visit, fertility preference, husband’s desire number of children, region and information about family planning were factors associated with decision making power to use family planning among married women.
... Knowledge and experience of elder women encourage them to get maternity and childbirth care [61]. Additionally, older young women have higher decision making autonomy, which has a positive association with greater use of maternal health care services [51,62]. Therefore, delaying childbearing of young women would be beneficial for greater coverage of maternity care services. ...
... Knowledge and experience of elder women encourage them to get maternity and childbirth care [61]. Additionally, older young women have higher decision making autonomy, which has a positive association with greater use of maternal health care services [51,62]. Therefore, delaying childbearing of young women would be beneficial for greater coverage of maternity care services. ...
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Background Maternal deaths among young women (15–24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. Methods The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15–24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05. Results The use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992–2016. SBA utilization was 88 and 83% during 2015–16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. Conclusions In India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states.
... These barriers to men's participation in RMNCH include gendered cultural norms such as pregnancy considered to be the sole responsibility of the woman, negative health care worker attitudes, and unsupportive maternity and community infrastructure [19]. As empowered women are more likely to attend facility-based reproductive health services, utilize modern family planning (FP) methods, and experience fewer pregnancy complications, an increased emphasis on male engagement in women's health may assist in preventing reproductive health issues, increasing acceptance of contraceptive methods, and empowering women's decision making [20][21][22]. As such, the promotion of family planning initiatives that involve men is key to addressing barriers to men's supportive participation in reproductive and maternal health and has been linked to positive health outcomes for women and children [23][24][25][26]. ...
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BACKGROUND Globally, male involvement in reproductive, maternal, newborn and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University has been implementing the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Towards the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced reproductive, maternal, newborn and child health in rural Kisii and Kilifi. METHODS The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions with the community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews with facility health managers, and sub county and county officials who were aware of the AQCESS project. RESULTS Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning, spousal/partner accompaniment to facility care and defeminization of social and gender roles. CONCLUSION This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children’s health as well as in improving spousal support for use of family planning methods.
... The better use of care by older women arises in part from their better confidence and greater autonomy than adolescents (Reynolds, Wong & Tucker, 2006). However, other studies show teenage mothers being more likely to use more care and initiate use of services earlier than older women out of fear of pregnancy related complications (Bhatia and Cleland 1995;Furuta & Salway, 2006;Haque et al., 2012). Differences in household wealth or income and the cost of care level explain differences in MHC utilization. ...
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BACKGROUND: Fluctuating economic conditions, changes in user fee policies in the post the reform period and macroeconomic deterioration between 2000 and 2009 have affected the use of maternal healthcare services in Zimbabwe in the past two decades. Maternal mortality increased during the same period and Zimbabwe will miss the 2015 MDG targets by a significant margin. Although economic turnaround since 2009 has seen improved public healthcare funding and availability of care, no study to date has assessed and compared utilization trends in these periods. AIM: This study aimed to examine trends, levels and differentials in the utilization of antenatal care (ANC), safe delivery and postnatal care (PNC) services in Zimbabwe Methods: Maternal healthcare utilization data were drawn from the 1999, 2005-06 and 2010-11 rounds of the cross sectional Zimbabwe demographic and health surveys. Study samples consisted subsets of the last live birth from women reporting a live birth in the five years preceding each survey. A set of socioeconomic and demographic independent variables were used to examine antenatal, safe delivery and postnatal care utilization. An indexed variable, full ANC (FANC), was used to assess antenatal care utilization using bivariate (chi-square) and multivariate (ordinal logistic regression) techniques. Binary Logistic regression was also run to understand differentials in safe delivery care and postnatal care utilization. FINDINGS: Late initiation ANC visits and partial utilization of ANC components by a majority of women in both rural and urban areas and across levels of living standards result in ineffective utilization of care. Urban residence, wealth, insurance coverage and formal education were found to be highly significant determinants of safe delivery. Use of maternal healthcare was also found to vary widely between and within the ten provinces of Zimbabwe with wide socioeconomic disparities. IMPLICATIONS: To achieve good maternal health outcomes, there is need for improved healthcare financing, adequate funding for maternal health services, better targeting and monitoring of resources, expansion of the primary healthcare network and more reliance on evidence based policy making. KEYWORDS: Zimbabwe, effective utilization, content, antenatal care, safe delivery, postnatal care, utilization differentials
... Knowledge and experience of elder women encourage them to get maternity and childbirth care [68]. Additionally, older young women have higher decision making autonomy, which has a positive association with greater use of maternal health care services [56,69]. Therefore, delaying childbearing of young women would be bene cial for greater coverage of maternity care services. ...
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Background: Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper therefore aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. Methods: The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15-24 years with at least one live birth in the three years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. Results: The use of full ANC among young mothers increased from 27% to 46% in India, and from 9% to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88% and 83% during 2015-16 by showing an increment of 20% and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. Conclusions: Utilization of full ANC remained unacceptably low, specifically in EAG states. Programmatic interventions, targeting women residing in EAG states, adolescents, illiterate, poor and Muslim and SC/ST women would help to increase full ANC utilization and to maintain the increasing trend of SBA use.
... These barriers to men's participation in RMNCH include gendered cultural norms such as pregnancy considered to be the sole responsibility of the woman, negative health care worker attitudes, and unsupportive maternity and community infrastructure [19]. As empowered women are more likely to attend facility-based reproductive health services, utilize modern family planning (FP) methods, and experience fewer pregnancy complications, an increased emphasis on male engagement in women's health may assist in preventing reproductive health issues, increasing acceptance of contraceptive methods, and empowering women's decision making [20][21][22]. As such, the promotion of family planning initiatives that involve men is key to addressing barriers to men's supportive participation in reproductive and maternal health and has been linked to positive health outcomes for women and children [23][24][25][26]. ...
Full-text available
Preprint
Background Globally, male involvement in reproductive, maternal, newborn and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University has been implementing the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Towards the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. AIM This paper presents the endline evaluative study findings on how male engagement influenced reproductive, maternal, newborn and child health in rural Kisii and Kilifi. METHODS The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions with the community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews with facility health managers,and sub county and county officials who were aware of the AQCESS project. FINDINGS Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning, spousal/partner accompaniment to facility care and defeminization of social and gender roles. CONCLUSION This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children’s health as well as in improving spousal support for use of family planning methods.
... Currently, over 200 million women, especially in developing countries, are not using any effective contraceptives despite their desire to prevent pregnancy [22,23]. On the other hand, behavioural patterns in the adoption and use of contraceptives differ signi cantly between adolescents and adult women [24,25]. Adolescent women use lower reproductive health services, such as contraceptives than adults. ...
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Background: Reproductive health of married adolescent mothers including family planning, sexual, psycho-social and maternal health is still a severe and persistent challenge, where millions of women give birth before the age of 18 in developing countries. Therefore, this study was conducted to determine the reproductive health status in married adolescent mothers attending Ardabil health care centers in 2019. Methods: This cross-sectional study was conducted on 312 married adolescent mothers, which were selected through a convenient sampling method in 2019. A demographic information questionnaire and Adolescent Women's Reproductive Health Questionnaire were completed anonymously. Data were analyzed using Statisical Package for the Social Sciences (SPSS version 20). Results: The mean age of the participants, the mean age of their husbands, and the mean age of marriage were 16.41±0.85, 24.18±2.29 and 15.06±1.15 years, respectively. The mean score of reproductive health for adolescent mothers in this study was 63.78 ±11.06. There was a significant relationship between age, education, parity, age and education of husband and contraceptive methods with reproductive health status in married adolescent mothers (p<0.05). Conclusion: This study showed that to promote the reproductive health in adolescent mother, we need to improve the education level, and awareness of women, and their spouses and increasing their ability to use contraceptive methods. This study supports the evidence of the negative role of early marriage and motherhood on the reproductive health of adolescent mothers.
... Knowledge and experience of elder women encourage them to get maternity and childbirth care [68]. Additionally, older young women have higher decision making autonomy, which has a positive association with greater use of maternal health care services [56,69]. Therefore, delaying childbearing of young women would be bene cial for greater coverage of maternity care services. ...
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Background: Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper therefore aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. Methods: The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15-24 years with at least one live birth in the three years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. Results: The use of full ANC among young mothers increased from 27% to 46% in India, and from 9% to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88% and 83% during 2015-16 by showing an increment of 20% and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. Conclusions: Utilization of full ANC remained unacceptably low, specifically in EAG states. Programmatic interventions, targeting women residing in EAG states, adolescents, illiterate, poor and Muslim and SC/ST women would help to increase full ANC utilization and to maintain the increasing trend of SBA use.
... The results emphasize the significance of women's education to achieving MDG 5. Attitude towards wife beating was not significantly associated with using SBAs in urban areas, but it was significantly associated with using SBAs in rural areas in our study. This result is consistent with other studies [24,42,43]; however, they did not analyze rural and urban areas separately. The lack of education and following traditional gender-based misconceptions in rural areas may contribute to supporting wife beating, which hinders access to maternal health care. ...
... The results emphasize the significance of women's education to achieving MDG 5. Attitude towards wife beating was not significantly associated with using SBAs in urban areas, but it was significantly associated with using SBAs in rural areas in our study. This result is consistent with other studies [24,42,43]; however, they did not analyze rural and urban areas separately. The lack of education and following traditional gender-based misconceptions in rural areas may contribute to supporting wife beating, which hinders access to maternal health care. ...
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Background Each day, approximately 810 women die during pregnancy and childbirth and 94% of the deaths take place in low and middle income countries. Only 45% of the births in South Asia are attended by skilled professionals, which is lower than that in other Asian regions. Antenatal and postnatal care received from skilled providers can help prevent maternal and neonatal mortality by identifying pregnancy-related complications. Women’s empowerment is considered to be a significant determinant of maternal health care outcomes; however, studies on the contextual influences of different dimensions of empowerment in Nepal are relatively limited. Therefore, this study analyzed nationwide survey data to examine the influence of women’s economic empowerment, sociocultural empowerment, familial/interpersonal empowerment and media and information technology empowerment on accessing skilled delivery services among the married women in Nepal. Methods This study examined the influence of women’s empowerment on skilled delivery services among married women ( n = 4400) aged 15–49 years using data from the 2016 Nepal Demographic and Health Survey. Descriptive analysis and binary logistic regression analysis were employed to analyze the data. Results Significant associations were found between women’s media and information technology empowerment, economic empowerment and sociocultural empowerment and access to skilled birth attendants. Specifically, the education of women, their occupation, owning a bank account, media exposure, and internet use were significantly associated with the use of skilled birth attendants. Conclusion Focusing on women’s access to media and information technology, economic enhancement and education may increase the use of skilled birth attendants in Nepal.
... To our knowledge, none of the previous studies used composite dimension index to measure the levels of CFP in Bangladesh. Although dimension index is originally developed and used to calculate Human Development Index by the United Nations Development Programme (UNDP), it is also applied to address other issues 23,24 . ...
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Objective: To estimate the level of complementary feeding pattern (CFP) among children aged between 6 to 23 months and to identify the determinants in individual, household and community level in Bangladesh. Methods: From secondary data of Bangladesh Demographic Health Survey (BDHS) 2011 was used in this study. A total of 2,373 children aged between 6 to 23 months were selected. To estimate the level of CFP dimension index and the “score of the index” was used as dependent variables. Statistical analyses and tests were guided by the nature of the variables. Multivariable logistic regression analyses were performed to identify the significant determinants of CFP. Results: The overall level of CFP among children aged between 6 to 23 months was low. More than 95% of the children experienced inadequate (92.7%) CFP level. The mean levels of CFP as well as percentages of no or inadequate (94.1%) CFP were significantly lower among children of the youngest age group (06 months), uneducated parents, unemployed/laborer fathers, socio-economically poor families, food insecure families and rural areas. However, only few variables remained significant for adequate CFP in the multivariable logistic regression analysis. Adequate CFP was significantly lower among the children aged between 6 to 23 months (OR: 0.22, 95% CI: 0.10-0.47), children of illiterate fathers (OR: 0.32, 95% CI: 0.11-0.95) and socio-economically middle-class families (OR: 0.28, 95% CI: 0.09-0.86) as compared to their reference categories. Conclusion: Inappropriate and inadequate CFP may cause serious health hazards among children of 6 to 23 months in Bangladesh. It is ethical to take effective interventions and strategies by the government and other concerned stakeholders to improve the overall situation of CFP in Bangladesh.
... Knowledge and experience of elder women encourage them to get maternity and childbirth care [67]. Additionally, older young women have higher decision making autonomy, which has a positive association with greater use of maternal health care services [55,68]. Therefore, delaying childbearing of young women would be bene cial for greater coverage of maternity care services. ...
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Background: Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. However, there is a paucity of studies focusing on the maternity care needs of young women. This paper therefore aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. Methods: The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15-24 years with at least one live birth in the three years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. Results: The use of full ANC among young mothers increased from 27% to 46% in India, and from 9% to 28% in EAG (Empowered Action Group) states during the study period. SBA utilization was 88% and 83% during 2015-16 by showing an increment of 20% and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, SC/ST women and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. Conclusions: Utilization of full ANC remained unacceptably low, specifically in EAG states. Programmatic interventions, targeting women residing in EAG states, adolescents, illiterate, poor and Muslim and SC/ST women would help to increase full ANC utilization and to maintain the increasing trend of SBA use.
Article
Malnutrition during childhood remains a major public health concern in developing countries. Within the household, the responsibility of the mother in child nutrition is crucial. Their empowerment is recognized by previous research as a social factor associated with low rates of malnutrition in Sub-Saharan Africa. Using data from the Cameroon Demographic and Health Survey of 2018, this study investigates the associations between the dimensions of maternal empowerment and childhood stunting and wasting. A logistic regression model was used to estimate these associations. Considering each dimension of maternal empowerment, the results suggest that mother’s economic status was associated with greater odds of childhood stunting (OR = 1.110; 95% CI:1.014, 1.215; p < 0.05), and lower odds of childhood wasting (OR = 0.456; 95% CI: 0.373, 0.557; p < 0.01). Mother’s control over financial resources was associated with lower odds of childhood stunting (OR = 0.696; 95% CI: 0.642, 0.756; p < 0.01) and wasting (OR = 0.362; 95% CI: 0.309, 0.424; p < 0.01). Mother’s participation in decision-making was related to lower odds of childhood stunting (OR = 0.878; 95% CI: 0.826, 0.933; p < 0.01) and wasting (OR = 0.699; 95% CI: 0.622, 0.786; p < 0.01). Thus, the findings of this study suggest that maternal empowerment dimensions associated differently with childhood stunting and wasting. For a better effectiveness of any policy intervention, it is important to clarify the contribution of each dimension of maternal empowerment when analyzing its relationship with the nutritional status of children.
Article
High under-five mortality rate remains one of the public health challenges, especially in sub-Saharans Africa, accounting for more than half of all global cases. Sierra Leone was and still one of the countries with the highest under-five mortality rate. Using the latest 2019 SLDHS data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead=1; alive=0). A total of 871 (9%) children died before their fifth birthday. Maternal age of 20-24 years (AOR=0.46; CI=0.33-0.64; P<0.001) up to 40-44 years (AOR=0.43; CI=0.27-0.7; P=0.001), currently breastfeeding (AOR=0.20; CI=0.17-0.24; P<0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR=0.48; CI=0.28-0.85; P=0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR=0.68; CI=0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR=1.31; CI=1.08-1.59; P=0.007) watched television less than once a week (AOR=1.48; CI=1.16-1.90), had two (AOR=3.4, CI=2.78-4.16; P<0.001) or three and above birth (AOR=8.11; CI=6.07-10.83; P<0.001) in five years, had multiple birth children (AOR=1.41; CI=1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI=1.41-2.70) were more likely to lose their children below the age of five years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child’s sex, multiple birth type, very small-sized child and the total number of births in five years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.
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Background: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among the vulnerable groups. Moreover, women empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women tackle the barriers to accessing healthcare. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment among Rwandan women. Methods: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and health insurance utilisation using SPSS version 25. Results: Out of the 14,634 women, 12095 (82.6%) (95% CI: 82.0-83.2) were using or had subscribed to health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators significantly associated with health insurance utilisation were; exposure to mass media, decision making and economic empowerment. Low decision making (AOR=1.195, 95% CI: 0.897-1.592), and low economic empowerment (AOR=1.128, 95% CI: 0.986-1.290) had a positive association with health insurance coverage, while high exposure to media had a negative association (AOR=0.664, 95% CI: 0.522-0.845). Other factors that were significant include; educational level, wealth index, residence, region, household size, and household head. Conclusions: Improving women's access to health facilities as well as media material tailored to the specific knowledge gaps could significantly increase enrolment rates of Rwandan women to health insurance.
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Background: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among the vulnerable groups. Moreover, women empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women tackle the barriers to accessing healthcare. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment among Rwandan women. Methods: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and health insurance utilisation using SPSS version 25. Results: Out of the 14,634 women, 12095 (82.6%) (95% CI: 82.0-83.2) were using or had subscribed to health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators significantly associated with health insurance utilisation were; exposure to mass media, decision making and economic empowerment. Low decision making (AOR=1.195, 95% CI: 0.897-1.592), and low economic empowerment (AOR=1.128, 95% CI: 0.986-1.290) had a positive association with health insurance coverage, while high exposure to media had a negative association (AOR=0.664, 95% CI: 0.522-0.845). Other factors that were significant include; educational level, wealth index, residence, region, household size, and household head. Conclusions: Improving women's access to health facilities as well as media material tailored to the specific knowledge gaps could significantly increase enrolment rates of Rwandan women to health insurance.
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Article
Making financial decisions for the household is an important component of married life in the domestic sphere. It relates to making decisions about children's health, family relationships, and happiness. This study used a cross-sectional quantitative research design and the survey as a method for data collection. The focus of the current study was to learn about spouses' autonomy in making domestic economic decisions. There were three groups in the study: employed husband and non-employed wife, both husband, and wife working, and employed wife and husband with no stable income. The sample comprises 200 participants that were chosen using convenient as well as snowball sampling procedures. The respondents were chosen from various parts of Lahore. A self-constructed and self-generated questionnaire was used by taking help from the women autonomy measurement scale and J-PAL guidelines for measuring women and girls' empowerment. Independent t-tests and One-way ANOVA were used to find out the results. The outcomes specified that due to current transitions, and trends both married partners experienced a change in their autonomy and, in most of the cases, there is an improved autonomy of wives in the financial domestic decision.
Article
Making financial decisions for the household is an important component of married life in the domestic sphere. It relates to making decisions about children's health, family relationships, and happiness. This study used a cross-sectional quantitative research design and the survey as a method for data collection. The focus of the current study was to learn about spouses' autonomy in making domestic economic decisions. There were three groups in the study: employed husband and non-employed wife, both husband, and wife working, and employed wife and husband with no stable income. The sample comprises 200 participants that were chosen using convenient as well as snowball sampling procedures. The respondents were chosen from various parts of Lahore. A self-constructed and self-generated questionnaire was used by taking help from the women autonomy measurement scale and J-PAL guidelines for measuring women and girls' empowerment. Independent t-tests and One-way ANOVA were used to find out the results. The outcomes specified that due to current transitions, and trends both married partners experienced a change in their autonomy and, in most of the cases, there is an improved autonomy of wives in the financial domestic decision.
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This paper focuses on the elicitation of factors that determine the health-seeking behavior and healthcare access of married women living in both rural-urban areas of Bangladesh. A sample survey comprised of 357 women was conducted on two municipality wards and two villages under four districts of Bangladesh. Major findings demonstrate that education, employment, income and knowledge of illnesses, family type, and location of residence of both the married women (respondents) and their husbands increase their access to health care. Data confirms that health seeking behavior depends on a combination of social, personal, familial, and cultural and experience factors. The process of responding to illness or seeking care involves multiple steps and can rarely be termed as choices or acts. Since married women are the dependants on their husband in Bangladesh, this status sometimes pushes them to ignore health-care-seeking during their illness. Private practices of medical professionals claim more out-of-pocket expenses that go beyond their capabilities. Though government and non-government organizations have been trying to provide basic healthcare to vulnerable populations like rural poor women but the essential cares are out of their hands. Male family members are not enough conscious about the concomitant health hazards and seriousness of diseases of women. In contrary, healthcare access of married women is reportedly deterred by husbands' family members. Finally, the study concludes that health-seeking behavior and healthcare access evidently depends on multifarious factors as resultant of a person, family and community identity. But data of women's health is hardly traced in detail in Bangladesh. Therefore, there is a crucial need to continue this type of study in Bangladesh as well as to test its reliability in future.
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Background: Autonomy of women in health care decision-making is tremendously crucial for improved maternal health outcomes and women’s empowerment. Women with greater freedom of movement are more likely to receive maternal health services. However, little has been investigated about women’s autonomy in maternal health care decision-making and contributing factors in Ethiopia. The aim of this study was to assess decision-making autonomy on maternal health care services utilization and associated factors among women. Methods: A community-based cross-sectional study was conducted in Mettu rural Woreda, Ilu Aba Bor zone, southwest Ethiopia from June 19 to August 20, 2021. Data was collected using a pretested interviewer-administered questionnaire from 541 randomly selected women. The collected data was entered into Epi-Data version 3.1 and exported to SPSS version 22 for analysis. Bivariate and multivariate logistic regression was used to identify factors associated with women's decision-making autonomy on maternal health service utilization. The significance of association was declared by using the odds ratio with a 95% confidence interval and a p-value less than 0.05 in the multivariable model. Results: Out of 522 women included in the analysis, 322 (60.5%) (95% CI: 56.2%-64.7%) were found to be autonomous on maternal health service utilization. Age category from 30-39 years, AOR=4.27 (95%CI: 1.59-11.43), attending primary education and above, AOR=3.87 (95%CI: 2.15-6.99), greater than five family size, AOR=0.25 (95%CI: 0.15-0.41), and distance from the health facility, AOR=5.33 (95%CI: 2.50-11.33) were significantly associated with women's decision-making autonomy on maternal health care services utilization. Conclusion: Even though every woman has the right to participate in her own health care decision-making, around two fifths of them have no role in making health care decisions about their own health. Socio-demographic factors like age and education were found to influence women’s autonomy. Special attention has to be given to women living in rural areas in order to reduce their dependency through education.
Article
Objective This study aimed to examine the impact of maternal decision-making autonomy and self-reliance in accessing health care on childhood diarrhea and acute respiratory tract infection (ARI) in Nepal. Study design This was a cross-sectional study. Methods This study used data from the Nepal Demographic and Health Survey 2016. Mothers aged 15–49 years provided information about the health of 5308 children included in this analysis. Composite measures of maternal decision-making autonomy and self-reliance in accessing health care were used as exposure variables. Childhood diarrhea and ARI in the 2 weeks preceding the survey were primary outcome variables. Descriptive statistics and multivariable survey-weighted logistic regression methods were used in the analyses. Results Maternal decision-making autonomy was high for approximately one-fourth (24.7%) of the children's mothers, and 81.7% of children's mothers reported self-reliance in accessing health care as a big problem. Diarrhea among children in the prior 2 weeks was reported among 8% (95% confidence interval [CI]: 6.9–8.4), whereas ARI was reported among 22% (95% CI: 21.1–23.5). The children of women who viewed a lack of self-reliance as a big problem had a 88% (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.26–2.82, P < 0.01) higher odds of diarrhea and 59% (aOR = 1.59, 95% CI: 1.29–1.95, P < 0.001) higher odds of ARI compared with children of women who did not view self-reliance as a big problem. Conclusions The study found a significant effect of maternal self-reliance in accessing health care on childhood diarrhea and ARI, independent of other sociodemographic factors. Improvement in maternal self-reliance in accessing health care of women is essential, particularly their autonomy with regard to healthcare seeking behavior and financial empowerment.
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Background: The prevalence of contraception among married women, evaluated at 23%, is low in Cameroon. Maternal death rates, estimated at 782 deaths per 100,000 live births, are very worrying. The National Strategic Plan for Reproductive, Maternal, Newborn and Child Health (2015-2020) and the Health Sector Strategy (2016-2027) focuses on increasing modern contraceptive prevalence as a means to reduce maternal death. This paper identifies women’s bargaining power as a factor that may stimulate contraceptive use. The objective of this study is to analyze the association between women's bargaining power within couples and modern contraceptive use. Methods: The data used come from the fifth Demographic and Health Survey (DHS) conducted in 2018. Women’s bargaining power within couple is measured by a Woman Bargaining Power Composite Index (WBPCI) built through a multiple correspondence analysis. The logistic regression model was used to analyze the relationship between WBPCI and modern contraceptive use. Results: The results of the descriptive statistics show that women's bargaining power is higher among women who use contraception than for those who do not. The results of the logistic regression model show that an increase of WBPCI was significantly associated with higher chances of using a modern contraceptive method (OR = 1.352; 95% CI: 1.257, 1.454; p <0.01). The education of women is also a key determinant since educated women were at least two times more likely to use a modern contraceptive method than uneducated women. Conclusions: To reduce high maternal death rates in Cameroon, public health policies should not only focus on the health system itself, but should also focus on social policies to empower women in the household.
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Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996–2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10–19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10–15 years old) were more likely to be underweight (+11 pp), have lower education (−24 pp), have less decision‐making power (−10 pp), live in poorer households (−0.9 SD) with poorer sanitation (−15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (−3 to −24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height‐for‐age Z‐scores (−0.29 SD for young and −0.10 SD for old adolescents (16–19 years old)), weight‐for‐age Z‐score (−0.18 and −0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth. Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys. Our analysis demonstrates that birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition.
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There has been an increasing availability and accessibility of modern health services in rural Bangladesh over the past decades. However, previous studies on the socioeconomic differentials in the utilization of these services were based on a limited number of factors, focusing either on preventive or on curative modern health services. These studies failed to collect data from remote rural areas of the different regions to examine the socioeconomic differentials in health-seeking behavior. Data from 3,498 randomly selected currently married women from three strata of households within 128 purposively chosen remote villages in three divisions of Bangladesh were collected in 2006. This study used bivariate and multivariate logistic analyses to examine both curative and preventive health-seeking behaviors in seven areas of maternal and child health care: antenatal care, postnatal care, child delivery care, mother's receipt of Vitamin A postpartum, newborn baby care, care during recent child fever/cough episodes, and maternal coverageby tetanus toxoid (TT). A principal finding was that a household's relative poverty status, as reflected by wealth quintiles, was a major determinant in health-seeking behavior. Mothers in the highest wealth quintile were significantly more likely to use modern trained providers for antenatal care, birth attendance, post natal care and child health care than those in the poorest quintile (chi2, p < 0.01). The differentials were less pronounced for other factors examined, such as education, age, and the relative decision-making power of a woman, in both bivariate and multivariate analyses. Within rural areas of Bangladesh, where overall poverty is greater and access to health care more difficult, wealth differentials in utilization remain pronounced. Those programs with high international visibility and dedicated funding (e.g., Immunization and Vitamin A delivery) have higher overall prevalence and a more equitable distribution of beneficiaries than the use of modern trained providers for basic essential health care services. Implications of these findings and recommendations are provided.
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Objectives: This paper sought to identify factors associated with modes of delivery assistance among adolescent mothers in rural Bangladesh. Methodology: Bangladesh Demographic and Health Survey of 2004 data for the last 5 years (N = 867) were used. Univariate statistical analysis and multivariate logistic regression methods were employed in analyzing the data. Results: We observed that almost all adolescent deliveries (93.6 %) took place at home, and most (80.1%) were assisted by untrained traditional birth attendants, relatives or neighbours. Only 8.8% were attended by medically trained persons. Main factors affecting delivery practices among adolescents were mass media exposure, parents' education, antenatal care received, type of toilet facilities and visits by family planning workers (FPW), wanted last child and told about pregnancy complications. Conclusions: RESULTS indicate several policy options to improve outcomes for adolescent mothers: (a) create awareness of appropriate behaviours during pregnancy, delivery and post-partum period, (b) ensure maternal healthcare centres are available, especially rurally, for antenatal care, expand and improve the quality of home births by trained providers and introduce post-partum visits, (c) increase the number of visits by family welfare visitors/family welfare assistants (FWV/FWA), and (d) emphasize adolescent education to make a lasting impact on the overall health of adolescent mothers.
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Bangladesh has achieved important health gains over the last decade but there is still an enormous gap between rural and urban areas with regard to utilization of reproductive health care services. The study utilizes Bangladesh Demographic and Health Survey (BDHS) 2004 data to identify the more important factors affecting ante-natal health care services in the urban and rural areas. Findings reveal that there exist strong urban-rural differentials of receiving antenatal care. It was found that three quarters of urban women receive antenatal care compared to only half of their rural counterparts. Doctors form the highest proportion of antenatal care providers. The mean number of antenatal visits is higher among urban mothers than that of their rural counterparts. The study also unveils that the majority of urban mothers have their blood pressure and weight measured during pregnancy period while the corresponding figure for rural mothers is found to be low. Logistic regression analysis shows that a mother's education, children ever born, wealth index, telling about pregnancy complications and permission to go to hospital/health center are the significant determinants of receiving ANC. Other significant determinants include the source of drinking water, the region and the husband's education.
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To examine determinants of maternal mortality and assess the effect of programmes aimed at increasing the number of births attended by health professionals in two districts in West Java, Indonesia. We used informant networks to characterize all maternal deaths, and a capture-recapture method to estimate the total number of maternal deaths. Through a survey of recent births we counted all midwives practising in the two study districts. We used case-control analysis to examine determinants of maternal mortality, and cohort analysis to estimate overall maternal mortality ratios. The overall maternal mortality ratio was 435 per 100,000 live births (95% confidence interval, CI: 376-498). Only 33% of women gave birth with assistance from a health professional, and among them, mortality was extremely high for those in the lowest wealth quartile range (2303 per 100,000) and remained very high for those in the lower middle and upper middle quartile ranges (1218 and 778 per 100,000, respectively). This is perhaps because the women, especially poor ones, may have sought help only once a serious complication had arisen. Achieving equitable coverage of all births by health professionals is still a distant goal in Indonesia, but even among women who receive professional care, maternal mortality ratios remain surprisingly high. This may reflect the limitations of home-based care. Phased introduction of fee exemption and transport incentives to enable all women to access skilled delivery care in health centres and emergency care in hospitals may be a feasible, sustainable way to reduce Indonesia's maternal mortality ratio.
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Despite various international efforts initiated to improve maternal health, more than half a million women worldwide die each year as a result of complications arising from pregnancy and childbirth. This research was guided by the following questions: 1) How does women's autonomy influence the choice of place of delivery in resource-poor urban settings? 2) Does its effect vary by household wealth? and 3) To what extent does women's autonomy mediate the relationship between women's education and use of health facility for delivery? The data used is from a maternal health study carried out in the slums of Nairobi, Kenya. A total of 1,927 women (out of 2,482) who had a pregnancy outcome in 2004-2005 were selected and interviewed. Seventeen variable items on autonomy were used to construct women's decision-making, freedom of movement, and overall autonomy. Further, all health facilities serving the study population were assessed with regard to the number, training and competency of obstetric staff; services offered; physical infrastructure; and availability, adequacy and functional status of supplies and other essential equipment for safe delivery, among others. A total of 25 facilities were surveyed. While household wealth, education and demographic and health covariates had strong relationships with place of delivery, the effects of women's overall autonomy, decision-making and freedom of movement were rather weak. Among middle to least poor households, all three measures of women's autonomy were associated with place of delivery, and in the expected direction; whereas among the poorest women, they were strong and counter-intuitive. Finally, the study showed that autonomy may not be a major mediator of the link between education and use of health services for delivery. The paper argues in favor of broad actions to increase women's autonomy both as an end and as a means to facilitate improved reproductive health outcomes. It also supports the call for more appropriate data that could further support this line of action. It highlights the need for efforts to improve households' livelihoods and increase girls' schooling to alter perceptions of the value of skilled maternal health care.
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The objective was to provide a systematic review of the effectiveness of community-level interventions to reduce maternal mortality. We searched published papers using Medline, Embase, Cochrane library, CINAHL, BNI, CAB ABSTRACTS, IBSS, Web of Science, LILACS and African Index Medicus from inception or at least 1982 to June 2006; searched unpublished works using National Research Register website, metaRegister and the WHO International Trial Registry portal. We hand searched major references.Selection criteria were maternity or childbearing age women, comparative study designs with concurrent controls, community-level interventions and maternal death as an outcome. We carried out study selection, data abstraction and quality assessment independently in duplicate. We found five cluster randomised controlled trials (RCT) and eight cohort studies of community-level interventions. We summarised results as odds ratios (OR) and confidence intervals (CI), combined using the Peto method for meta-analysis. Two high quality cluster RCTs, aimed at improving perinatal care practices, showed a reduction in maternal mortality reaching statistical significance (OR 0.62, 95% CI 0.39 to 0.98). Three equivalence RCTs of minimal goal-oriented versus usual antenatal care showed no difference in maternal mortality (1.09, 95% CI 0.53 to 2.25). The cohort studies were of low quality and did not contribute further evidence. Community-level interventions of improved perinatal care practices can bring about a reduction in maternal mortality. This challenges the view that investment in such interventions is not worthwhile. Programmes to improve maternal mortality should be evaluated using randomised controlled techniques to generate further evidence.
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Maternal health services have a potentially critical role in the improvement of reproductive health. In order to get a better understanding of adolescent mothers'needs we compared health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood in Wakiso district, Uganda. This was a cross-sectional study conducted between May and August, 2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult) were interviewed using a structured questionnaire. We calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. STATA V.8 was used for data analysis. Adolescent mothers were significantly more disadvantaged in terms of health care seeking for reproductive health services and faced more challenges during pregnancy and early motherhood compared to adult mothers. Adolescent mothers were more likely to have dropped out of school due to pregnancy (OR = 3.61, 95% CI: 2.40-5.44), less likely to earn a salary (OR = 0.43, 95%CI: 0.24-0.76), and more likely to attend antenatal care visits less than four times compared to adult mothers (OR = 1.52, 95%CI: 1.12-2.07). Adolescents were also more likely to experience violence from parents (OR = 2.07, 95%CI: 1.39-3.08) and to be stigmatized by the community (CI = 1.58, 95%CI: 1.09-2.59). In early motherhood, adolescent mothers were less likely to seek for second and third vaccine doses for their infants [Polio2 (OR = 0.73, 95% CI: 0.55-0.98), Polio3 (OR = 0.70: 95% CI: 0.51-0.95), DPT2 (OR = 0.71, 95% CI: 0.53-0.96), DPT3 (OR = 0.68, 95% CI: 0.50-0.92)] compared to adult mothers. These results are compelling and call for urgent adolescent focused interventions. Adolescents showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatization and violence, suggesting bigger challenges to the adolescent mothers in terms of social support. Adolescent friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented.
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In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or "modern") health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.
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Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers. This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator--two or more visits versus less--masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75th percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25th percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.
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The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.
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Bangladesh typifies many south-eastern countries where female children experience inferior health and uncertain survival, especially after the neonatal period. This paper attempts to study the gender inequality in nutritional status and the effects of various socioeconomic, demographic, and health-programme factors on gender inequality in a remote rural area of Bangladesh. Measurements of mid-upper arm circumference (MUAC) were taken from 2,016 children aged less than 5 years (50.8% male, 49.2% female) in 1994. Children were characterized as severely malnourished if MUAC was < 125 mm. Independent variables included various characteristics of children, households, and mothers. Average MUAC for all children was 130 mm; 33% were severely malnourished. Of the severely-malnourished children, 54.2% were female, and 45.8% were male. The gender gap persisted in the multivariate situation, with female 1.44 times more likely to be severely malnourished. Other variables with a statistically significant relationship included the age of children, acceptance of DPT1, and education of household heads. The persistence of such a gender discrimination now when the country has achieved a lot in terms of child survival is striking. The issue is important and demands appropriate corrective actions.
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Although gender inequality is often cited as a barrier to improving maternal health in Nepal, little attention has been directed at understanding how sociocultural factors may influence the use of health care. In particular, how a woman's position within her household may affect the receipt of health care deserves further investigation. Data on ever-married women aged 15-49 from the 2001 Nepal Demographic and Health Survey were analyzed to explore three dimensions of women's position within their household-decision making, employment and influence over earnings, and spousal discussion of family planning. Logistic regression models assessed the relationship of these variables to receipt of skilled antenatal and delivery care. Few women reported participation in household decision making, and even fewer had any control over their own earnings. However, more than half reported discussing family planning with their husbands, and there were significant differences among subgroups in these indicators of women's position. Though associations were not consistent across all indicators, spousal discussion of family planning was linked to an increased likelihood of receiving skilled antenatal and delivery care (odds ratios, 1.4 and 1.3, respectively). Women's secondary education was also strongly associated with the greater use of health care (5.1-5.6). Gender inequality constrains women's access to skilled health care in Nepal. Interventions to improve communication and strengthen women's influence deserve continued support. The strong association of women's education with health care use highlights the need for efforts to increase girls' schooling and alter perceptions of the value of skilled maternal health care.
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Although the reduction of maternal mortality levels is a key Millennium Development Goal, community-based evidence on obstetric complications and maternal care-seeking behavior remains limited in low-resource countries. This study presents an overview of key findings from the 2001 Bangladesh Maternal Health Services and Maternal Mortality Survey of ever-married women aged 13-49. The survey collected data on the prevalence of obstetric complications, women's knowledge of life-threatening complications, treatment-seeking behavior and reasons for delay in seeking medical care. Bangladeshi women report low but increasing use of antenatal care, as well as low rates of delivery in a health facility or with the assistance of a skilled provider. Although almost half of women reported having one or more complications during pregnancy that they perceived as life threatening, only one in three sought treatment from a qualified provider. More than three-fourths of women with the time-sensitive complications of convulsions or excessive bleeding either failed to seek any treatment or sought treatment from an unqualified provider. The principal reason cited for failing to seek care for life-threatening complications was concern over medical costs, and pronounced socioeconomic disparities were found for maternal care-seeking behavior in both urban and rural Bangladesh. Despite these gaps in access to skilled delivery and effective emergency obstetric care, some progress has been made in reducing maternal mortality levels. Improved obstetric care and declining levels of fertility and unwanted pregnancy may have played critical roles in addressing the maternal health care needs of Bangladeshi women.
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This paper examines gender inequalities of health in Third World Countries. Health hazards are present at every stage of a woman's life cycle. Health problems which pose the greatest hardship to women in these countries include: reproductive health problems, excess female mortality in childhood, violence against girls and women, occupational and environmental hazards, and cervical and breast cancer. Many of these lead to maternal mortality which was the most focussed upon indicator of women's health in the literature. Gender inequalities of health originate in the traditional society where definitions of health status and traditional medical practices all reflect the subordinate social status of women. Gender inequalities in health are manifested in traditional medical practices which attribute women's illnesses to behavioral lapses by women; differential access to and utilization of modern healthcare services by women and girls, including maternal care, general healthcare, family planning and safe abortion services. Reasons for gender inequalities in health include--emphasis on women's childbearing roles resulting in early and excessive childbearing; sex preference manifested in discrimination against female children in health and general care; women's workloads which not only expose them to health hazards but also make it difficult for them to take time off for healthcare; lack of autonomy by women leading to lack of decision-making power and access to independent income; early marriage which exposes women to the complications of early and excessive childbearing. Gender inequality in health is one of the social dimensions in which gender inequality is manifested in Third World societies. Strategies to eradicate gender inequalities in health must therefore involve efforts to improve the status of women.
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OBJECTIVE: To examine determinants of maternal mortality and assess the effect of programmes aimed at increasing the number of births attended by health professionals in two districts in West Java, Indonesia. METHODS: We used informant networks to characterize all maternal deaths, and a capture-recapture method to estimate the total number of maternal deaths. Through a survey of recent births we counted all midwives practising in the two study districts. We used case-control analysis to examine determinants of maternal mortality, and cohort analysis to estimate overall maternal mortality ratios. FINDINGS: The overall maternal mortality ratio was 435 per 100 000 live births (95% confidence interval, CI: 376-498). Only 33% of women gave birth with assistance from a health professional, and among them, mortality was extremely high for those in the lowest wealth quartile range (2303 per 100 000) and remained very high for those in the lower middle and upper middle quartile ranges (1218 and 778 per 100 000, respectively). This is perhaps because the women, especially poor ones, may have sought help only once a serious complication had arisen. CONCLUSION: Achieving equitable coverage of all births by health professionals is still a distant goal in Indonesia, but even among women who receive professional care, maternal mortality ratios remain surprisingly high. This may reflect the limitations of home-based care. Phased introduction of fee exemption and transport incentives to enable all women to access skilled delivery care in health centres and emergency care in hospitals may be a feasible, sustainable way to reduce Indonesia's maternal mortality ratio.
Article
In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or "modern") health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.
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Abstract Utilisation of health services is a complex behavioural phenomenon. Empirical studies of preventive and curative services in Bangladesh have often showed that the use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. The present paper attempts to examine factors associated with the utilisation of healthcare services during the postnatal period in Bangladesh by using prospective data from a survey on maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERT). Both bivariate and multivariate analyses of the data confirmed that the mother's age at marriage had a significant and positive impact on the utilisation of quality healthcare services. The husband's occupation also showed a strong impact on healthcare utilisation, indicating higher use of quality care for postpartum morbidity by wives of business and service workers. The bivariate analysis showed that the number of pregnancies prior to the index pregnancy and desired pregnancies are significantly associated with the utilisation of postpartum healthcare. However, the results of this study were inconclusive on the influence of other predisposing and enabling factors, such as maternal education, the number of previous pregnancies, the occupation of the husband, antenatal care visits during pregnancy and access to health facilities. Multivariate logistic regression estimates did not show any significant impact of these factors on the use of maternal healthcare.
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This article discusses the third Millennium Development Goal (MDG), on gender equality and women's empowerment. It explores the concept of women's empowerment and highlights ways in which the indicators associated with this Goal – on education, employment, and political participation – can contribute to it.
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Although women constitute about half of the Bangladesh population, their social status especially in rural areas remains very low. Rural women belong to the most deprived section of the society facing adverse conditions in terms of social oppression and economic inequality, a visible majority of them being extremely poor. Considering this scenario, this paper investigates the nature and extent of rural women's empowerment and factors influencing it. The paper further outlines a strategic framework for enhancing rural women's empowerment. The methodology of this study is an integration of quantitative and qualitative methods based on data collected in three villages of Mymensingh district. Six key indicators of empowerment covering three dimensions were chosen for this purpose. Data were collected from 156 respondents during January-April 2003 following stratified random sampling. Finally, a cumulative empowerment index (CEI) was developed adding the obtained scores of six empowerment indicators. The distribution of empowerment indicators show that 83% of the women have a very low to low economic contribution, 44% have a very low to low access to resources, 93% have a very poor to poor asset ownership, 73% have a moderate to high participation in household decision-making, 43% have a highly unfavourable to unfavourable perception on gender awareness and 72% have a moderate to high coping capacity to household shocks. The distribution of CEI demonstrates that the majority of rural women have a very low to moderate (82%) level of empowerment. The multiple regression analysis shows that there were strong positive effects of formal and non-formal education, information media exposure and spatial mobility on women's CEI, while traditional socio-cultural norms have a strong negative effect. The study concludes that education, training and exposure to information media have the potential to increase womens empowerment. Therefore, effective initiatives undertaken by the concerned agencies in improving womens education, skill acquisition training and access to information could enhance women's empowerment in order to achieve gender equality and development at all levels in the rural society of Bangladesh.
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This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Care is the provision in the household and the community of time, attention, and support to meet the physical, mental, and social needs of the growing child and other household members. The significance of care has best been articulated in the framework developed by the United Nations Children's Fund (UNICEF). This paper extends the UNICEF model of care and summarizes the literature on the relationship of care practices and resources to child nutrition. The paper also summarizes attempts to measure the various dimensions of care. The concept of care is extended in two directions: first, we define resources needed by the caregiver for care and, second, we show that the child's own characteristics play a role in the kind of care that he or she receives. The literature summary and methodological recommendations are made for six types of resources for care and for two of the least studied care practices: complementary feeding and psychosocial care. The other care practices are care for women, breast-feeding, food preparation, hygiene, and home health practices. Feeding practices that affect a child's nutritional status include adaptation of feeding to the child's abilities (offering finger foods, for example); responsiveness of the caregiver to the child (perhaps offering additional or different foods); and selection of an appropriate feeding context. Psychosocial care is the provision of affection and attention to the child and responsiveness to the child's cues. It includes physical, visual, and verbal interactions.
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This article addresses the hypothesis that predisposing, enabling and need factors of households influence utilisation of postpartum care among the young mothers according to the timing and type of providers. To reach our goal Bangladesh Demographic and Health Survey of 2007 data (n = 2376) were used. Findings revealed that only one-third of the young mothers received postpartum care. Postpartum care by medically trained personnel and within the most critical period (within 48 h after delivery) was found to be very low (25.5 and 16.6%). Regarding postpartum morbidities, only one-fifth to one-half of the women reporting a complication consulted medically trained providers. Indeed, between one third and two thirds did not seek any postpartum care. The highest percentages contacting healthcare providers were for convulsions and the lowest was when the baby's hands or feet came first. The stronger influence of the mother's education and antenatal care on the utilisation of postpartum care is consistent with findings from other studies. Concern of the husband or family about pregnancy complications showed a significant and positive impact on the utilisation of postpartum care. Multivariate analysis showed that mother's age at delivery, residence, education, antenatal care, place of delivery, wealth, husband's occupation, husband's concern about pregnancy complications and mother's permission to go to a health centre alone were likely to affect utilisation of postpartum care services. The results indicate urgent needs in Bangladesh for an awareness-raising program highlighting the importance and availability of postpartum care; for strategies to improve the availability and accessibility of antenatal care services and skilled birth attendance, including focused financial support; for women's education to be given high priority; and to enable women to exercise their rights to control their freedom of movement, own health care and access to economic resources.
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The main goal of antenatal care in developing countries is to identify women whose pregnancy or delivery is likely to raise problems and to refer them at the appropriate time to a hospital facility where the necessary medical equipment and expertise (vacuum extractors, cesarian sections, human skill, etc.) is available. This approach, which is known as the Risk Approach (RA) strategy, is expected to significantly reduce maternal morbidity and mortality. However, the RA will function properly only if the women identified at risk agree to give birth in a hospital on the one hand, and if they can indeed reach this hospital on the other hand. In this article the authors assess to what extent women with a risk of difficult labor (nulliparous or primiparous women under 150 cm, history of previous difficult delivery or stillbirth, women with transverse lie) agreed to give birth in a hospital. This descriptive survey, which covered 5060 pregnancies monitored in the Kasongo District, Maniema, in eastern Zaire, showed that the referral success rate in this socioeconomically very disadvantaged region was only 33%, despite some favorable conditions, such as a strong emphasis on community participation, a complementarity of health centers and hospital, and the absence of financial barriers within the health services system. Of the various hypotheses tested, the geographic accessibility of the hospital and the parturient's perception of the risk status were the two most important factors determining the compliance rate. A stratified analysis shows that the intensity of the parturient's perception has a different impact on compliance whether rural or urban situations are considered.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This report assesses the role of demographic, socioeconomic, and cultural factors in explaining differentials in maternal health-care use in North Africa. Analyses of the Demographic and Health Surveys for Morocco and Tunisia show substantial differences in the use of prenatal care and in the proportion of home compared with hospital births, both within and between the two countries. The findings raise the question of whether lower use rates are a reflection of the low status of women. The question is addressed first through a statistical analysis of the differences within the two countries in terms of the demographic, socioeconomic, and educational characteristics of individuals, and second, through a comparison of the social context, health-care systems, and population policies of the two countries. The findings are interpreted in light of field research on the cultural context of maternal health care.