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Mathur S, Kirk K, Dadi C, Dougherty L. Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger. BMC Womens Health 2024; 24:278. [PMID: 38715013 PMCID: PMC11075281 DOI: 10.1186/s12905-024-03115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).
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Affiliation(s)
- Sanyukta Mathur
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA.
| | - Karen Kirk
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA
| | - Chaibou Dadi
- Conception Etudes Suivi Evaluation Appuis Formation, Niamey, Niger
| | - Leanne Dougherty
- Population Council, 1015 15th St., NW, Washington, DC, 20005, USA
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Boyce SC, Minnis AM, Deardorff J, McCoy SI, Challa S, Johns NE, Aliou S, Brooks MI, Nouhou AM, Baker H, Silverman JG. Effect of a gender-synchronized family planning intervention on inequitable gender norms in a cluster randomized control trial among husbands of married adolescent girls in Dosso, Niger. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.28.23296292. [PMID: 37808735 PMCID: PMC10557813 DOI: 10.1101/2023.09.28.23296292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Gender inequity is pervasive globally and has severe consequences for health and well-being, particularly for women and girls in Niger. The Reaching Married Adolescents in Niger (RMA) intervention aimed to promote equitable gender norms in order to increase modern contraceptive use and reduce intimate partner violence among married adolescent girls and their husbands in Niger. Using data from a 4-arm factorial cluster randomized control trial of the RMA intervention (2016-2019), the current study assesses effects of the RMA intervention on gender norms among husbands. We used an adjusted hierarchical difference-in-differences linear regression model to assess these effects. The mean score for perceived gender inequitable norms at baseline was 4.1 (n=1,055; range: 0-5). Assignment to the RMA small groups intervention was associated with a 0.62 lower score (95% CI: -1.05, -0.18) relative to controls at follow-up, after adjusting for baseline differences. No significant effects were detected for other intervention arms. As a low-cost, simple, scalable, and transferrable intervention with rigorous evidence of being able to change such gender norms, this community health worker-based small group intervention could be valuable to the field of public health for reducing the negative impact of inequitable gender norms on health and wellbeing in similar settings.
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Silverman JG, Brooks MI, Aliou S, Johns NE, Challa S, Nouhou AM, Tomar S, Baker H, Boyce SC, McDougal L, DeLong S, Raj A. Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger. Reprod Health 2023; 20:83. [PMID: 37277837 PMCID: PMC10243049 DOI: 10.1186/s12978-023-01609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. METHODS We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13-19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. RESULTS Baseline and 24-month follow-up data were collected April-June 2016 and April-June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41-8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68-5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18-0.88 for Arm 2; aIRR 0.46, 95% CI 0.21-1.01 for Arm 3). No Arm 1 effects were observed. CONCLUSIONS The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730.
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Affiliation(s)
- Jay G. Silverman
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Sani Aliou
- Pathfinder International, Watertown, USA
| | - Nicole E. Johns
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sneha Challa
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Shweta Tomar
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Holly Baker
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sabrina C. Boyce
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Lotus McDougal
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Stephanie DeLong
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
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Nadi-Ravandi S, Batooli Z. Knowledge Mapping of Articles on Application of the Quran and Hadiths in Health Care: VOSviewer Visualization Techniques. JOURNAL OF RELIGION AND HEALTH 2022; 61:3940-3968. [PMID: 35486283 DOI: 10.1007/s10943-022-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
This study sought to conduct a knowledge mapping of articles to shed light on the application of the Quran and Hadiths in health care. The study is applied in terms of purpose and scientometrics in terms of type, which has been carried out using retrospective bibliometric analysis methods and visualization through knowledge mapping. In order to do so, the PubMed database with related keywords was thoroughly searched. Then, 302 relevant articles were reviewed in terms of the author, the year of publication, the journal, and the subject. In addition, VOSviewer software was employed to analyze and visualize keywords and maps of the articles. The findings showed that 302 articles were published between 1972 and 2021 in 190 journals, among which the Journal of Religion and Health was ranked first with 43 articles. Word co-occurrence map of scientific products of the Quran and Hadith in health care were categorized into six clusters, namely: "complementary and alternative medicine," "ethics," "the effectiveness of spirituality on the treatment and control of mental illness," "women's rights and status," "family planning, infertility treatment and abortion," and "the views of the Quran and Hadiths on sexual issues." Adopting a holistic approach toward the application of various aspects of the Quran and Hadiths on health care, the present study can be considered as a pioneering research whose results can account for determining relevant applied research projects.
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Affiliation(s)
- Somayyeh Nadi-Ravandi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Educational Development Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Batooli
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran.
- Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran.
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Shakya HB, Cislaghi B, Fleming P, Levtov RG, Boyce SC, Raj A, Silverman JG. Associations of attitudes and social norms with experiences of intimate partner violence among married adolescents and their husbands in rural Niger: a dyadic cross-sectional study. BMC Womens Health 2022; 22:180. [PMID: 35585589 PMCID: PMC9118706 DOI: 10.1186/s12905-022-01724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Prior cross-sectional research suggests that both men’s and women’s attitudes towards intimate partner violence (IPV) are predictive of women’s IPV experience, although this can vary greatly by context. In general, women who have experienced IPV are likely to report attitudes accepting of it. Men who perpetrate IPV may also report attitudes accepting of it, although some research has found that there is not always an association. Studies that investigate these dynamics often conflate attitudes with social norms, or use attitudes as a proxy for social norms, given that valid measures on social norms are usually lacking. Here we conduct a secondary data analysis to ask how are men’s and women’s IPV-related attitudes associated with women’s reports of IPV and how are men’s and women’s perceived social norms associated with women’s reports of IPV. Methods Dyadic data were collected from a representative sample of married adolescent girls and their husbands in 48 rural villages of the Dosso region of Niger (N = 1010). Assessments included logistic regression analyses of husbands’ and wives’ reports of individual attitudes towards IPV, and social norms based on husbands’ and wives’ perceptions of their communities’ beliefs related to gender roles and acceptability of IPV. Results Eight percent of women in this sample reported IPV. We found that, consistent with other research, wives who have reported IPV are more likely to report attitudes in support of IPV, while for husbands whose wives report IPV, that relationship is insignificant. On the other hand, husbands who report that people in their community believe there are times when a woman deserves to be beaten are more likely to have perpetrated IPV, while for wives there is no association between the community norm and IPV reporting. Finally, wives who report that people in their community hold inequitable gender norms in general are more likely to have experienced IPV, while for husbands, community gender norms are not predictive of whether their wives have reported IPV. Conclusions Our results are evidence that IPV prevention interventions focused solely on individual attitudes may be insufficient. Targeting and assessment of social norms are likely critical to advancing understanding and prevention of IPV.
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Affiliation(s)
- Holly Baker Shakya
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA.
| | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine Room, 330 LSHTM 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Paul Fleming
- Department of Health Behavior & Health Education, 3814 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | | | - Sabrina C Boyce
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA
| | - Jay G Silverman
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9100 Gilman Dr., San Diego, CA, USA
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Mutumba M. Mass media influences on family planning knowledge, attitudes and method choice among sexually active men in sub-Saharan Africa. PLoS One 2022; 17:e0261068. [PMID: 35085245 PMCID: PMC8794141 DOI: 10.1371/journal.pone.0261068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
Men are underrepresented in family planning (FP) research, and despite the widespread promotion of FP through mass media, there is no systematic evaluation on how mass media exposure influences their FP knowledge, attitudes and behavior. Using Demographic and Health Survey (DHS) data from 31 countries in Sub-Saharan Africa (SSA), collected between 2010 and 2019, this paper examines the associations between three types of traditional mass media (radio, television and print) with FP knowledge, attitudes and method choices among reproductive age men in SSA, relative to other socio-cultural factors. Estimates to quantify the relative contribution of each type of mass media, relative to other evidence-based socio-cultural influences on FP outcomes, were derived using the Shorrocks-Shapley decomposition. Radio exposure had the largest impact on FP knowledge, attitudes and method choice, accounting for 26.1% of the variance in FP knowledge, followed by Television (21.4%) and education attainment (20.7%). Mass media exposure had relatively minimal impact on FP method choice, and between the three types of mass media, television (8%) had the largest influence on FP method choice. Print media had comparatively lesser impact on FP knowledge (8%), attitudes (6.2%) and method choice (3.2%). Findings suggest that mass media exposure has positive influences on FP knowledge, attitudes and method choice but its influence on FP knowledge, attitudes and method choice is smaller relative to other socio-cultural factors such as education, household wealth and marital status. As such, efforts to increase FP uptake in Sub-Saharan Africa should take into consideration the impact of these socio-cultural economic factors.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
- * E-mail:
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