Measurement of Women's Empowerment in Rural Bangladesh

How does male out-migration impact the lives of left-behind women? Trade-off between feminization of agriculture and empowerment of farm women

Male out-migration has become a key livelihood strategy to diversify farm income in the developing nations. This has a widespread effect in terms of a significant shift in gender roles and a change in the agricultural landscape. Current research frequently depicts the left-behinds as passive recipients of remittances, ignoring their experiences of separation and how they maintain the farm. In this context, present study aimed to evaluate the impact of male outmigration on the feminization of agriculture and empowerment of the left-behind women. Relevant literatures were collected by systematically searching the online databases. By following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards, 25 articles were finalized for the review process. The decision-making ability of the left-behind women on and off the farm was found improved, but it was influenced by the family composition. The feminization of agriculture has been found hampering farm productivity and increasing the drudgery of women. Due to male migration, the autonomy of women has increased to some extent in terms of decision-making, access to resources, and mobility in nuclear family. Understanding the gendered consequences of male out-migration will help to formulate policies and programmes that strengthen the position of left-behind farm women. The empowerment of women on the farm and within the household needs to be discussed beyond the role of gender in agriculture, and the intersectionality of different social factors is important to gain better insight into individual experience that will be pivotal for future programme planning for addressing both the issues of male migration and empowerment of farm women.

Intimate Partner Violence in El Salvador: A Relationship Between Femicide Attempts and Barriers to Help-Seeking

Research has examined the relationship between femicides, understood as the killing of any woman, and intimate partner violence (IPV). Additionally, women have been found to seek out formal help when they deem their experiences to be severe, yet many reasons prevent them from doing so; hindering our ability to interrupt the cycle of violence and further victimization. Using the Salvadoran 2017 Violence Against Women National Survey, this study examines the relationships between femicide attempts, IPV, and formal help-seeking. We find a significant positive relationship between experiencing a femicide attempt and IPV, and specific reasons for not seeking formal help.

Female agency and probable depression in the perinatal period and beyond: Longitudinal findings from rural Pakistan

In Pakistan, a setting with high gender inequality, the relationship between female agency and mental health has not been studied longitudinally or beyond a defined life stage like pregnancy. Using data from the Bachpan cohort of mother-infant dyads in Pakistan, we investigated female agency and depression at two life stages: perinatal (third trimester to 6-months postpartum; n = 1154) and beyond (3- to 4-years postpartum). Modified Poisson models estimated adjusted prevalence ratios (PR) for probable depression (PHQ-9) associated with female agency (freedom of movement and participation in household decision-making) at the two life stages. Among 1154 mothers (average age 26.6 years), female agency was substantially lower during pregnancy than it was at 3-years and depression was more common during postpartum than at 4-years. Low freedom of movement during pregnancy nominally increased the likelihood of postpartum depression (PR: 1.33; 95% CI: 0.98, 1.80). The risk of depression was higher for low- (PR: 1.01; 95% CI: 0.72-1.41) and high- (PR: 1.24; 95% CI: 0.65-2.36) participation in household decision-making compared to moderate, but estimates were imprecise. Results from beyond the perinatal period indicated a stronger relationship between low freedom of movement and subsequent depression (PR: 1.89; 95% CI: 1.12, 3.20; Table 3). Low- (PR: 1.19; 95% CI: 0.67-2.12) and high- (PR: 1.21; 95% CI: 0.67-2.17) decision-making continued to demonstrate a nominal U-shaped relationship with depression, but estimates were imprecise. Overall, restricted freedom of movement beyond the perinatal period, may increase the likelihood of depression. Future research should explore the nuances of participation in decision-making and how it impacts women's mental health.

Prevalence and Determinants of Home Delivery among Women with Easy Access to Health Facilities in Sub‑Saharan African Countries: A Multi‑level Mixed Effect Analysis

Introduction: Most maternal deaths are associated with home deliveries, which account for half of births in low‑income countries. To develop appropriate policies and methods that could aid in addressing the issues, it is important to understand the burden of home delivery despite having easy access to health facilities in low‑income nations such as sub‑Saharan Africa. In addition, identifying and prioritizing determinants could help executives to review their perinatal policies. Therefore, this study aimed at assessing the prevalence and factors associated with home delivery among women who have access to health facilities. Methods: A population‑based cross‑sectional study was done. The most recent Demographic and Health Survey (DHS) data from 22 sub‑Saharan African (SSA) countries from 2015 to 2022 were used. A total weighted samples of 493,396 women who gave birth at home despite having access to health facilities were included in the study. The data were examined using Stata 17. A multi‑level logistic regression model was used to identify factors associated with lactation-home delivery despite easy access to health facility. The adjusted odds ratio at the 95% confidence interval (Cl) was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p‑value of < 0.05 are declared statistically significant. Results: The pooled prevalence of home delivery among women who had easy access to health facilities in 22 SSA countries was 23.67% (95% CI, 23.55-23.79). After adjusting for confounders, being above 35 years, being a rural resident, being from the poorest and lowest wealth quintile, and living in rural regions all increase the likelihood of home birth among women in sub‑Saharan Africa who have easy access to healthcare. Women with higher education, women who have optimal antenatal care (ANC) visits, women involved in healthcare decisions in households, and households with health insurance coverage reduce the odds of home delivery among women who have easy access to health facilities in sub‑Saharan Africa. Conclusion: According to this study, a higher portion of women in sub‑Saharan Africa who had easy access to medical facilities gave birth at home. The study's findings demonstrated that factors at the individual and community levels influence home delivery with easy access to health facilities. Policymakers, the government, health planners, and implementers must therefore understand the burden of the problem and should increase media coverage, enhance health insurance coverage, empower women, and mobilize resources for maternal care.

Malnutrition among under-5 children and its determinants in the southwestern coastal region of Bangladesh: A community-based study

OBJECTIVE

The study examines the prevalence of stunting, the most common form of malnutrition and its determinants among children under-5 in the southwestern coastal region of Bangladesh.

DESIGN

Cross-sectional survey.

SETTINGS

Two coastal villages of the Bagerhat and Khulna districts of Bangladesh.

PARTICIPANTS

Participants were selected using the simple random sampling technique with the following criteria: mothers who had at least one under-5 child and resided in the study area for not less than three consecutive years.

OUTCOME MEASURES

To assess the nutritional status particularly, stunting (height for age) in children under-5, a standardised anthropometric measurement tool, such as a height-measuring vertical scale, was used and categorised into severely stunted, moderately stunted and normal height.

RESULTS

The study found that 57.5% of children were severely and 29% were moderately stunted. Findings revealed that mothers' age, prior experience of under-5 mortality, mothers' working status and age of the children were significant determinants of stunting prevalence among children under-5. Moreover, children of mothers aged 21-30 years (AOR = 2.190; 95% CI: 1.039 to 4.613; p = 0.039) and children of mothers without prior experience of under-5 mortality (AOR = 4.426; 95% CI: 1.461 to 13.405; p = 0.009) were more possibly to be severely and moderately stunted, respectively. Additionally, children of non-working mothers were more likely to be moderately (AOR = 4.037; 95% CI: 1.382 to 11.792; p = 0.011) and severely stunted (AOR = 2.538; 95% CI: 1.033 to 6.238; p = 0.042). Moreover, children aged ≤24 months (AOR = 0.151; 95% CI: 0.034 to 0.661; p = 0.012) and 25-36 months (AOR = 0.195; 95% CI: 0.046 to 0.829; p = 0.027) were less possibly to be moderately stunted.

CONCLUSION

The study recommends training young mothers on effective child-rearing practices, creating income opportunities for women in rural Bangladesh, implementing local awareness programmes about appropriate growth standards for children and expanding facility-based healthcare centres in rural areas for better access to quality healthcare.

The role of community-level men's and women's inequitable gender norms on women's empowerment in India: A multilevel analysis using India's National Family Health Survey-5

BACKGROUND

Lower empowerment of women is a critical social issue with adverse public health implications. In India, deeply ingrained gender norms shape a patriarchal structure that creates systemic disadvantages for women relative to men. These gender norms-socially constructed expectations about the roles, behaviors, and attributes of men and women-perpetuate inequality and limit women's opportunities.

OBJECTIVES

The aim of this study was to examine the association between community-level men's and women's gender norms on women's empowerment in India. Women's empowerment was defined using four measures: freedom of movement, decision-making power, economic empowerment, and health empowerment.

METHODS

Using a nationally representative demographic health survey data from 2019-21 of 63,112 married women who participated in the women's empowerment module and 101,839 men surveyed, we constructed community-level men's and women's inequitable gender norms variables as our independent variable using attitudes towards wife-beating questions. We used random effects logistic regression models to examine if community-level men's and women's inequitable gender norms were independently associated with the different dimensions of women's empowerment.

RESULTS

One standard deviation increase in community-level men's and women's inequitable gender norms was associated with reduced odds of freedom of movement, decision-making power, and health empowerment. No statistically significant association was observed between community-level men's and women's gender norms and economic empowerment.

CONCLUSION

Inequitable gender norms are a risk factor that is negatively associated with several dimensions of women's empowerment. Our findings support our hypotheses that women's empowerment is impacted separately by men's and women's gender norms. Our study underscores the pressing need for concerted efforts to challenge and transform inequitable gender norms, paving the way for achieving gender equality and women's empowerment, as envisioned by the Sustainable Development Goals.

Construction of women's empowerment index for Bangladesh

Introduction

This study is dedicated to refining and enhancing the measurement model of women's empowerment in Bangladesh. Women's empowerment, a crucial and multifaceted aspect of societal growth, is often hindered by gender disparities. This is particularly evident in societies like Bangladesh, where women face inequalities in education, economic opportunities, and decision-making power. To address these disparities effectively, it is essential to have a comprehensive understanding of women's empowerment. Therefore, this study aims to refine and enhance the measurement model to capture the multifaceted nature of women's empowerment accurately.

Methods

To gather data for this study, a structured questionnaire was administered to married women of reproductive age (15-49) in eight Mouza/Mohalla in Dhaka, Bangladesh. This unique approach allowed us to capture a diverse range of perspectives. We used thirty-three indicators across economic, socio-cultural, household, and psychological dimensions to measure women's empowerment. The sample data were then randomly divided for exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) to identify and validate a comprehensive multidimensional framework.

Results

Out of 625 respondents, only 36% of women worked, and ~39% married before age 18. Employing thirty-three items in EFA led to identifying eight critical factors (economic independence, control over household financial decisions, household decision-making, reproductive decision-making, freedom of movement, media exposure, positive self-esteem, and negative self-esteem). These factors, which explained 72.661% of the total variance in the data, provide a practical framework for understanding and addressing women's empowerment. Each component was then divided into two sub-dimensions to acquire a better understanding. The CFA indicated a good model fit for each dimension, and convergent and discriminant validity assessments were used to establish reliability and validity, further enhancing the practical implications of our findings.

Conclusions

The results of our rigorous exploratory and confirmatory factor analyses not only confirmed the sample structures and internal consistency but also provided significant insights. The findings suggested an adequate fit for all CFA models, indicating the robustness of our measurement model. According to the CFA results, each dimension's variables are satisfactory, and all the dimensions can be combined to create a single index measuring women's empowerment. This comprehensive understanding of women's empowerment, with its specific dimensions and factors, equips policymakers and practitioners with the knowledge to develop a wide range of interventions appropriate to particular facets of empowerment, thereby fostering societal growth and gender equality.

The effect of Transcendental Meditation on self-esteem, self-efficacy, and gratitude, for increasing empowerment of female youth in Uganda

This longitudinal study with female youth in the slums of Kampala, Uganda (n = 130), explored the impact of the Transcendental Meditation® (TM®) technique on self-esteem, the primary outcome measure, and self-efficacy, gratitude, hope, tiredness, and resilience as secondary outcomes. Quality-of-life behaviors were also assessed, including excessive alcohol use. After baseline testing participants learned TM over five consecutive days. Participants practiced TM at home for 20 min twice a day and attended two follow-up sessions. Post-testing occurred at five months. Significant improvements in self-esteem (p < .001), self-efficacy (p < .001), gratitude (p < .001), and tiredness (p = .05) were found. A decrease in excessive alcohol use was also observed (p = .02). At eight months a short answer questionnaire showed improved physical health, decreased stress and anxiety levels, and improved relationships in the family and community. Our findings have important implications for enhancing the well-being and empowerment of these vulnerable female youth.

Women's participation in household decision-making: Qualitative findings from the Shonjibon Trial in rural Bangladesh

A key element of women's empowerment is the ability to participate in household decision-making. This study presents the qualitative results from the Shonjibon Cash and Counselling Trial baseline process evaluation with the aim of exploring the status of women's decision-making at the trial's outset and to facilitate the exploration of any changes in women's empowerment over the course of the trial. Between January and March 2021, we conducted forty-one in-depth interviews with pregnant women in rural Bangladesh. The research team translated, transcribed, coded, and discussed the interviews. We used thematic analysis to examine women's experience and perceptions on household decision-making. The key findings that emerged; women jointly participated in financial decision-making with their husbands; men made the final decision regarding seeking healthcare, and women solely made choices regarding infant and young child feeding. Our findings revealed that women felt that they needed to discuss their plans to go outside the house with their husbands, many perceived a lack of importance in the community towards women's participation in decision-making. This study documents current contextual information on the status of women's involvement in household decision-making and intrahousehold power dynamics at the start of the Shonjibon Cash and Counselling Trial.

Migration, Gender, and Families: The Effects of Spousal Migration on Women's Empowerment

Labor migration has a profound effect on families, but evidence documenting the impact of migration on women left behind is still lacking. Utilizing the Matlab Health and Socioeconomic Surveys, we examined the roles of migration and families in four domains of empowerment for women in Bangladesh. We found that women with international migrant spouses saw significant improvements in economic empowerment, mobility, and decision-making relative to women with coresident spouses (p < .0001). However, women who lived in multigenerational households with their parents or in-laws experienced significant reductions in empowerment across these three domains. Both having a migrant spouse and living in a multigenerational household had negative effects on beliefs about gender equivalence and reduced joint decision-making for women. Results, which were robust to migration selection controls (including propensity approaches), indicate that the benefits of migration for women left behind might be diluted by family structures that perpetuate unequal gender dynamics.

Assessing women's empowerment, participation, and engagement in aquaculture in Bangladesh

Women's empowerment and gender equality are key goals for development and human rights. However, a significant gap still exists in achieving these twin goals. Formulating appropriate strategies for women's empowerment requires first understanding context-specific patterns and sources of disempowerment. We use data collected using a questionnaire survey from 1653 households in Rangpur and Rajshahi districts in Bangladesh. Guided by an analytic tool that measures women's empowerment, inclusion and agency (the project level Women's Empowerment in Fisheries and aquaculture Index (pro-WEFI)), and using seven empowerment indicators, we provide findings on the status of women's empowerment, participation, and engagement in aquaculture in Bangladesh. Results show that women were highly involved in making household decisions, mainly jointly with their husbands. However, data suggest a substantial gap in women's access to financial services, in participation in aquaculture activities, and in access to and control over productive capital and remuneration for aquaculture labor. Finally, despite some women achieving adequacy on some indicators, most women in fish farming households in Bangladesh lack adequacy on many of the selected indicators.

Influence of type of violence on women's help-seeking behaviour: Evidence from 10 countries in sub-Saharan Africa

BACKGROUND

Intimate partner violence (IPV) is a major public health concern that mostly impacts women's health and social well-being. This study explored how the various types of IPV (physical, sexual, and emotional) including women's experience of childhood violence influence their help-seeking behavior in sub-Saharan Africa (SSA).

METHODS

We analyzed data from the most recent Demographic and Health Surveys (DHS), carried out between 2018 and 2021. The outcome variable was help-seeking behavior. Descriptive and inferential analyses were carried out. The descriptive analysis looked at the bivariate analysis between the country and outcome variables. Using a binary logistic regression model, a multivariate analysis was utilized to determine the association between the outcome variable and the explanatory variables. Binary logistic regression modelling was used based on the dichotomous nature of the outcome variable. The results were sample-weighted to account for any under- or over-sampling in the sample.

RESULTS

The proportion of women who sought help for intimate partner violence was 36.1 percent. This ranged from 19.2 percent in Mali to 49.6 percent in Rwanda. Women who experienced violence in childhood (OR = 0.75, CI = 0.69, 0.82) have a lower likelihood of seeking help compared to those who did not experience violence in their childhood. Women who had experienced emotional violence (OR = 1.94, CI = 1.80, 2.08), and physical violence (OR = 1.37, CI = 1.26, 1.48) have a higher likelihood of seeking help compared to those who have not. Women with secondary educational levels (aOR = 1.13, CI = = 1.02, 1.24) have a higher likelihood of seeking help compared to those with no education. Cohabiting women have a higher likelihood (aOR = 1.22, CI = 1.10, 1.35) of seeking help compared to married women.

CONCLUSION

The study highlights the importance of early identification of IPV and fit-for-purpose interventions to demystify IPV normalization to enhance women's willingness to seek help. The study's findings suggest that education is crucial for increasing women's awareness of the legalities surrounding IPV and available structures and institutions for seeking help.

Women's Empowerment in the Context of Rural West Bengal: An Index Construction with Exploratory Factor Analysis

Background

Women's empowerment, a precondition of sustainable development, is a multidimensional and complex concept, often described with three interrelated components: resources, agency, and achievement. There is no universal construct for women's empowerment; rather, it has been assessed based on the context. It had been hardly explored in rural West Bengal.

Objectives

This study was formulated to construct a women's empowerment index (WEI), in rural West Bengal, and assess the reliability of the index.

Methods

A community-based cross-sectional study focusing on Women's Empowerment, Child Health and Nutrition (WE-CHANT) was conducted in a community development block in West Bengal. Mother (of reproductive age)-child (6-59 months) pairs were recruited from 20 villages by two-stage sampling (n = 268). Mothers were interviewed. Exploratory factor analysis (EFA) with oblique rotation was conducted with 25 measurement variables to construct the WEI. The internal consistency was assessed with Cronbach's alpha, item-rest, average inter-item, inter-domain, and domain-to-index correlation.

Results

A 12-item (factor loading ≥0.40) WEI comprising three domains-decision-making power, attitude toward gender-based violence (GBV), and social independence-was constructed with acceptable internal consistency (Cronbach's alpha = 0.747). The multidimensionality of the index was also observed.

Conclusion

A concise agency-based WEI was constructed, where decision-making power was explored as the major domain. This index in the context of rural West Bengal could be further utilized to assess women's empowerment and elicit its association with resources and achievements.

Reimagining gendered community interventions: the case of family planning programs in rural Bangladesh

Family planning programs in Bangladesh have been successfully operating for over half a century, achieving phenomenal reductions in fertility rates. Acknowledging restrictions on women's freedoms, much of the initial program design was concentrated on giving household supplies for women priority. However, one unfortunate impact of these outreach services is that, by bypassing the opportunity to challenge patriarchal attitudes directly, they inadvertently reinforce the power relationships of the status quo. Hence, we problematise the decision-making structures within Bangladesh's family planning programs. We argue that the fundamental flaw with Bangladesh's family planning program is the lack of conscious effort to understand women's health choices and decision-making as a complex contextual process of relational, structural, and institutional forces. Additionally, avoiding men in these programs often creates new dependencies for women, as this approach does not directly seek to build relational bridges based on equality between genders. As a result, many women still depend on permission from their husbands and family for reproductive health services and face constrained family planning choices and access to care. We recommend that family planning programs adopt a broader vision to create new and more sustainable possibilities in an ever-evolving social relations landscape where gender is constantly negotiated. Such strategies are even more pressing in the post-Covid world, as national systems are exposed to uncertainty and ambiguity.

Exploring spousal disparities: Age, earnings, and education as predictors of intimate partner violence in 29 developing countries

BACKGROUND

Intimate partner violence (IPV) is widespread and is influenced by individual-specific factors. However, the impact of spousal sociodemographic disparities (age, earnings, education) remains understudied.

OBJECTIVES

This study investigates the relationship between spousal sociodemographic disparities and women's IPV experiences in 29 developing countries in South Asia, Sub-Saharan Africa, and the Middle East and North Africa.

DESIGN

We used a cross-sectional design, analyzing data from the Integrated Public Use Microdata Series-Demographic and Health Surveys (IPUMS-DHS).

METHODS

We conducted logistic regression to assess associations between spousal disparities and four forms of IPV including less severe physical violence (LSPV), severe physical violence (SPV), emotional violence (EV), and sexual violence (SV) based on spousal age, earnings, and education disparities.

RESULTS

The analysis revealed that spousal education disparities are significantly associated with increased IPV odds. Women with more educated husbands faced higher odds of LSPV (OR = 1.044, 95% CI = 1.01, 1.08; p < 0.05) and SV (OR = 1.085, 95% CI = 1.04, 1.14; p < 0.01), with no significant association for SPV or EV. Larger spousal age gaps were consistently associated with a reduced probability of all IPV forms, particularly LSPV (OR = 0.765, 95% CI = 0.72, 0.81; p < 0.001) and SV (OR = 0.656, 95% CI = 0.58, 0.74; p < 0.001). Earnings disparities also played a crucial role: women earning more than their husbands faced higher odds of LSPV (OR = 1.361, 95% CI = 1.23, 1.50; p < 0.001), EV (OR = 1.573, 95% CI = 1.42, 1.74; p < 0.001), and SV (OR = 1.624, 95% CI = 1.42, 1.86; p < 0.001). When husbands earned more, women also faced higher odds of IPV, although these associations were weaker.

CONCLUSION

The findings underscore the need for targeted policies to prevent IPV, particularly in low- and middle-income countries, by addressing spousal disparities in age, earnings, and education to promote gender equality.

Patterns and correlates of intention to use contraceptives among fecund sexually active women in developing countries

BACKGROUND

Understanding a woman's future contraceptive needs and enhancing her chances of putting those needs into action depend heavily on her intentions to use contraceptive methods. However, there is little information about global perspectives of intention to utilise contraceptives among fecund sexually active women.

OBJECTIVES

This study examines the patterns and determinants of contraception intention of fecund sexually active women.

METHODS

The most recent Demographic and Health Surveys (DHS) from 59 countries were used for secondary data analysis. The DHSs applied a cross-sectional survey design to collect data from women between the ages of 15 and 49. The study comprises a sample of 697,590 fecund sexually active women in the reproductive ages. The desire to utilise contraceptive methods was examined using a multivariable binary logistic regression analysis. All analyses were weighted to allow for a complex survey design.

RESULTS

A pooled prevalence of intention to utilise contraception was 42.8% (95% CI: 42.5, 43.1) at the global level. Eastern and Southern Europe had the lowest prevalence, 17.3% (95% CI: 16.4, 18.2), and the highest prevalence was observed in countries from Latin America and the Caribbean, 68.0% (95% CI: 67.5, 69.9). Attaining secondary-level education (adjusted odds ratio (aOR) = 1.68; 95% CI: 1.62-1.72) or higher (aOR = 1.71; 95% CI: 1.63-1.80), working (aOR = 1.21; 95% CI: 1.18-1.24), experience of a pregnancy loss (aOR = 1.06; 95% CI: 1.03-1.09), or being exposed to media family planning messages (aOR = 1.51; 95% CI: 1.48-1.55) were factors associated with an increased likelihood of intent to use contraceptives.

CONCLUSIONS

The study has established that contraceptive use intention was low in many developing countries. Education, age, employment status, fertility preference, and exposure to family planning messages influenced contraceptive use intention. Health policy-makers ought to consider these factors when designing sexual and reproductive health strategies in developing countries.

The role of skill development in improving the performance of agricultural extension agents in Iran using structural equation modeling and grounded theory

Performance improvement is the main concept of development policy. Belief in strengthening and improving the performance of individuals and institutions in developing countries for success in development policy has gradually formed among development agents. Performance improvement at the individual level pays attention to individual needs in order to enhance performance. Development requires developed and trained people. Therefore, the better the human resources as wealth and national capital are cultivated, the smoother the development path will be. The dimensions of improving performance at the individual level include things such as abilities, needs, attitudes, psychology, motivations, talents and skills, which also raises the need for skill development. In this regard, the current research seeks to investigate the relationship between skill development and performance improvement in extension in Iranian agriculture. The statistical population includes agricultural jihad centers in five regions of the country (the division of the country's provinces according to the Ministry of Agricultural Jihad, where each region includes 6 provinces) which is 8142 people, and accordingly, Cochran's formula was used to determine the sample size and the number of sample size 366 people were obtained. A structured questionnaire was developed to collect data. Structural equation modeling was used to examine the skill development measurement model, the performance improvement measurement model, and the skill development model. The research results show the significant relationship of all the indicators extracted from the interview in the structural equations.

Ending violence against women: Help-seeking behaviour of women exposed to intimate partner violence in sub-Saharan Africa

INTRODUCTION

Intimate partner violence is a serious public health problem that transcends cultural boundaries in sub-Saharan Africa. Studies have reported that violence characteristics and perception are strong predictors of help-seeking among women. We assessed the prevalence and factors associated with help-seeking among female survivors of intimate partner violence in sub-Saharan Africa.

METHODS

We pooled data from the most recent Demographic and Health Surveys (DHS) of eighteen sub-Saharan African countries. The data were extracted from the women's files in countries with datasets from 2014 to 2021. A weighted sample of 33,837 women in sexual relationships: married or cohabiting who had ever experienced intimate partner violence within the five years preceding the survey were included in the analysis. Percentages with 95% confidence interval (CI) were used to present the results of the prevalence of help-seeking for intimate partner violence. We used a multilevel binary logistic regression analysis to examine the factors associated with help-seeking among survivors of intimate partner violence. The results were presented using adjusted odds ratio (AOR) with their respective 95% CI. Statistical significance was set at p<0.05.

RESULTS

Out of the 33,837 women who had ever experienced intimate partner violence in sub-Saharan Africa, only 38.77% (95% CI = 38.26-39.28) of them sought help. Ethiopia had the lowest prevalence of women who sought help after experiencing intimate partner violence (19.75%; 95% CI = 17.58-21.92) and Tanzania had the highest prevalence (57.56%; 95% CI = 55.86-59.26). Marital status, educational level, current working status, parity, exposure to interparental violence, women's autonomy in household decision-making, mass media exposure, intimate partner violence justification, wealth index, and place of residence were associated with help-seeking behaviour of intimate partner violence survivors.

CONCLUSION

The low prevalence of help seeking among women who have experienced intimate partner violence in sub-Saharan Africa calls for the intensification of formal and informal sources of assistance. Education can play a critical role in empowering girls, which may increase future help-seeking rates. Through media efforts aimed at parental awareness, the long-term benefits of females enrolling in school could be achieved. However, concentrating solely on individual measures to strengthen women's empowerment may not bring a significant rise in help-seeking as far as patriarchal attitudes that permit violence continue to exist. Consequently, it is critical to address intimate partner violence from the dimensions of both the individual and violence-related norms and attitudes. Based on the findings, there should be public awareness creation on the consequences of intimate partner violence. Respective governments must increase their coverage of formal support services to intimate partner violence survivors especially those in rural communities.

Perceived Social Support and Women's Empowerment and Their Associations with Pregnancy Experiences in Anxious Women: A Study from Urban Pakistan

OBJECTIVES

Psychological distress in pregnancy is associated with adverse postnatal outcomes. We aimed to identify how social support and women's empowerment are associated with pregnancy-specific daily experiences among women suffering antenatal anxiety in Pakistan.

METHODS

Data were collected as part of a randomized controlled trial of a psychosocial intervention for antenatal anxiety in a tertiary hospital in Pakistan. We included 594 women in early pregnancy (≤ 22 weeks) who endorsed mild to severe anxiety symptoms. Generalized linear regression models were used to analyze the associations of perceived social support and women's empowerment in relation to pregnancy-specific daily hassles and uplifts using a culturally adapted and psychometrically validated version of the Pregnancy Experience Scale-Brief.

RESULTS

High social support was positively associated with frequency and intensity of positive pregnancy-specific experiences (B = 0.39, 95% CI 0.23-0.54 uplifts frequency; and B = 0.17, 95% CI 0.12-0.22 uplifts intensity), and was inversely associated with frequency of negative pregnancy-specific experiences (B = - 0.44, 95% CI - 0.66, - 0.22). Women's household empowerment was associated with greater uplifts frequency and intensity (B = 0.55, 95% CI 0.20-0.90 frequency; and B = 0.28, 95% CI 0.17-0.40 intensity). High social support and household empowerment were inversely related to PES hassle-to-uplift ratio scores.

CONCLUSIONS FOR PRACTICE

Greater social support and household empowerment were associated with positive pregnancy-specific experiences in the context of antenatal anxiety in Pakistan.

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

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

Socio-economic inequalities in minimum dietary diversity among Bangladeshi children aged 6-23 months: a decomposition analysis

This study aimed to measure the socio-economic inequalities in having minimum dietary diversity (MDD) among Bangladeshi children aged 6-23 months as well as to determine the factors that potentially contribute to the inequity. The Bangladesh Demographic and Health Survey (BDHS) 2017-2018 data were used in this study. A sample of 2405 (weighted) children aged 6-23 months was included. The overall weighted prevalence of MDD was 37.47%. The concentration index (CIX) value for inequalities in MDD due to wealth status was positive and the concentration curve lay below the line of equality (CIX: 0.1211, p < 0.001), where 49.47% inequality was contributed by wealth status, 25.06% contributed by the education level of mother, and 20.41% contributed by the number of ante-natal care (ANC) visits. Similarly, the CIX value due to the education level of mothers was also positive and the concentration curve lay below the line of equality (CIX: 0.1341, p < 0.001), where 52.68% inequality was contributed by the education level of mother, 18.07% contributed by wealth status, and 14.69% contributed by the number of ANC visits. MDD was higher among higher socioeconomic status (SES) groups. Appropriate intervention design should prioritize minimizing socioeconomic inequities in MDD, especially targeting the contributing factors of these inequities.

Women empowerment indicators and uptake of child health services in sub-Saharan Africa: a multilevel analysis using cross-sectional data from 26 countries

BACKGROUND

The sustainable development goal 3, target 2, seeks to reduce under-five mortality to as low as 25 deaths per 1000 live births by 2030. As such, seeking child health services has become a priority concern for all countries, particularly those in sub-Saharan Africa (SSA). Evidence suggests that empowered women are more likely to seek child health services. Hence, this study examined the association between women empowerment indicators and uptake of child health services in SSA.

METHODS

The study used data from the Demographic and Health Surveys of 26 SSA countries, which were conducted between 2010 and 2019. Two different samples were considered in the study: a total of 12 961 children within the vaccination age of 12-23, and 9489 children under age 5 with diarrhoea symptoms in the last 2 weeks before the survey. Women empowerment indicators comprised disagreement with reasons to justify wife beating, decision-making power and knowledge level, while child health services constituted complete vaccination uptake and seeking diarrhoea treatment. Frequencies, percentages and multivariable, multilevel binary logistic regression models were employed.

RESULTS

The study shows that women with high decision-making power [adjusted odds ratio (AOR) = 1.20, 95% confidence interval (CI) = 1.07, 1.35] had higher odds of seeking treatment for childhood diarrhoea compared to those with low decision-making power. It was also observed that among children aged 12-23 months [AOR = 1.28, 95% CI = 1.14, 1.43], mothers had higher odds of seeking diarrhoea treatment for them compared to those who were aged less than 12 months. Children whose mothers had medium decision-making power [AOR = 1.30, 95% CI = 1.19, 1.41] were more likely to seek complete immunization for their children compared to those with low decision-making power. Also, those with medium [AOR = 1.19, 95% CI = 1.07, 1.31] and high knowledge [AOR = 1.25, 95% CI = 1.10, 1.42] had higher odds of completing immunization for their children compared to those with low knowledge. Women with medium acceptance had lower odds [AOR = 0.76, 95% CI = 0.67, 0.83] of completing immunization for their children compared with those with low acceptance of wife beating.

CONCLUSIONS

This study has demonstrated a strong association between women empowerment indicators and the uptake of child health services. Therefore, efforts should be made to seek policy tools to empower women to help improve the well-being of women and the children they care for.

Troubling Trade-offs Between Women's Work and Intimate Partner Violence: Evidence From 19 Developing Countries

The empirical link between women's employment status and their experience of different types of intimate partner violence (IPV) is not very apparent. Using Demographic and Health Surveys (DHS) data from 19 developing countries in South Asia, Sub-Saharan Africa, and the Middle East, we found that working women were significantly more likely to experience IPV than their stay-at-home counterparts. Given the great diversity in women's employment with respect to economic returns and working conditions, we disaggregated women's employment into three categories vis-à-vis agriculture jobs (AJ), blue-collar jobs (BJ), and white-collar jobs (WJ). The disaggregated analysis revealed that women engaged in all three job categories were significantly more likely to experience IPV. After controlling for potential endogeneity of women's employment, we found that women's work increased the risk of less severe physical violence (LSPV) and emotional violence (EV) but reduced the risk of sexual violence (SV). Endogeneity-adjusted disaggregated analysis showed that women engaged in BJ and WJ faced an increased risk of LSPV but reduced risk of SV. In contrast, women undertaking AJ faced a smaller risk of severe physical violence (SPV) and SV. This study contradicts some long-held beliefs that women's work is a sufficient condition for protecting them from IPV. The public policy should not assume that women's earnings automatically protect them against the risk of IPV. While encouraging a greater female labor force participation rate is important in its own right, women's risk of IPV is context-specific.

Microcredit Membership and Self-Reported Healthcare Autonomy among Bangladeshi Women

Participation in microcredit programs has so far received widespread research and policy attention in the context of health and empowerment among Bangladeshi women. However, not much is known regarding the relationship between participation in microcredit programs and healthcare autonomy (HA) among women. In the present study, we analyzed two nationally representative surveys (Bangladesh Demographic and Health Survey 2004 and 2014), to assess the relationships between MC membership and HA among adult women (n = 29163), while adjusting for various sociodemographic correlates. Self-reported healthcare decision-making autonomy was assessed by asking whether or not the participant had final say on her healthcare. The findings revealed that between 2004 (20.9%, 95%CI = 19.8, 22.0) and 2014 (14.1%, 95%CI = 13.3, 15.0), the proportion of women reporting HA decreased significantly, despite considerable improvements across several socioeconomic indices, including higher education enrollment and labor market participation. Between 2004 and 2014, the percentage of microcredit borrowers decreased for Grameen (18.9% vs. 10.7%) and BRAC (7.9% vs. 7.4%), while it increased for BRDB (0.9% vs. 7.0%). A multivariate regression analysis revealed that Grameen Bank membership was positively associated with reporting HA in both male- (OR = 1.16, 95%CI = 1.09, 1.23) and female-headed households (OR = 1.44, 95%CI = 1.13, 1.85). A positive association between microcredit membership and HA was also observed for BRAC (OR = 1.33, 95%CI = 1.20, 1.47) and BRDB (OR = 1.18, 95%CI = 1.09, 1.29), but in the male-headed households only. Further analysis indicated that membership with Grameen bank was the most important predictor of HA, followed by BRAC, BRDB, and ASA, with the degree of importance varying substantially between male- and female-headed households. In conclusion, these findings suggest the potential of microcredit programs to promote healthcare autonomy among Bangladeshi women and provide insights for further research, as to why certain programs are more effective than others.

Large-scale rollout of extension training in Bangladesh: Challenges and opportunities for gender-inclusive participation

Despite the recognized importance of women’s participation in agricultural extension services, research continues to show inequalities in women’s participation. Emerging capacities for conducting large-scale extension training using information and communication technologies (ICTs) now afford opportunities for generating the rich datasets needed to analyze situational factors that affect women’s participation. Data was recorded from 1,070 video-based agricultural extension training events (131,073 farmers) in four Administrative Divisions of Bangladesh (Rangpur, Dhaka, Khulna, and Rajshahi). The study analyzed the effect of gender of the trainer, time of the day, day of the week, month of the year, Bangladesh Administrative Division, and venue type on (1) the expected number of extension event attendees and (2) the odds of females attending the event conditioned on the total number of attendees. The study revealed strong gender specific training preferences. Several factors that increased total participation, decreased female attendance (e.g., male-led training event held after 3:30 pm in Rangpur). These findings highlight the dilemma faced by extension trainers seeking to maximize attendance at training events while avoiding exacerbating gender inequalities. The study concludes with a discussion of ways to mitigate gender exclusion in extension training by extending data collection processes, incorporating machine learning to understand gender preferences, and applying optimization theory to increase total participation while concurrently improving gender inclusivity.

Identifying the association of women’s empowerment with reproductive and maternal health practices using a cross-sectional study in the context of self-help groups in rural India

Background: Globally, women’s empowerment is captured through different combinations of indicators related to their collective and individual empowerment. In this paper, the association of diverse domains related to women’s collective and individual empowerment on their reproductive and maternal health practices were assessed. Collective empowerment referred to a cluster of indicators measuring mutual support, rights, and access to services women received, as a result of membership in self-help groups (SHGs) focused on micro-finance activities. Women’s individual empowerment was measured through their perception to make decisions on their own, be mobile, financially self-reliant, self-confident in expressing themselves, having self-esteem and being free from spousal violence. Methods: Cross-sectional data were collected in 2017 from 2,197 SHG members across 57 administrative blocks of Uttar Pradesh, India. Using exploratory and confirmatory factor analysis, the sub-domains of individual and collective empowerment were developed. The reproductive and maternal health indicators included antenatal care, delivery preparedness, postnatal care and current contraceptive use. Bivariate and multivariate analyses, using logistic regression, were carried out to measure the association of sub-domains of women’s empowerment with health practices. Results: Collective and individual empowerment were independently and jointly associated with correct health practices. Women with greater empowerment through independent mobility, high self-esteem, access to financial resources, and confidence in interacting with a frontline worker, were more likely to access antenatal care. Similarly, delivery preparedness—which entailed deciding on the place of delivery, arranging for transportation during labor, and managing expenses for the delivery—was positively influenced by collective support from fellow SHG members. Receiving postnatal care was positively associated with self-confidence and financial autonomy, and current family planning method use was positively associated with self-confidence, lower spousal violence and confidence in support from the group. Conclusions: Women’s collective and individual empowerment were independently and jointly positively associated with health outcomes among SHG members.

Is maternal autonomy associated with child nutritional status? Evidence from a cross-sectional study in India

Despite India’s steady economic growth over recent the period, the burden of childhood malnutrition persists, contributing to higher neonatal and infant mortality. There is limited evidence available to contextualise mothers’ crucial role in childcare practices and health status in the Indian context. This study attempts to assess the association between maternal autonomy and the nutritional status of children under five. We used samples of 38,685 mother-child pairs from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015–16. We considered three widely used indicators of child nutrition as outcome variables: stunting, wasting, and underweight. Maternal autonomy (measured from three dimensions: household decision-making, freedom of physical movement, and access to economic resources/control over assets) was the key predictor variable, and various child demographics, maternal, and household characteristics were considered control variables. Stepwise binary logistic regression models were performed to examine the association. Of study participants, 38%, 21%, and 35% of children were stunted, wasted, and underweight, respectively. Our results (models 1 to 4) indicate that mothers with greater autonomy were significantly associated with lower odds of malnourished children. After controlling for all potential confounding variables (in model 5), maternal autonomy had a statistically insignificant association with children’s stunting (Odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.87, 1.00) and wasting (OR: 0.92; 95% CI: 0.85, 1.00). However, a significant relationship (though marginally) was retained with underweight (OR: 0.94; 95% CI: 0.88, 0.99). In addition, socio-demographic characteristics such as child age, birth order, maternal education, maternal BMI, place of residence and household wealth quintile were found to be strong predictors of child nutritional status. Future policies should not only inform women’s empowerment programmes but also emphasise effective interventions toward improving female educational attainment and nutritional status of women, as well as addressing socioeconomic inequalities in order to combat the persistent burden of childhood malnutrition in India.

Factors associated with women's healthcare decision-making during and after pregnancy in urban slums in Mumbai, India: a cross-sectional analysis

BACKGROUND

Understanding factors associated with women's healthcare decision-making during and after pregnancy is important. While there is considerable evidence related to general determinants of women's decision-making abilities or agency, there is little evidence on factors associated with women's decision-making abilities or agency with regards to health care (henceforth, health agency), especially for antenatal and postnatal care. We assessed women's health agency during and after pregnancy in slums in Mumbai, India, and examined factors associated with increased participation in healthcare decisions.

METHODS

Cross-sectional data were collected from 2,630 women who gave birth and lived in 48 slums in Mumbai. A health agency module was developed to assess participation in healthcare decision-making during and after pregnancy. Linear regression analysis was used to examine factors associated with increased health agency.

RESULTS

Around two-thirds of women made decisions about perinatal care by themselves or jointly with their husband, leaving about one-third outside the decision-making process. Participation increased with age, secondary and higher education, and paid employment, but decreased with age at marriage and household size. The strongest associations were with age and household size, each accounting for about a 0.2 standard deviation difference in health agency score for each one standard deviation change (although in different directions). Similar differences were observed for those in paid employment compared to those who were not, and for those with higher education compared to those with no schooling.

CONCLUSION

Exclusion of women from maternal healthcare decision-making threatens the effectiveness of health interventions. Factors such as age, employment, education, and household size need to be considered when designing health interventions targeting new mothers living in challenging conditions, such as urban slums in low- and middle-income countries.

Prevalence and associated factors of home delivery in Eastern Africa: Further analysis of data from the recent Demographic and Health Survey data

Objectives:

The current study aimed to determine the magnitude of home delivery and its associated factors in East Africa using data from the Demographic and Health Survey.

Methods:

We pooled data from the Demographic and Health Survey of the 11 East African countries and included a total weighted sample of 126,107 women in the study. The generalized linear mixed model was fitted to identify factors associated with home delivery. Variables with adjusted odds ratio with a 95% confidence interval, and p value < 0.05 in the final generalized linear mixed model were reported to declare significantly associated factors with home delivery.

Result:

The weighted prevalence of home delivery was 23.68% (95% confidence interval: [23.45, 23.92]) among women in East African countries. Home delivery was highest in Ethiopia (72.5%) whereas, it was lowest in Mozambique (2.8%). In generalized linear mixed model, respondent’s age group, marital status, educational status, place of residence, living country, wealth index, media exposure, and number of children ever born were shown significant association with the home delivery in the East African countries,

Conclusion:

Home delivery varied between countries in the East African zone. Home delivery was significantly increased among women aged 20–34 years, higher number of ever born children, rural residence, never married, or formerly married participants. On the contrary, home delivery decreased with higher educational level, media exposure, and higher wealth index. Wide-range interventions to reduce home delivery should focus on addressing inequities associated with maternal education, family wealth, increased access to the media, and narrowing the gap between rural and urban areas, poor and rich families, and married and unmarried mothers.

Dimensions of women empowerment on access to antenatal care in Uganda: A further analysis of the Uganda demographic health survey 2016

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.

Factors Associated with Domestic Violence in Rural Bangladesh

Women's experience of domestic violence has adverse consequences on women's health globally and is itself affected by several factors. This study aims to determine the factors that are associated with experience of any form of domestic violence in rural Bangladesh. Data were derived from the baseline survey database of Suchana, a large-scale nutrition program in Bangladesh. Data of 5,440 women from poor households in rural areas were analyzed. Descriptive statistics were used to summarize the data. Multilevel logistic regression analysis was conducted to determine the factors that were significantly associated with experiencing any form of domestic violence. The prevalence of women experiencing domestic violence was found to be 35% and household food insecurity was 86%. Of the women's characteristic domain, age at marriage, lack of any support from household members, visit from non-governmental organizations (NGO) health professionals, number of children, and decision-making power of women at the household level were significantly associated with reporting of domestic violence. Of the household characteristic domain, the associated factors were having a male household head, increased household size, low socio-economic status, having a loan, experience of at least one crisis event, and household food insecurity. The strength of association between household food insecurity and domestic violence was higher among poor families. Experience of domestic violence is inevitably associated with women's decision-making power and household food insecurity. Behavioral change communication interventions may help to positively affect decision-making power but a holistic approach needs to be undertaken to reduce food insecurity, for which the underlying mechanism of food insecurity in Bangladesh needs to be explored further.

Is mother's financial autonomy associated with stunting among children aged 7-35 months: An empirical study from India

Stunting depicts chronic deprivation and is a huge public health problem in several developing countries. Considering the sociocultural and sociodemographic factors of India, we aimed to examine the relationship between maternal autonomy and stunting among children <35 months. We have used the data from the latest round of National Family health survey conducted in 2015-16. The main exposure variable was women's autonomy which are represented in our study by the four dimensions- decision-making, physical mobility, financial autonomy, attitudes towards domestic violence, the main predictor variable was stunting among children. Chi-square analysis, univariate and multivariable binary logistic regression analysis were performed to find the association of childhood stunting and women's autonomy. The results were reported at 5% level of significance. All the autonomy variables have shown a significant association with child stunting at 5% level of significance. The unadjusted odds of stunting were found to be significant with respect to all the four dimensions of autonomy variables except physical autonomy. However, after adjusting for other explanatory factors attenuated these relationships and made them statistically insignificant except for women's economic autonomy (AOR = 0.91; 95% C.I.-(0.85, 0.98)) which was found to be significantly affecting the child's status of stunting. Our study reinforces that maternal autonomy is a significant predictor of childhood stunting. Hence, we recommend that policy makers, while designing interventions and policies, must address the socioeconomic inequalities at the community level while devising ways to improve women's empowerment. As it has far-reaching consequences on the nutrition status of the upcoming generations.

Factors affecting farmers' use of organic and inorganic fertilizers in South Asia

Fertilizer, though one of the most essential inputs for increasing agricultural production, is a leading cause of nitrous oxide emissions from agriculture, contributing significantly to global warming. Therefore, understanding factors affecting farmers' use of fertilizers is crucial to develop strategies to improve its efficient use and to minimize its negative impacts. Using data from 2528 households across the Indo-Gangetic Plains in India, Nepal, and Bangladesh, this study examines the factors affecting farmers' use of organic and inorganic fertilizers for the two most important cereal crops - rice and wheat. Together, these crops provide the bulk of calories consumed in the region. As nitrogen (N) fertilizer is the major source of global warming and other environmental effects, we also examine the factors contributing to its overuse. We applied multiple regression models to understand the factors influencing the use of inorganic fertilizer, Heckman models to understand the likelihood and intensity of organic fertilizer (manure) use, and a probit model to examine the over-use of N fertilizer. Our results indicate that various socio-economic and geographical factors influence the use of organic and inorganic fertilizers in rice and wheat. Across the study sites, N fertilizer over-use is the highest in Haryana (India) and the lowest in Nepal. Across all locations, farmers reported a decline in manure application, concomitant with a lack of awareness of the principles of appropriate fertilizer management that can limit environmental externalities. Educational programs highlighting measures to improving nutrient-use-efficiency and reducing the negative externalities of N fertilizer over-use are proposed to address these problems.

The Gender System and Class Mobility: How Wealth and Community Veiling Shape Women's Autonomy in India

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

Effects of the COVID-19 pandemic on caregiver mental health and the child caregiving environment in a low-resource, rural context

Early child development has been influenced directly and indirectly by the COVID‐19 pandemic, and these effects are exacerbated in contexts of poverty. This study estimates effects of the pandemic and subsequent population lockdowns on mental health, caregiving practices, and freedom of movement among female caregivers of children 6–27 months (50% female), in rural Bangladesh. A cohort (N = 517) was assessed before and during the pandemic (May–June, 2019 and July–September, 2020). Caregivers who experienced more food insecurity and financial loss during the pandemic reported larger increases in depressive symptoms (0.26 SD, 95% CI 0.08–0.44; 0.21 SD, 0.04–0.40) compared to less affected caregivers. Stimulating caregiving and freedom of movement results were inconsistent. Increases in depressive symptoms during the pandemic may have consequences for child development.

Women's empowerment and gender equality in agricultural value chains: evidence from four countries in Asia and Africa

Women play important roles at different nodes of both agricultural and off-farm value chains, but in many countries their contributions are either underestimated or limited by prevailing societal norms or gender-specific barriers. We use primary data collected in Asia (Bangladesh, Philippines) and Africa (Benin, Malawi) to examine the relationships between women's empowerment, gender equality, and participation in a variety of local agricultural value chains that comprise the food system. We find that the value chain and the specific node of engagement matter, as do other individual and household characteristics, but in different ways depending on country context. Entrepreneurship-often engaged in by wealthier households with greater ability to take risks-is not necessarily empowering for women; nor is household wealth, as proxied by their asset ownership. Increased involvement in the market is not necessarily correlated with greater gender equality. Education is positively correlated with higher empowerment of both men and women, but the strength of this association varies. Training and extension services are generally positively associated with empowerment but could also exacerbate the inequality in empowerment between men and women in the same household. All in all, culture and context determine whether participation in value chains-and which node of the value chain-is empowering. In designing food systems interventions, care should be taken to consider the social and cultural contexts in which these food systems operate, so that interventions do not exacerbate existing gender inequalities.

Determinants of women's empowerment in Pakistan: evidence from Demographic and Health Surveys, 2012-13 and 2017-18

Background

Women’s empowerment has always remained a contested issue in the complex socio-demographic and cultural milieu of Pakistani society. Women are ranked lower than men on all vital human development indicators. Therefore, studying various determinants of women’s empowerment is urgently needed in the Pakistani context.

Methods

The study empirically operationalized the concept of women’s empowerment and investigated its determinants through representative secondary data taken from the Pakistan Demographic and Health Surveys among women at reproductive age (15–49 years) in 2012–13 (n = 13,558) and 2017–18 (n = 15,068). The study used simple binary logistic and multivariable regression analyses.

Results

The results of the binary logistic regression highlighted that almost all of the selected demographic, economic, social, and access to information variables were significantly associated with women’s empowerment (p < 0.05) in both PDHS datasets. In the multivariable regression analysis, the adjusted odds ratios highlighted that reproductive-age women in higher age groups having children, with a higher level of education and wealth index, involved in skilled work, who were the head of household, and had access to information were reported to be more empowered.

Results of the multivariable regression analysis conducted separately for two empowerment indicators (decision-making and ownership) corroborated the findings of the one indicator of women empowerment, except where ownership did not appear to be significantly associated with number of children and sex of household head in both data sets (2012–13 and 2017–18).

Conclusions

A number of social, economic, demographic, familial, and information-exposure factors determine women’s empowerment. The study proposes some evidence-based policy options to improve the status of women in Pakistan.

The Influence of Women's Empowerment on Poverty Reduction in the Rural Areas of Bangladesh: Focus on Health, Education and Living Standard

Women’s empowerment has a great influence on health, nutrition, education, and the overall well-being of societies as well as of the children and households. This study investigates the effect of women’s empowerment on poverty reduction and focuses on household deprivation, in terms of education, health, and standard of living. Primary data was collected from 914 married women from rural areas of Bangladesh using a well-structured questionnaire and a random sampling technique. Descriptive statistics, logistic regression, and ordinary least squares models were used in this study. The results indicate that increased women’s access to education, asset ownership, decision-making power on children’s health and education, and access to medical facilities, have caused a significant decline in income poverty and multidimensional poverty. However, gender violence, taking resources against women’s will, and preventing women from working outside, have caused a considerable decline in per capita income and an increase in income poverty and multidimensional poverty. Overall, it is found that women’s empowerment has a great impact on the reduction of income poverty and multidimensional poverty in society. The findings of the study can assist and guide policymakers to initiate appropriate strategies for women’s empowerment to reducing poverty in Bangladesh while making progress towards other social and developmental goals.

Which factors predict fertility intentions of married men and women? Results from the 2012 Niger Demographic and Health Survey

INTRODUCTION

Niger is the country with the highest total fertility rate in the world. In the present study, we investigated factors associated with the desire for more children among married men and women in Niger.

MATERIALS AND METHODS

We utilised data from the 2012 Niger Demographic and Health Survey. The outcome variable for the study was fertility intentions. The data were analysed with Stata version 14.0. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out.

RESULTS

Desire for more children was 97.2% and 87.2% among men and women respectively. Women aged 45-49 were less likely to desire more children, compared to those aged 25-39 [aOR = 0.13, CI = 0.11-0.16]. The odds of desire for more children were high in rural areas, compared to urban areas [aOR = 1.61, CI = 1.20-2.17]. Childbearing women with seven or more births were less likely to desire more children, compared to those with 1-3 births [aOR = 0.09, CI = 0.06-0.14]. Men aged 50-59 were less likely to desire more children, compared to those aged 25-39 [aOR = 0.13, CI = 0.05-0.35]. Men with secondary/higher level of education were less likely to desire more children, compared to those with no formal education [aOR = 0.24, CI = 0.11-0.52]. Childbearing men with seven or more births were less likely to desire more children, compared to those with 1-3 births [aOR = 0.06, CI = 0.01-0.30].

CONCLUSION

This study shows high fertility desire among men and women in Niger. However, the prevalence of fertility desire among men is higher than that of women. A number of socio-economic and demographic factors were found to be associated with desire for more children among men and women in Niger. This calls for a collective effort to educate women and men in Niger on the negative consequences of rapid population growth and large family sizes.

The effect of women's bargaining power within couples on contraceptive use in Cameroon

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.

Women's empowerment and their experience to food security in rural Bangladesh

Global discourses have advocated women's empowerment as a means to reduce their own's food insecurity, which is also key development challenges in Bangladesh. However, little empirical research has conducted on this issue, especially in the rural area of Bangladesh. Therefore, the present study was conducted to examine the relationship of six domains of women's empowerment with their food security in rural Bangladesh using a partial least square structural equation modelling approach. Our empirical analysis indicates that women's accesses to their legal and familial rights and decision-making roles in households increase their bargaining power over the utilization of resources and to choices of food which significantly and negatively decrease their food insecurity. Moreover, information and communication technologies and infrastructure facilities also negatively and significantly associated with women's food insecurity. However, women's leadership has a negative but not significant effect on their food insecurity, as low self-esteem rural women feel no ease in publicly addressing their inequalities. By understanding family composition from women's perceptions, the results from our research can assist policymakers to develop more suitable strategies to enhance the empowerment status of rural women and reduce their food insecurity.

Help-Seeking Behaviors of Intimate Partner Violence Victims: A Cross-National Analysis in Developing Nations

There is a dearth of research on help-seeking behaviors of intimate partner violence (IPV) victims, especially within developing nations. The current study uses the nationally representative population-based Demographic and Health Surveys (DHS) of 31 nations to address this gap in the literature. Specifically, the study (a) assesses the extent to which IPV victims sought help in developing nations, (b) investigates from whom IPV victims sought help, and (c) evaluates individual and national factors that influence the likelihood of help seeking among IPV victims in developing nations. Given the hierarchical structure of the data, multilevel modeling techniques are used (individual level N = 65,530; national level N = 31). Descriptive findings revealed 34.88% of IPV victims engaged in help-seeking behaviors and the majority of victims who sought help reached out to family members (63.10%). Few IPV victims (3.24%) sought help from formal institutions. Results from the hierarchical generalized linear regression models indicated the severity of abuse, attitudes toward IPV, and indicators of empowerment all affected the likelihood of help seeking. National-level factors, including whether the nation had a law against IPV, were not significant. While providing formal services is important, policies designed to help IPV victims must recognize and address cultural barriers that may inhibit help-seeking behaviors. Because the majority of IPV victims sought help from informal support networks, it is important that individuals in these extended networks receive information about gendered norms and IPV so they can extend help and respond appropriately to family and friends.

How the persistence of patriarchy undermines the financial empowerment of women microfinance borrowers? Evidence from a southern sub-district of Bangladesh

A significant body of multi-disciplinary research supports the proposition that women may experience empowerment from microfinance programs. This is based on the assumption that an increase in women's financial contribution to the household helps to transform gender norms and relations which increases their decision-making power. However, the relationship between the strength and persistence of patriarchal gender norms within the household and women's financial empowerment needs further exploration. This paper presents the findings of a mixed-method study comprising 331 surveys and 33 in-depth interviews with women receiving microfinance and their husbands in a southern sub-district of Bangladesh; it draws upon gender socialisation and gender performance theory to understand how patriarchal gender norms influence women's financial empowerment in households receiving microfinance. Findings demonstrate that participation in microfinance programs has not shifted gender norms, nor financially empowered women. Women's loans were largely controlled by men as prescribed by underlying, unchanged patriarchal gender norms. The inter-generational reproduction of patriarchal gender relations continued to reproduce a strict gendered division of labour that reinforced restrictions on women's behaviour, mobility, and decision-making domains, and men's dominance in household and economic decision-making.

Informal and formal systems of care for women experiencing intimate partner violence in Kenya

Several factors influence a victim's decision on whether or not to seek help after experiencing Intimate Partner Violence (IPV). This study used data from the Demographic and Health Surveys (DHS) for Kenya (2014) of ever married women (n = 5265). Majority of the women did not seek help after experiencing IPV (55.5%). Women justification for IPV decreased the odds of seeking help from informal services by 0.75 times and formal services by 0.58 times. Understanding cultural determinants of help seeking would contribute in the development of effective policies and programs for preventing and responding to IPV in Kenya and across the world.

Prevalence of unintended pregnancy and its associated factors: Evidence from six south Asian countries

AIM

Unintended pregnancy is a significant public health concern in South Asian countries because of its negative association with the socioeconomic and health outcomes for both children and mothers. The present study aimed to explore the prevalence of unintended pregnancy and explore its determinants among women of reproductive age in six South Asian countries.

METHODS

Nationwide latest demography and health survey data from six South Asian countries, including Bangladesh (2014), Pakistan (2017-2018), Nepal (2016), Afghanistan (2015), Maldives (2016-2017) and India (2015-2016) were pooled for the present study. Multivariate analysis was performed to explore the association between unintended pregnancy and its associated factors.

RESULTS

Amongst the total women (n = 41,689), overall, 19.1% pregnancies were reported as unintended (ranging from 11.9% in India to 28.4% in Bangladesh). The logistic regression model showed that younger women (15-19 years) had 1.42 times higher chance of unintended pregnancies. The odds of unintended pregnancies was 1.24 times higher for poorest women and 1.19 times higher for poorer women. Further, urban women (aOR = 0.70, 95% CI = 0.50-0.80), women having no children (aOR = 0.10, 95% CI = 0.09-0.12), smaller (≤4) family (aOR = 0.72, 95% CI = 0.67-0.78), those who intent to use contraceptive (aOR = 0.72, 95% CI = 0.60-0.86), currently living with partner (aOR = 0.90, 95% CI = 0.81-0.99), first cohabitation in teenage (≤19 years) (aOR = 0.85, 95% CI = 0.78-0.92) were less likely to report unintended pregnancies.

CONCLUSIONS

This study has showed that women's age, wealth index, place of residence, number of children, family size, the intention of contraceptive use, living with a partner, and first cohabitation age are essential determinants of unintended pregnancy. These factors should be considered when trying to reduce unintended pregnancy in six South Asian countries. However, there is a need to improve health education, counselling, skills-building, sex education, modern contraceptive use and its access in this region. Intervention programs regarding reproductive health and policies are warranted to reduce rates of unintended pregnancy in South Asian countries.

Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis

BACKGROUND

The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care.

OBJECTIVE

To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care.

METHODS

We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the 'best-fit framework approach'.

RESULTS

This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model's structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay's definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women's individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach.

CONCLUSION

This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women's Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women's empowerment during pregnancy and childbirth.