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Nibogore G, Eryurt MA. Women's Empowerment and Infant Mortality: Evidence from Rwanda. Matern Child Health J 2024; 28:1092-1102. [PMID: 38461476 DOI: 10.1007/s10995-024-03918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Rwanda stands out in East Africa with the lowest infant mortality ratio at 29 per 1000 live births. It also leads in gender equality on the African continent, ranking sixth globally according to the 2022 Global Gender Gap Report. This makes Rwanda an ideal case for studying the link between women's empowerment and infant mortality. METHOD This study aims to assess the impact of women's empowerment on infant mortality using data obtained from the Rwanda Demographic and Health Survey conducted in 2005, 2010, and 2015. A three-category women's empowerment index was created using the principal component analysis method. The statistical analysis employed in this study is multivariate binary logistic regression. RESULTS: Results demonstrate a significant impact of women's empowerment on reducing infant mortality, considering regional and residential inequalities, bio-demographic factors, and healthcare variables. CONCLUSION The findings contribute to existing literature and highlight the importance of empowering women to improve maternal and child health outcomes. Such empowerment not only enhances health but also supports sustainable development and social progress. Policymakers, healthcare providers, and organizations should prioritize investing in women's empowerment to achieve maternal and child health goals, as empowered women play a pivotal role in driving positive change for a healthier and more equitable society.
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Affiliation(s)
- Gloria Nibogore
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey.
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Alinsato AS, Alakonon CB, Bassongui N. Women's empowerment, modern energy, and demand for maternal health services in Benin. Int J Health Econ Manag 2024:10.1007/s10754-024-09368-1. [PMID: 38451446 DOI: 10.1007/s10754-024-09368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
One of the major concerns for developing countries is improving the use of health services by the general population, and in particular, maternal and child health services. This concern reflects the Sustainable Development Goals 3, which aim to ensure the health and well-being of all by improving reproductive health, and especially maternal and child health. This study analyses the extent to which modern energies improve women's empowerment and the demand for maternal health services in a low income country. The empirical estimations were based on the 2017 Benin Demographic Health Survey data. We adopted the trivariate recursive probit modelling to find out the extent to which modern energies improve women's empowerment and the demand for maternal health services. The results revealed that the demand for maternal health services was significantly and positively associated with women's empowerment. Notably, being an empowered woman (social independence and decision-making) increases the chance of completing antenatal care visits. We further highlighted the importance of women's wealth in accessing maternal health services. To address maternal mortality in sub-Saharan African countries, policymakers should improve women's social independence, decision making power and attitude to violence by promoting access to modern energies such as electricity, Liquefied petroleum gas, and bio gas.
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Affiliation(s)
| | | | - Nassibou Bassongui
- Laboratory of Public Economics, University of Abomey-Calavi, Abomey Calavi, Benin
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Castro Lopes S, Constant D, Fraga S, Harries J. Women's voices and meanings of empowerment for reproductive decisions: a qualitative study in Mozambique. Reprod Health 2024; 21:16. [PMID: 38308322 PMCID: PMC10837942 DOI: 10.1186/s12978-024-01748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Women in Mozambique are often disempowered when it comes to making decisions concerning their lives, including their bodies and reproductive options. This study aimed to explore the views of women in Mozambique about key elements of empowerment for reproductive decisions and the meanings they attach to these elements. METHODS Qualitative in-depth interviews were undertaken with 64 women of reproductive age (18-49 years) in two provinces in Mozambique. Participants were recruited through convenience sampling. Data collection took place between February and March 2020 in Maputo city and Province, and during August 2020 in Nampula Province. A thematic analysis was performed. RESULTS Women described crucial elements of how power is exerted for reproductive choices. These choices include the ability to plan the number and timing of pregnancies and the ability either to negotiate with sexual partners by voicing choice and influencing decisions, or to exercise their right to make decisions independently. They considered that women with empowerment had characteristics such as independence, active participation and being free. These characteristics are recognized key enablers for the process of women's empowerment. CONCLUSIONS This study's findings contribute to an expanded conceptualization and operationalization of women's sexual and reproductive empowerment by unveiling key elements that need to be considered in future research and approaches to women's empowerment. Furthermore, it gave women the central role and voice in the research of empowerment's conceptualization and measurement where women's views and meanings are seldom considered.
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Affiliation(s)
- Sofia Castro Lopes
- Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa.
| | - Deborah Constant
- Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Sílvia Fraga
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Jane Harries
- Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Cape Town, South Africa
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Bozkur B, Yetim Ü. The effect of Feminist Therapy-Based Group Counseling program on women's psychological empowerment and internalized sexism. Arch Womens Ment Health 2024; 27:77-87. [PMID: 37934280 DOI: 10.1007/s00737-023-01393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
This study aims to develop and examine the effectiveness of a group counseling program based on feminist therapy to empower women and reduce internalized sexism. The program was designed based on the perspective of consciousness-raising groups, which have an essential place in women's movements. A quasi-experimental design with a pretest-posttest control group was used. The participants of the study were 26 young women, with an average age of 22.50±1.10. Data collection tools included the Internalized Sexism Scale, Woman Psychological Power Scale, and Personal Information Form. Analysis of covariance was used for the data analysis. The results suggested a decrease in internalized sexism levels and an increase in psychological power levels among the participants. These results are important for both mental health and gender studies, and may contribute to future practices and research on psychological and educational interventions to reduce sexism among women.
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Affiliation(s)
- Binaz Bozkur
- Counseling and Guidance Unit, Department of Educational Sciences, Faculty of Education, Mersin University, Mersin, Turkey.
| | - Ünsal Yetim
- Department of Psychology, Faculty of Economics, Administrative and Social Sciences, Toros University, Mersin, Turkey
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Salinger AP, Vermes E, Waid JL, Wendt AS, Dupuis SJN, Kalam MA, Kader A, Sinharoy SS. The role of self-efficacy in women's autonomy for health and nutrition decision-making in rural Bangladesh. BMC Public Health 2024; 24:338. [PMID: 38297259 PMCID: PMC10832193 DOI: 10.1186/s12889-024-17663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Agency - including the sub-domains of intrinsic agency, instrumental agency, and collective agency - is a critical component of the women's empowerment process. Self-efficacy (a component of intrinsic agency) may operate as a motivational influence for women to make choices according to their own preferences or goals, such that higher self-efficacy would be associated with more autonomous decision-making (a key component of instrumental agency). METHODS We examine these relationships using mixed methods. We developed a series of decision-making autonomy indices, which captured alignment between the woman's reported and preferred roles in health and nutrition decisions. Using ordinal logistic regression, we assessed the relationship between generalized self-efficacy and decision-making autonomy. RESULTS There was a consistently positive association across all categories of decision-making, controlling for a number of individual and household-level covariates. In a sub-sample of joint decision-makers (i.e., women who reported making decisions with at least one other household member), we compared the association between generalized self-efficacy (i.e., one's overall belief in their ability to succeed) and decision-making autonomy to that of domain-specific self-efficacy (i.e., one's belief in their ability to achieve a specific goal) and decision-making autonomy. Across all decision-making categories, domain-specific self-efficacy was more strongly associated with decision-making autonomy than generalized self-efficacy. In-depth interviews provided additional context for interpretation of the regression analyses. CONCLUSIONS The results indicate the importance of the role of self-efficacy in the women's empowerment process, even in the traditionally female-controlled areas of health and nutrition decision-making. The development of the decision-making autonomy index is an important contribution to the literature in that it directly recognizes and captures the role of women's preferences regarding participation in decision-making.
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Affiliation(s)
- Allison P Salinger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Ellen Vermes
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jillian L Waid
- Research Department 2, Potsdam Institute of Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute of Climate Impact Research, Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sarah J N Dupuis
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
- Global Health and Development Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Abdul Kader
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Ezzeddin N, Kalantari N, Abdollahi M, Amiri P, Amini B, Zayeri F. Outcomes of a homestead food production program on nutritional knowledge, dietary diversity, food security and empowerment of rural women in Tehran province, Iran. BMC Public Health 2024; 24:118. [PMID: 38191378 PMCID: PMC10775463 DOI: 10.1186/s12889-024-17658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled "Nutrition Improvement of Rural and Nomadic Women" in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province. METHODS The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women's empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software. RESULTS The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women's empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women's empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p < 0.05), while household food insecurity predicted it negatively (r=-0.138) (p < 0.05). CONCLUSION Because the current evaluated program has not been able to improve the expected indicators, modification of the program implementation may be needed, such as: addressing the probable barriers and challenges and strengthening the facilities in the covered villages. The current study presents a model of the dietary diversity predictors for consideration in redesigning or enhancing the program.
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Affiliation(s)
- Neda Ezzeddin
- Department of Community Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Kalantari
- Department of Community Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Abdollahi
- Faculty of Nutrition Sciences and Food Technology, and Social Determinants of Health Research Center, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Centre for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Amini
- Department of Community Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center, Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Darband Street, Tehran, Iran.
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Schierl T, Tanaka LF, Klug SJ, Winkler AS, Stelzle D. The Association of Women's Empowerment with HIV-Related Indicators: A Pooled Analysis of Demographic and Health Surveys in Sub-Saharan Africa. J Epidemiol Glob Health 2023; 13:816-824. [PMID: 37751144 PMCID: PMC10686950 DOI: 10.1007/s44197-023-00153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 09/05/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Women's empowerment is an important factor for HIV prevention, but the association with HIV-related indicators has never been quantified. In this study, we examined the association between women's empowerment and selected HIV-related indicators. METHODS We used the latest Demographic and Health Surveys that included HIV testing among other biomarkers of 31 countries in sub-Saharan Africa. Empowerment was measured by the Survey-based Women's EmPowERment (SWPER) index and was compared to the HIV-related indicators: HIV status, HIV testing (ever and in the past 12 months), condom use at last high-risk sex, the ability to ask the partner to use a condom, and the ability to refuse sex. RESULTS 208,947 women were included in the analysis, of whom 100,924 (48%) were considered highly empowered and 21,933 (10%) as lowly empowered. There was no association between empowerment and HIV status (OR = 1.12, 95% confidence interval [CI] 0.98-1.28). Highly empowered women were more likely to have ever been tested for HIV (OR = 1.67, 95% CI 1.60-1.74) but less likely to have been tested for HIV in the past 12 months (OR = 0.92, 95%CI 0.88-0.96). Highly empowered women were more commonly able to ask the partner to use a condom (OR = 1.69, 95% CI 1.63-1.75) and to refuse sex (OR = 1.78, 95%CI 1.72-1.85). CONCLUSIONS Women's empowerment does not seem to be linked to HIV status, but it is strongly associated with a woman's ability to make decisions about their sexual behavior. Empowering women and young girls has the potential to contribute toward achieving the United Nations' goal of ending AIDS by 2030.
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Affiliation(s)
- Theresa Schierl
- Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, Munich, Germany.
| | - Luana Fiengo Tanaka
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, Munich, Germany
- Center for International Health, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Stefanie J Klug
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, Munich, Germany
| | - Andrea Sylvia Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Dominik Stelzle
- Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, Munich, Germany
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Tagang G, Rwenge JRM. Women's autonomy and fertility in Chad. Afr J Reprod Health 2023; 27:63-82. [PMID: 38051305 DOI: 10.29063/ajrh2023/v27i11.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Chad's total fertility rate (TFR) is 6.4 children per woman, compared with no more than 5.5 in neighbouring countries: Cameroon and the Central African Republic. Scientific research on the determinants of fertility in Chad should therefore be carried out in order to show decision-makers how they can strengthen their actions in this area. This is the aim of this study, which focuses on the influence of women's autonomy on fertility in Chad. Analyses of data from the Multiple Indicator and Demographic and Health Survey (DHS/MICS) conducted in Chad in 2014/2015 and a qualitative survey conducted in the same country in 2020 show, among other things, that 1) in socio-cultural groups characterised by strong gender inequalities, women's autonomy is positively associated with their desired fertility; 2) in these and other groups characterised by less gender inequality, women's autonomy is negatively associated with their actual fertility, all things being equal; 3) the hypotheses explaining this relationship differ across sociocultural groups: In highly gender- inegalitarian groups, the frequent death of children leads couples in which women have either little or no autonomy to compensate with high fertility, whereas in less gender- inegalitarian groups, the negative association between women's autonomy and fertility is due to late union formation, union dissolution, the fertility-reducing effects of breastfeeding and modern contraception, and other intermediate fertility variables not considered here. These findings highlight both the importance of designing development programmes in Chad that focus on women's empowerment and the need for such programmes to take sufficient account of the socio-cultural contexts in which the populations concerned live.
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Affiliation(s)
- Georges Tagang
- Institute for Training and Research in Demography (IFORD), University of Yaoundé 2, Cameroon
| | - Jean-Robert M Rwenge
- Institute for Training and Research in Demography (IFORD), University of Yaoundé 2, Cameroon
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James PB, Yendewa GA, Bah AJ, Osborne A, Kpagoi SS, Margao EK, Kangbai J, Wardle J. Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey. BMC Pregnancy Childbirth 2023; 23:810. [PMID: 37993807 PMCID: PMC10664373 DOI: 10.1186/s12884-023-06126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND A nationwide assessment of the link between women's empowerment and homebirth has not been fully examined in Sierra Leone. Our study examined the association between women's empowerment and homebirth among childbearing women in Sierra Leone using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data. METHOD We used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15-49 years who gave birth in the five years preceding the survey were included. Outcome variable was "home birth of their last child among women in the five years preceding the 2019 SLDHS. Women's empowerment parameters include women's knowledge level, economic participation, decision-making ability and power to refuse the idea of intimate partner violence. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses. RESULTS Three in every 20 women had home childbirth (n = 1177; 15.3%). Women with low [aOR 2.04; 95% CI 1.43-2.92] and medium [aOR 1.44; 95%CI 1.05-1.97] levels of knowledge had higher odds of giving birth at home compared to those with high levels of knowledge. Women who did not have power to refuse the idea of intimate partner violence against women were more likely to had given birth at home [aOR 1.38; 95% CI1.09-1.74]. In addition, women with no [aOR 2.71; 95% CI1.34-5.46) and less than four antenatal care visits [aOR 2.08; 95% CI:1.51-2.88] and for whom distance to a health facility was a major problem [aOR 1.95; 95% CI1.49-2.56] were more likely to have had a homebirth. However, no statistically significant association was observed between a women's decision-making power and home birth [aOR 1.11; 95% CI 0.86-1.41]. CONCLUSION Despite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who did not have power to refuse the idea of intimate partner violence against women, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that promote gender-based violence against women, and improving roads and transport infrastructure.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala Campus, Njala, Sierra Leone
| | - Satta Sylvia Kpagoi
- Bo Government Hospital, Ministry of Health and Sanitation, Bo, Sierra Leone
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Emmanuel Kamanda Margao
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jia Kangbai
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
- Faculty of Health Sciences and Disaster Management, Eastern Technical University of Sierra Leone, Kenema, Sierra Leone
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia
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Ahmed A, Coleman F, Hoddinott J, Menon P, Parvin A, Pereira A, Quisumbing A, Roy S. Comparing delivery channels to promote nutrition-sensitive agriculture: A cluster-randomized controlled trial in Bangladesh. Food Policy 2023; 118:102484. [PMID: 37547489 PMCID: PMC10398750 DOI: 10.1016/j.foodpol.2023.102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 08/08/2023]
Abstract
We use a randomized controlled trial in rural Bangladesh to compare two models of delivering nutrition content jointly to husbands and wives: deploying female nutrition workers versus mostly male agriculture extension workers. Both approaches increased nutrition knowledge of men and women, household and individual diet quality, and women's empowerment. Intervention effects on agriculture and nutrition knowledge, agricultural production diversity, dietary diversity, women's empowerment, and gender parity do not significantly differ between models where nutrition workers versus agriculture extension workers provide the training. The exception is in an attitudes score, where results indicate same-sex agents may affect scores differently than opposite-sex agents. Our results suggest opposite-sex agents may not necessarily be less effective in providing training. In South Asia, where agricultural extension systems and the pipeline to those systems are male-dominated, training men to deliver nutrition messages may offer a temporary solution to the shortage of female extension workers and offer opportunities to scale and promote nutrition-sensitive agriculture. However, in both models, we find evidence that the presence of mothers-in-law within households modifies the programs' effectiveness on some nutrition, empowerment, and attitude measures, suggesting that accounting for other influential household members is a potential area for future programming.
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Affiliation(s)
- Akhter Ahmed
- International Food Policy Research Institute, Washington, DC, United States
| | | | - John Hoddinott
- International Food Policy Research Institute, Washington, DC, United States
- Cornell University, Ithaca, NY, United States
| | - Purnima Menon
- International Food Policy Research Institute, Washington, DC, United States
| | - Aklima Parvin
- International Food Policy Research Institute, Washington, DC, United States
| | - Audrey Pereira
- University of North Carolina, Chapel Hill, NC, United States
| | - Agnes Quisumbing
- International Food Policy Research Institute, Washington, DC, United States
| | - Shalini Roy
- International Food Policy Research Institute, Washington, DC, United States
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Winters S, Pitchik HO, Akter F, Yeasmin F, Jahir T, Huda TMN, Rahman M, Winch PJ, Luby SP, Fernald LCH. How does women's empowerment relate to antenatal care attendance? A cross-sectional analysis among rural women in Bangladesh. BMC Pregnancy Childbirth 2023; 23:436. [PMID: 37312017 PMCID: PMC10262442 DOI: 10.1186/s12884-023-05737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status. METHODS We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects. RESULTS Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status. CONCLUSIONS Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019.
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Affiliation(s)
- Solis Winters
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA.
| | - Helen O Pitchik
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
| | - Fahmida Akter
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Farzana Yeasmin
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Tania Jahir
- College of Medicine, Nursing, & Health Sciences, University of Galway, Galway, Ireland
| | - Tarique Md Nurul Huda
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, 52741, Saudi Arabia
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Peter J Winch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA
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12
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Malik A, Park S, Mumtaz S, Rowther A, Zulfiqar S, Perin J, Zaidi A, Atif N, Rahman A, Surkan PJ. Perceived Social Support and Women's Empowerment and Their Associations with Pregnancy Experiences in Anxious Women: A Study from Urban Pakistan. Matern Child Health J 2023; 27:916-925. [PMID: 36746839 PMCID: PMC10121818 DOI: 10.1007/s10995-023-03588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Abid Malik
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
- Health Services Academy, Park Road, Chack shahzad, Islamabad, Pakistan
| | - Soim Park
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA
| | - Sidra Mumtaz
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Armaan Rowther
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA
| | - Shaffaq Zulfiqar
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Jamie Perin
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Najia Atif
- Human Development Research Foundation, House No 06, Street No 55, F-7/4, 44000, Islamabad, Pakistan
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, L12 2AP, UK
| | - Pamela J Surkan
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., MD, 21205, Baltimore, USA.
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13
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Gregg C, Valdez M, Stollak I, Martin S, Story WT, Perry HB. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups. Int J Equity Health 2023; 21:199. [PMID: 36855142 PMCID: PMC9976358 DOI: 10.1186/s12939-022-01759-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND While there is extensive published evidence regarding the effectiveness of the Care Group Approach in promoting community-wide health behavior change, there is no published evidence regarding its empowering effect on its participants. Our study aimed to understand if the Care Group Approach as applied in the Curamericas/Guatemala Maternal and Child Health Project in isolated rural mountainous communities in Guatemala produced evidence of empowerment among the female participants. This is the seventh of 10 papers describing the expanded Census-Based, Impact-Oriented (CBIO+) Approach in improving the health and well-being of mothers and children in the rural highlands of the Department of Huehuetenango, Guatemala. METHODS We conducted semi-structured individual and group interviews with 96 female Care Group participants -including Level-1 Care Group Promoters, Care Group Volunteers, and Self-Help Group participants. The participants were from six communities - two from each of the three municipalities making up the Project Area. Data were analyzed both using deductive thematic and by exploring the following social constructs: perceived social status, self-efficacy, decision-making autonomy, and formation of social capital. RESULTS The findings supported the hypothesis that Care Group participation was an empowering process. The primary themes that emerged included increased respect accorded to women in the community, women's willingness and ability to make decisions and their confidence in making those decisions, and the development of stronger bonds among Care Group members, with other community members, and with community leaders. CONCLUSION Through increased theoretical and practical knowledge about important maternal and child health matters and through the social experience of obtaining this knowledge and sharing it with other community members, participation in the Care Group Approach empowered participants to make positive health behavior changes for themselves and for their children and families. This, in turn, led many participants to become more engaged in community activities for improved health and beyond, thereby enhancing social capital in the community. We conclude that the Care Group Approach, as applied in this setting, has made it possible for marginalized indigenous women living in a male-dominated society to become more empowered.
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Affiliation(s)
- Corey Gregg
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Mario Valdez
- Curamericas/ Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | - Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
| | - Shayanne Martin
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - William T Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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14
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Stollak I, Valdez M, Story WT, Perry HB. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 8. Impact on women's empowerment. Int J Equity Health 2023; 21:200. [PMID: 36855052 PMCID: PMC9976544 DOI: 10.1186/s12939-022-01760-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Indigenous Maya women in the rural highlands of Guatemala have traditionally faced constraints to decision-making and participation in community affairs. Anecdotal experiences from previous Curamericas Global projects in Guatemala and Liberia have suggested that interventions using the CBIO+ Approach (which consists of implementing together the Census-Based, Impact-Oriented Approach, the Care Group Approach, and Community Birthing Centers), can be empowering and can facilitate improvements in maternal and child health. This paper, the eighth in a series of 10 papers examining the effectiveness of CBIO+ in improving the health and well-being of mothers and children in an isolated mountainous rural area of the Department of Huehuetenango, explores changes in women's empowerment among mothers of young children associated with the Curamericas/Guatemala Maternal and Child Health Project, 2011-2015. METHODS Knowledge, practice, and coverage (KPC) surveys and focus group discussions (FGDs) were used to explore six indicators of women's empowerment focusing on participation in health-related decision-making and participation in community meetings. KPC surveys were conducted at baseline (January 2012) and endline (June 2015) using standard stratified cluster sampling. Seventeen FGDs (9 with women, 3 with men, 2 with mothers-in-law, and 3 with health committees), approximately 120 people in all, were conducted to obtain opinions about changes in empowerment and to identify and assess qualitative factors that facilitate and/or impede women's empowerment. RESULTS The KPC surveys revealed statistically significant increases in women's active participation in community meetings. Women also reported statistically significant increases in rates of participation in health-related decision-making. Further, the findings show a dose-response effect for two of the six empowerment indicators. The qualitative findings from FGDs show that the Project accelerated progress in increasing women's empowerment though women still face major barriers in accessing needed health care services for themselves and their children. CONCLUSION The Project achieved some notable improvements in women's decision-making autonomy and participation in community activities. These improvements often translated into making decisions to practice recommended health behaviors. Traditional cultural norms and the barriers to accessing needed health services are not easily overcome, even when empowerment strategies are effective.
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Affiliation(s)
- Ira Stollak
- Curamericas Global, Raleigh, North Carolina, USA
| | - Mario Valdez
- Curamericas/Guatemala, Calhuitz, San Sebastián Coatán, Huehuetenango, Guatemala
| | - William T Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
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15
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Ortigoza A, Braverman A, Hessel P, Di Cecco V, Friche AA, Teixeira Caiaffa W, Diez Roux AV. Women's empowerment and infant mortality in Latin America: evidence from 286 cities. Cities Health 2023; 7:93-101. [PMID: 36818398 PMCID: PMC7614198 DOI: 10.1080/23748834.2021.1908794] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Levels of women's empowerment (WE) can contribute to differences in infant mortality rates (IMRs) across cities. We used a cross-sectional multilevel study to examine associations of WE with IMRs across 286 cities in seven Latin American countries. We estimated IMRs for 2014-2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision. WE was operationalized: (1) in cities, by using scores for women's labor force participation (WLFP) and educational attainment among women derived from education and employment indicators disaggregated by sex; (2) in countries, by including a scale of enforcements of laws related to women's rights. We estimated adjusted percent differences in IMRs associated with higher WE scores across all cities and stratified by country GDP. We found substantial heterogeneity in IMRs and WE across cities. Higher WLFP was associated with lower IMRs. Higher women's educational attainment was associated with lower IMRs only in cities from countries with lower GDP. Poorer national enforcement of laws protecting women's rights was associated with higher IMRs in all countries. Women's empowerment could have positive implications for population health. Fostering women's socioeconomic development and girls' education should be part of strategies to reduce IMRs in cities of Global South.
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Affiliation(s)
- Ana Ortigoza
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA,CONTACT Ana Ortigoza Urban Health Collaborative, Drexel University, 3600 Market Street, Room 717E, Philadelphia19104, USA
| | - Ariela Braverman
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Philipp Hessel
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | - Vanessa Di Cecco
- Instituto Salud Colectiva, Universidad Nacional de Lanus, Buenos Aires, Argentina
| | - Amélia Augusta Friche
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana em Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
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Jayachandran S, Biradavolu M, Cooper J. Using machine learning and qualitative interviews to design a five-question survey module for women's agency. World Dev 2023; 161:106076. [PMID: 36597415 PMCID: PMC9693692 DOI: 10.1016/j.worlddev.2022.106076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/17/2023]
Abstract
Open-ended interview questions elicit rich information about people's lives, but in large-scale surveys, social scientists often need to measure complex concepts using only a few close-ended questions. We propose a new method to design a short survey measure for such cases by combining mixed-methods data collection and machine learning. We identify the best survey questions based on how well they predict a benchmark measure of the concept derived from qualitative interviews. We apply the method to create a survey module and index for women's agency. We measure agency for 209 married women in Haryana, India, first, through a semi-structured interview and, second, through a large set of close-ended questions. We use qualitative coding methods to score each woman's agency based on the interview, which we use as a benchmark measure of agency. To determine the close-ended questions most predictive of the benchmark, we apply statistical algorithms that build on LASSO and random forest but constrain how many variables are selected for the model (five in our case). The resulting five-question index is as strongly correlated with the coded qualitative interview as is an index that uses all of the candidate questions. This approach of selecting survey questions based on their statistical correspondence to coded qualitative interviews could be used to design short survey modules for many other latent constructs.
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17
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Zegeye B, Idriss-Wheeler D, Yaya S. Association between women's empowerment and diarrhoea in children under five years: evidence from the 2017/18 Benin Demographic and Health Survey. J Biosoc Sci 2023; 55:35-54. [PMID: 34814972 DOI: 10.1017/S002193202100064X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Globally, diarrhoea is the third leading cause of death for under five-children. Women's empowerment can significantly reduce under-five mortality due to diarrhoea. This study investigated the association between women's empowerment and childhood diarrhoea in Benin using data from the 2017/18 Benin Demographic and Health Survey. A total of 7979 currently married women were included in the study. A logistic regression model was used to control for possible confounders. The prevalence of diarrhoea among children under five years of age was 13.6%. About 36.3% of the currently married women decided either alone or together with their husband on their own health, purchase of large household items and visiting family/relatives. Close to 65.4% of currently married women disagreed with all five reasons to justify wife-beating. The children of mothers who had decision-making power were less likely to have diarrhoea (aOR = 0.74, 95% CI: 0.57-0.96) than the children of mothers who had no decision-making power. Moreover, the children of mothers who disagreed with all five reasons to justify wife-beating (aOR = 0.79, 95% CI: 0.65-0.96) were less likely to have diarrhoea than the children of mothers who accepted wife-beating as a part of life. Women's age, educational level, wealth index and region were associated with childhood diarrhoea in Benin. The role of women's empowerment, as determined by decision-making power and wife-beating attitude, was found to be significantly associated with the risk of childhood diarrhoea in Benin, after adjusting for other variables. Therefore, it is essential for policymakers in Benin to reinforce strategies and interventions focusing on women's empowerment to avert childhood mortality caused by diarrhoea. This includes improving household economic status, women's education and decision-making power and enhancing awareness of women's human and democratic rights.
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18
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Yeo S, Bell M, Kim YR, Alaofè H. Afghan women's empowerment and antenatal care utilization: a population-based cross-sectional study. BMC Pregnancy Childbirth 2022; 22:970. [PMID: 36575408 PMCID: PMC9793668 DOI: 10.1186/s12884-022-05328-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although antenatal care (ANC) offers a unique opportunity to diagnose and prevent complications by mitigating modifiable risk, 38.2% of women did not complete any ANC visits in Afghanistan in 2015. Women empowerment is associated with increased use of ANC; however, there is no evidence of the effect of women empowerment on ANC in the country. Addressing this gap, we aimed to evaluate the association between women's empowerment and ANC utilization based on the conceptual framework of women's empowerment. METHODS We analyzed data from the 2015 Afghanistan Demographic and Health Survey for 11,056 women. The association between four domains of women's empowerment, including capability, access to resources, security, and decision-making and power, and at least four ANC visits was analyzed using a multivariable logistic regression. RESULTS After adjusting for covariates, access to information (AOR 1.38, 95%CI 1.24, 1.54) and decision-making (AOR 1.16, 95%CI 1.08, 1.24) were positively associated with four or more ANC visits. Compared to those without any education, women with primary education (AOR 1.67, 95%CI 1.02, 2.72), secondary education (AOR 2.43, 95%CI 1.25, 4.70), and higher education (AOR 3.03, 95%CI 1.30, 7.07) had higher odds of least four ANC visits. However, asset ownership was negatively associated with ANC visits (AOR 0.72, 95%CI 0.56, 0.92). Variables related to security and literacy were not associated with the minimum ANC visits. CONCLUSIONS The mixed results of the study highlight the complex natures of women's empowerment, warranting a more nuanced understanding of women's empowerment in the context and future research that capture multidimensionality of women's empowerment. Also, efforts to empower women, particularly those with no education and had less decision-making power and access to health information, could be an effective strategy to enhance ANC use in Afghanistan.
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Affiliation(s)
- Sarah Yeo
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
| | - Melanie Bell
- grid.134563.60000 0001 2168 186XDepartment of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
| | - Yu Ri Kim
- grid.49606.3d0000 0001 1364 9317Asia-Pacific Research Center & School of International Studies, Hanyang University, Seoul, Republic of Korea
| | - Halimatou Alaofè
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ USA
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19
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Tumas N, Rodríguez López S, Mazariegos M, Ortigoza A, Anza Ramírez C, Pérez Ferrer C, Moore K, Yamada G, Menezes MC, Sarmiento OL, Pericàs JM, Belvis Costes F, Lazo M, Benach J. Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities? J Urban Health 2022; 99:1091-1103. [PMID: 36357625 PMCID: PMC7613896 DOI: 10.1007/s11524-022-00689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/12/2022]
Abstract
While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m2) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.
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Affiliation(s)
- Natalia Tumas
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain. .,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain. .,Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Córdoba, Argentina.,Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Ana Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Cecilia Anza Ramírez
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Goro Yamada
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | | | | | - Juan M Pericàs
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain.,Liver Unit, Internal Medicine Department, Vall d'Hebron Institute for Research, Vall d'Hebron University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Francesc Belvis Costes
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Mariana Lazo
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Joan Benach
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain.,Ecological Humanities Research Group (GHECO), Universidad Autónoma, Madrid, Spain
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Abstract
Women's empowerment has been a subject of interest because of its relevance to development and demography, particularly in West Africa. Women's empowerment is typically conceptualized as an individual attribute of women, associated with socioeconomic and demographic characteristics. However, we hypothesize a geography of women's empowerment in the West African region, where empowerment processes are culturally situated and embedded in place. Such a geography would be observable via spatial associations over the region. This study uses Demographic and Health Survey data from 14 West African states over the past decade and an innovative multi-stage approach combining advanced statistical methods and spatial assessment to analyze indicators of women's empowerment and its spatial variability across the West African region. First we use a multivariate classification method to identify patterns in responses to empowerment questions and derive an empowerment classification scheme. Next we use these classifications to render a map of West Africa depicting the spatial variation of women's empowerment in the region. Ultimately, we fit multinomial structured geo-additive regression models to the data to analyze spatial variation in women's empowerment while controlling for certain socioeconomic-demographic characteristics. Our results demonstrate that women's responses to empowerment survey questions indeed vary geographically, even when controlling for individual socioeconomic-demographic attributes. This finding suggests that women's empowerment may relate to aspects of culture embedded in place in addition to the ways it relates to socioeconomic and demographic characteristics.
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21
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Tolmay J, Knight L, Muvhango L, Polzer-Ngwato T, Stöckl H, Ranganathan M. Women's Economic Contribution, Relationship Status and Risky Sexual Behaviours: A Cross-Sectional Analysis from a Microfinance-Plus Programme in Rural South Africa. AIDS Behav 2022; 26:2349-62. [PMID: 35064391 DOI: 10.1007/s10461-021-03566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
Abstract
In sub-Saharan Africa, women bear a disproportionate burden of HIV/AIDS while also facing economic and gender inequalities. To explore the association of women’s economic contribution and relationship status with risky sexual behaviour, this study analysed cross-sectional data from 626 women aged 22 to 84 in rural South Africa. All women were enrolled in a microfinance plus gender training programme (Intervention with Microfinance for AIDS and Gender Equity (IMAGE)). We used univariable and multivariable logistic regression to explore the associations of relationship status and women’s household income contribution with inconsistent condom use, multiple sexual partners and transactional sex, respectively. We found that married, older women had the highest odds of inconsistent condom use, while those contributing all the household income had higher odds of multiple sexual partnerships, but lower odds of transactional sex compared to those with no contribution. Income contribution and relationship status have a nuanced relationship with sexual risk behaviours. Thus, economic strengthening interventions should target relevant vulnerable women while also addressing the broader social and economic drivers of risky sexual behaviour.
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22
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Allen EM, Frisancho A, Llanten C, Knep ME, Van Skiba MJ. Community Health Agents Advancing Women's Empowerment: A Qualitative Data Analysis. J Community Health 2022; 47:806-813. [PMID: 35749009 PMCID: PMC9477897 DOI: 10.1007/s10900-022-01107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/30/2022]
Abstract
Community health agents (CHAs) play a critical role in primary healthcare delivery and health promotion in low-resource settings. Though there is substantial evidence of the benefits of CHAs in achieving targeted community health outcomes, there is limited research into the impact of empowerment experienced by CHAs themselves. This study examined how working as a CHA impacts the lives and self-perceptions of women in Peru volunteering with Catholic Medical Mission Board’s (CMMB) markedly successful robust CHA model. We conducted six focus group discussions (FGDs) of 53 CHAs who implement CMMB programming in Trujillo and Huancayo, Peru. The FGDs were designed to explore themes related to empowerment, changes in women’s lives, and perceptions of themselves. We identified four major themes related to women’s empowerment: achievements, agency, meaningfulness, and resources. The most common empowerment theme was achievements, expressed through subthemes of changes in family behavior, self worth, education, health and nutrition, and rights and politics. The second most common empowerment theme was agency, with subthemes related to increases in using their voice, confidence, decision making, and participation. CHAs also reported experiencing empowerment through enhanced meaningfulness. CMMB’s CHA model is an example of how well-structured community programs can facilitate women’s empowerment. Providing meaningful community leadership opportunities can have far-reaching effects on women’s perceptions of themselves as valuable, capable, and empowered leaders. This work deepens our understanding of how to practically improve community health through empowering women to catalyze gender equality in communities with disproportionate barriers and limited opportunities burdening them.
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Affiliation(s)
- Elizabeth M Allen
- Department of Public Health, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55104, USA.
| | | | | | - Maren E Knep
- Department of Public Health, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55104, USA
| | - Michael J Van Skiba
- Department of Public Health, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55104, USA
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Zegeye B, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Yaya S. Understanding the factors associated with married women's attitudes towards wife-beating in sub-Saharan Africa. BMC Womens Health 2022; 22:242. [PMID: 35717213 PMCID: PMC9206377 DOI: 10.1186/s12905-022-01809-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence remains a major public health problem, especially in countries in sub-Saharan Africa. We examined the factors associated with married women's attitudes towards wife-beating in sub-Saharan Africa. METHODS We used Demographic and Health Survey data of 28 sub-Saharan African countries that had surveys conducted between 2010 and 2019. A sample of 253,782 married women was considered for the analysis. Bivariate and multivariate logistic regression analyses were carried out, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence interval. RESULTS The pooled result showed about 71.4% of married women in the 28 countries in this study did not justify wife-beating. However, the prevalence of non-justification of wife-beating varied from 83.4% in Malawi to 17.7% in Mali. Women's age (40-44 years-aOR = 1.61, 95% CI 1.16-2.24), women's educational level (secondary school-aOR = 1.47, 95% CI 1.13-1.91), husband's educational level (higher-aOR = 0.55, 95% CI 0.31-0.95), women's occupation type (professional, technical or managerial-aOR = 1.66, 95% CI 1.06-2.62), wealth index (richest-aOR = 5.52, 95% CI 3.46-8.80) and women's decision-making power (yes-aOR = 1.39, 95% CI 1.19-1.62) were significantly associated with attitude towards wife-beating. CONCLUSION Overall, less than three-fourth of married women in the 28 sub-Saharan African countries disagreed with wife-beating but marked differences were observed across socio-economic, decision making and women empowerment factors. Enhancing women's socioeconomic status, decision making power, and creating employment opportunities for women should be considered to increase women's intolerance of wife-beating practices, especially among countries with low prevalence rates such as Mali.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Vishwakarma D, Sharma SK, Kukreti S, Singh SK. Attitude towards negotiating safer sexual relations: Exploring power dynamics among married couples in India. J Biosoc Sci 2022;:1-14. [PMID: 35582994 DOI: 10.1017/S0021932022000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The study primarily focuses on analyzing married women's attitudes towards negotiating safer sex in two contexts. The first context is when a woman refuses to have sex with husband if she knows her husband has a sexually transmitted disease (STD) and the second is when she does so if she knows he has sex with other women. The study examined predictors of Indian women's attitude towards negotiating safer-sex using data on 92,306 ever married women from the state module of the 2015-16, National Family Health Survey 4. Descriptive and multilevel logistic regression was used to understand the interplay between the attitude towards negotiation of safer sexual relationships with husband and the selected background characteristics with a primary focus on controlling behaviour and power relations. About 17% of women did not believe in negotiating safer sexual relations with the husband. An approximately equal proportion of ever-married women (79% each) believed in doing so under the two specific conditions, that is, if they knew the husband had an STD and they knew he had sex with other women. Multilevel regression analysis showed that women who had household decision-making power [AOR=0.71; p<0.01] and those whose husbands displayed low control towards them [AOR=0.91; p<0.05] were more likely to believe in negotiating safer-sex. Our findings suggest that women who have controlling partners or those who live under the umbrella of the husband's authority lack the power to negotiate for safer sex. Interventions promoting sexual well-being must deal with negative male perceptions and expectations that perpetuate unhealthy sexual habits and marriage ties.
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Quisumbing A, Meinzen-Dick R, Malapit H. Women's empowerment and gender equality in South Asian agriculture: Measuring progress using the project-level Women's Empowerment in Agriculture Index (pro-WEAI) in Bangladesh and India. World Dev 2022; 151:105396. [PMID: 35241870 PMCID: PMC8844572 DOI: 10.1016/j.worlddev.2021.105396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This introduction to a special section describes how a recently developed measure, the project-level Women's Empowerment in Agriculture Index (pro-WEAI) can be used to assess empowerment impacts of agricultural development interventions in India and Bangladesh as well as broader changes in rural labor markets. The special section comprises three papers. The first examines the impact of membership in self-help groups in five states in rural India on women's and men's empowerment and gender equality. The second presents experimental evidence from a pilot project in Bangladesh that provided trainings in agricultural extension, nutrition behavior change communication, and gender sensitization to husbands and wives together. The third investigates changes in women's roles within the jute value chain in the Southern Delta region of Bangladesh as household members migrate out of the study area and the availability of male labor declines. Although these papers focus on Bangladesh and India, pro-WEAI can be applied to impact assessments of agricultural development projects more generally. The three papers show both the usefulness of this new measure in detecting changes in empowerment indicators within the lifespan of a project and the value of having explicit empowerment objectives in agricultural development projects. The papers also demonstrate the value of having data on both men and women so that project designers can be more intentional about including both of them and monitoring outcomes for both to promote more gender equitable outcomes.
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Bryan E, Garner E. Understanding the pathways to women's empowerment in Northern Ghana and the relationship with small-scale irrigation. Agric Human Values 2022; 39:905-920. [PMID: 35996747 PMCID: PMC9388471 DOI: 10.1007/s10460-021-10291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Women's empowerment is often an important goal of development interventions. This paper explores local perceptions of empowerment in the Upper East Region of Ghana and the pathways through which small-scale irrigation intervention targeted to men and women farmers contributes to women's empowerment. Using qualitative data collected with 144 farmers and traders through 28 individual interviews and 16 focus group discussions, this paper innovates a framework to integrate the linkages between small-scale irrigation and three dimensions of women's empowerment: resources, agency, and achievements. The relationship between the components of empowerment and small-scale irrigation are placed within a larger context of social change underlying these relationships. This shows that many women face serious constraints to participating in and benefitting from small-scale irrigation, including difficulties accessing land and water and gender norms that limit women's ability to control farm assets. Despite these constraints, many women do benefit from participating in irrigated farming activities leading to an increase in their agency and well-being achievements. For some women, these benefits are indirect-these women allocate their time to more preferred activities when the household gains access to modern irrigation technology. The result is a new approach to understanding women's empowerment in relation to irrigation technology.
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Affiliation(s)
- Elizabeth Bryan
- Environment and Production Technology Division, International Food Policy Research Institute, 1201 Eye St., NW, Washington, DC 20005 USA
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Sebayang SK, Has EMM, Hadisuyatmana S, Efendi F, Astutik E, Kuswanto H. Utilization of Postnatal Care Service in Indonesia and its Association with Women's Empowerment: An Analysis of 2017 Indonesian Demographic Health Survey Data. Matern Child Health J 2022; 26:545-555. [PMID: 35013886 PMCID: PMC8747864 DOI: 10.1007/s10995-021-03324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Objective The coverage of postnatal care (PNC) is among the lowest globally when compared with other maternal and child interventions. This study aims to assess PNC utilisation in Indonesia and its association with women’s empowerment indicators to provide evidence for the need for policy change. Methods Data from the 2017 Indonesian Demographic Health Surveys was analyzed for any use of PNC, early first PNC (within 2 days of birth) and PNC after discharge for newborns. Women’s empowerment factors were calculated using a principal component analysis of 17 indicators. The association between women’s empowerment factors and PNC was assessed using logistic regression adjusted for covariates and complex survey design. Results The prevalence of any PNC by skilled professionals in Indonesia was high but PNC after discharge was very low. Labor-force participation and women’s knowledge level were associated with any PNC, but the association between women’s knowledge level and any PNC was modified by place of birth. Disagreement towards justification of wife beating and women’s knowledge level were associated with early PNC but the association was modified by place of birth. Decision-making power was also associated with early PNC but modified by infant’s gender. Disagreement towards justification of wife beating was negatively associated with PNC after discharge, but the association between decision-making power and PNC after discharge was modified by the infant’s size at birth. Conclusions for Practice PNC coverage after discharge in Indonesia needs improvement. Women’s empowerment indicators need to be addressed in improving PNC coverage. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03324-y.
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Affiliation(s)
- Susy K Sebayang
- Research Group for Health and Well-Being of Women and Children, Universitas Airlangga, Surabaya, Indonesia. .,Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Banyuwangi Campus, Jl. Wijaya Kusuma No. 113, Banyuwangi, East Java, 68425, Indonesia.
| | - Eka M M Has
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group of Community Health, Surabaya, Indonesia
| | - Erni Astutik
- Research Group for Health and Well-Being of Women and Children, Universitas Airlangga, Surabaya, Indonesia.,Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Heri Kuswanto
- Department of Statistics, Institut Teknologi Sepuluh Nopember (ITS), Kampus ITS Sukolilo, Surabaya, Indonesia
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Mganga AE, Renju J, Todd J, Mahande MJ, Vyas S. Development of a women's empowerment index for Tanzania from the demographic and health surveys of 2004-05, 2010, and 2015-16. Emerg Themes Epidemiol 2021; 18:13. [PMID: 34620177 PMCID: PMC8499508 DOI: 10.1186/s12982-021-00103-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 09/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Women's empowerment is a multidimensional construct which varies by context. These variations make it challenging to have a concrete definition that can be measured quantitatively. Having a standard composite measure of empowerment at the individual and country level would help to assess how countries are progressing in efforts to achieve gender equality (SDG 5), enable standardization across and within settings and guide the formulation of policies and interventions. The aim of this study was to develop a women's empowerment index for Tanzania and to assess its evolution across three demographic and health surveys from 2004 to 2016. RESULTS Women's empowerment in Tanzania was categorized into six distinct domains namely; attitudes towards violence, decision making, social independence, age at critical life events, access to healthcare, and property ownership. The internal reliability of this six-domain model was shown to be acceptable by a Cronbach's α value of 0.658. The fit statistics of the root mean squared error of approximation (0.05), the comparative fit index (0.93), and the standardized root mean squared residual (0.04) indicated good internal validity. The structure of women's empowerment was observed to have remained relatively constant across three Tanzanian demographic and health surveys. CONCLUSIONS The use of factor analysis in this research has shown that women's empowerment in Tanzania is a six-domain construct that has remained relatively constant over the past ten years. This could be a stepping stone to reducing ambiguity in conceptualizing and operationalizing empowerment and expanding its applications in empirical research to study different women related outcomes in Tanzania.
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Affiliation(s)
- Andrew Evarist Mganga
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Jenny Renju
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,London School of Hygiene & Tropical Medicine, London, England
| | - Jim Todd
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,London School of Hygiene & Tropical Medicine, London, England.,National Institute of Medical Research, Mwanza, Tanzania
| | - Michael Johnson Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Seema Vyas
- London School of Hygiene & Tropical Medicine, London, England
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Quisumbing A, Ahmed A, Hoddinott J, Pereira A, Roy S. Designing for empowerment impact in agricultural development projects: Experimental evidence from the Agriculture, Nutrition, and Gender Linkages (ANGeL) project in Bangladesh. World Dev 2021; 146:105622. [PMID: 34602710 PMCID: PMC8350314 DOI: 10.1016/j.worlddev.2021.105622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The importance of women's roles for nutrition-sensitive agricultural projects is increasingly recognized, yet little is known about whether such projects improve women's empowerment and gender equality. We study the Agriculture, Nutrition, and Gender Linkages (ANGeL) pilot project, which was implemented as a cluster-randomized controlled trial by the Government of Bangladesh. The project's treatment arms included agricultural training, nutrition behavior change communication (BCC), and gender sensitization trainings delivered to husbands and wives together - with these components combined additively, such that the impact of gender sensitization could be distinguished from that of agriculture and nutrition trainings. Empowerment was measured using the internationally-validated project-level Women's Empowerment in Agriculture Index (pro-WEAI), and attitudes regarding gender roles were elicited from both men and women, to explore potentially gender-transformative impacts. Our study finds that ANGeL increased both women's and men's empowerment, raised the prevalence of households achieving gender parity, and led to small improvements in the gender attitudes of both women and men. We find significant increases in women's empowerment scores and empowerment status from all treatment arms but with no significant differences across these. We find no evidence of unintended impacts on workloads and inconclusive evidence around impacts on intimate partner violence. Our results also suggest some potential benefits of bundling nutrition and gender components with an agricultural development intervention; however, many of these benefits seem to be driven by bundling nutrition with agriculture. While we cannot assess the extent to which including men and women within the same treatment arms contributed to our results, it is plausible that the positive impacts of all treatment arms on women's empowerment outcomes may have arisen from implementation modalities that provided information to both husbands and wives when they were together. The role of engaging men and women jointly in interventions is a promising area for future research.
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Affiliation(s)
- Agnes Quisumbing
- International Food Policy Research Institute, Washington, DC, United States
| | - Akhter Ahmed
- International Food Policy Research Institute, Washington, DC, United States
| | | | - Audrey Pereira
- International Food Policy Research Institute, Washington, DC, United States
- University of North Carolina, Chapel Hill, NC, United States
| | - Shalini Roy
- International Food Policy Research Institute, Washington, DC, United States
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Ameen N, Madichie NO, Anand A. Between Handholding and Hand-held Devices: Marketing Through Smartphone Innovation and Women's Entrepreneurship in Post Conflict Economies in Times of Crisis. Inf Syst Front 2021; 25:401-423. [PMID: 34539227 PMCID: PMC8442645 DOI: 10.1007/s10796-021-10198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
There is a wide gender gap in developing countries due to a range of cultural, economic and political barriers. This is even more accentuated in post conflict economies in times of crisis. Smartphones and mobile applications can help to narrow this gap. The economic and non-economic challenges facing women entrepreneurs and the role of smartphone innovation in overcoming these challenges and developing strong marketing strategies were investigated. We drew on the 5 M model to investigate how mobile applications can support women entrepreneurs. We conducted thirty interviews with women entrepreneurs in Iraq. The findings show that mobile applications provided these entrepreneurs with innovative ways to overcome many of the challenges they face in relation to running a business. The research provides theoretical contributions by developing an integrated, multilevel analytical model on women in entrepreneurship based on extending the 5 M model with new technology-related elements. Practical, policy and managerial implications are discussed.
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Affiliation(s)
| | | | - Amitabh Anand
- Excelia Business School, CERIIM, La Rochelle, France
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Quisumbing A, Heckert J, Faas S, Ramani G, Raghunathan K, Malapit H. Women's empowerment and gender equality in agricultural value chains: evidence from four countries in Asia and Africa. Food Secur 2021; 13:1101-1124. [PMID: 34790280 PMCID: PMC8557149 DOI: 10.1007/s12571-021-01193-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Agnes Quisumbing
- International Food Policy Research Institute, Washington, DC USA
| | - Jessica Heckert
- International Food Policy Research Institute, Washington, DC USA
| | - Simone Faas
- International Food Policy Research Institute, Washington, DC USA
| | - Gayathri Ramani
- International Food Policy Research Institute, Washington, DC USA
| | | | - Hazel Malapit
- International Food Policy Research Institute, Washington, DC USA
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Crookston BT, West JH, Davis SF, Hall PC, Seymour G, Gray BL. Understanding female and male empowerment in Burkina Faso using the project-level Women's Empowerment in Agriculture Index (pro-WEAI): a longitudinal study. BMC Womens Health 2021; 21:230. [PMID: 34082722 DOI: 10.1186/s12905-021-01371-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Achieving gender equality and women's empowerment is a major global priority. The purpose of this study was to determine whether the Building the Resilience of Vulnerable Communities in Burkina Faso (BRB) project, an agricultural development program, improved women's empowerment, as measured by the project-level Women's Empowerment in Agriculture Index (pro-WEAI). METHODS This study used a longitudinal, quasi-experimental study design. Participants included both treatment and comparison groups (total N = 751) comprising female members of savings groups and their husbands or main male household member in Burkina Faso. All participants completed the pro-WEAI questionnaire at both baseline and endline. The treatment group received a comprehensive intervention package consisting of agriculture loans and services, microenterprise loans, and education, nutrition education, and women's empowerment programs including gender-based discussions designed to facilitate personalized changes in gender relations. RESULTS The proportion of the treatment group achieving empowerment did not change from baseline for women, but improved substantially for men. Women from the comparison group saw an increase in empowerment at endline while men saw a substantial decrease. Gender parity was high for women in both groups at baseline and increased slightly at endline. Women were more likely to have adequate empowerment in input in productive decisions, group membership, and membership in influential groups than men while men were more likely to have adequate empowerment in attitudes about domestic violence, control over use of income, and work balance than women. Participants from the treatment group reported an increase in the average number of empowerment indicators that they were adequate in while the comparison group saw a decrease in average adequacy over time (p = 0.002) after controlling for age, sex, and level of education. CONCLUSION Despite starting at an empowerment disadvantage, the treatment group experienced gains in individual indicators of empowerment while the comparison group men and women experienced mixed results, with the women gaining, and the men losing empowerment. This research suggests that the BRB intervention may have provided some protection for the treatment group when they faced an economic down-turn prior to the endline, indicative of household resilience. Future research should consider and strengthen relationships between resilience and empowerment.
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Shibre G, Zegeye B, Yeboah H, Bisjawit G, Ameyaw EK, Yaya S. Women empowerment and uptake of antenatal care services : A meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African countries. ACTA ACUST UNITED AC 2021; 79:87. [PMID: 34044892 PMCID: PMC8157464 DOI: 10.1186/s13690-021-00604-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/09/2021] [Indexed: 01/29/2023]
Abstract
Background Women empowerment has been linked to increased skilled antenatal care (ANC) service use. However, there is no evidence on the net effect of women empowerment on ANC in the Sub-saharan African (SSA) region. We aim to address the knowledge gap on whether or not women empowerment positively influences the uptake of ANC at the SSA regional level. Methods We analyzed the Demographic Health Survey (DHS) datasets from 33 SSA countries. Following the DHS data analysis guideline, we measured women empowerment using two indicators. The first indicator is an index, which comprises decision-making on women’s own health, household purchase and visit to family or relatives whilst disagreeing statements that husband is justified in beating his wife constitutes the second indictor. We performed confounder-adjusted logistic regression analysis for the two indicators with ANC attendance in each of the 33 countries. Then, we pooled the adjusted Odds Ratios (OR) using the random effect model through the two-stage Individual Participant Data meta-analysis technique. Summary findings are reported in OR and corresponding 95 %CI and are presented in a forest plot. Results Moderately empowered women had marginally higher odd of skilled ANC service across the SSA region (aOR = 1.19; 95 %CI: 1.03, 1.38, with a prediction interval of 0.58, 2.45). Conversely, being involved in the three decisions (aOR = 1.15; 95 %CI: 0.99, 1.33, with prediction interval 0.57, 2.31), and attitude towards wife-beating (aOR = 0.97; 95 %CI: 0.88, 1.06, with prediction interval of 0.63, 1.48) had no statistically significant relationship with ANC. Conclusions Women empowerment did not predict the use of skilled ANC in the context of the SSA region. We recommend that further studies be conducted in order to understand how women empowerment affects skilled ANC service utilization in the region.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Helena Yeboah
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Ghose Bisjawit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada. .,The George Institute for Global Health, Imperial College London, London, United Kingdom.
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Goulart CM, Purewal A, Nakhuda H, Ampadu A, Giancola A, Kortenaar JL, Bassani DG. Tools for measuring gender equality and women's empowerment (GEWE) indicators in humanitarian settings. Confl Health 2021; 15:39. [PMID: 34001201 PMCID: PMC8127307 DOI: 10.1186/s13031-021-00373-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/27/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Effective measurement of Gender Equality and Women's Empowerment (GEWE) is challenging in low and middle-income countries (LMICs), and even more so in humanitarian settings. Conflict, natural disasters, and epidemics may increase gender inequities, but also present an opportunity to address them. This scoping review describes and identifies gaps in the measurement tools, methods, and indicators used to measure GEWE in humanitarian settings, and presents a dashboard that can be used by researchers, organizations and governments to identify GEWE measurement tools. METHODS Scientific articles published between January 2004 and November 2019 were identified using Embase, Medline, PsycInfo, CINAHL, Scopus, and PAIS index. Relevant non peer-reviewed literature was downloaded from the websites of humanitarian organizations. Publications on women and/or girls impacted by a humanitarian crisis in a LMIC, within 5 years of data collection, were included. Publications were double-screened in the title/abstract and full-text stages. We used a machine learning software during the title/abstract screening to increase the efficiency of the process. Measurement tools, sampling and data collection methods, gap areas (geographical, topical and contextual), and indicators were catalogued for easy access in an interactive Tableau dashboard. RESULTS Our search yielded 27,197 publications and 2396 non peer-reviewed literature reports. One hundred and seventy publications were included in the final review. Extracted indicators were categorized into seven domains: economic, health, human development, leadership, psychological, security and justice, and sociocultural. The vast majority of studies were observational, and over 70% utilized a cross-sectional study design. Thirty-eight toolkits and questionnaires were identified in this review, of which 19 (50%) were designed specifically for humanitarian settings. Sociocultural was the largest domain in number of studies and indicators in this review, with gender-based violence indicators reported in 66% of studies. Indicators of economic, human development and leadership were uncommon in the peer-reviewed literature. DISCUSSION While there has been some effort to measure GEWE in conflict-affected and other humanitarian settings, measurement has largely focused on violence and security issues. A more comprehensive framework for measuring GEWE in these settings is needed; objective measurement of women's empowerment and gender equality should be prioritized by organizations providing humanitarian aid.
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Affiliation(s)
- Céline M Goulart
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
| | - Amber Purewal
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Humaira Nakhuda
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Anita Ampadu
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Amanda Giancola
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Jean-Luc Kortenaar
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Diego G Bassani
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
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Quisumbing AR, Sproule K, Martinez EM, Malapit H. Do tradeoffs among dimensions of women's empowerment and nutrition outcomes exist? Evidence from six countries in Africa and Asia. Food Policy 2021; 100:102001. [PMID: 33994651 PMCID: PMC8097635 DOI: 10.1016/j.foodpol.2020.102001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 06/12/2023]
Abstract
Although women's empowerment and gender equality are often linked with better maternal and child nutrition outcomes, recent systematic reviews find inconclusive evidence. This paper applies a comparable methodology to data on the Women's Empowerment in Agriculture Index (WEAI), an internationally-validated measure based on interviews of women and men within the same household, from six countries in Africa and Asia to identify which dimensions of women's empowerment are related to household-, woman-, and child-level dietary and nutrition outcomes. We examine relationships between women's empowerment and household-level dietary diversity; women's dietary diversity and BMI; and child-related outcomes, controlling for woman, child, and household characteristics. We also test for differential associations of women's empowerment with nutrition outcomes for boys and girls. We find few significant associations between the aggregate empowerment scores and nutritional outcomes. The women's empowerment score is positively associated only with child HAZ, while lower intrahousehold inequality is associated with a higher likelihood of exclusive breastfeeding and higher HAZ but with lower BMI. However, analysis of the subdomain indicators finds more significant associations, suggesting that tradeoffs exist among different dimensions of empowerment. Women's empowerment accounts for a small share of the variance in nutritional outcomes, with household wealth and country-level factors accounting for the largest share of the variation in household and women's dietary diversity. In contrast, most of the variation in child outcomes comes from child age. Improving nutritional outcomes requires addressing the underlying determinants of poor nutrition in addition to empowering women and improving gender equality.
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Affiliation(s)
| | | | - Elena M. Martinez
- International Food Policy Research Institute, Washington, DC, USA
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA
| | - Hazel Malapit
- International Food Policy Research Institute, Washington, DC, USA
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Kareem YO, Morhason-Bello IO, OlaOlorun FM, Yaya S. Temporal relationship between Women's empowerment and utilization of antenatal care services: lessons from four National Surveys in sub-Saharan Africa. BMC Pregnancy Childbirth 2021; 21:198. [PMID: 33691651 PMCID: PMC7944901 DOI: 10.1186/s12884-021-03679-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background In November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women’s empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women’s empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women’s empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model. Methods The most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women’s empowerment captured in the DHS. The 30 variables on women’s empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results. Results The proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women’s empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries. Conclusion This study highlights the significant impact of women’s empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03679-8.
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Affiliation(s)
- Yusuf Olushola Kareem
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Imran Oludare Morhason-Bello
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Funmilola M OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Singh K, Speizer IS, Ijdi RE, Calhoun LM. The association of empowerment measures with maternal, child and family planning outcomes in Plateau State Nigeria by urban-rural residence. BMC Pregnancy Childbirth 2021; 21:170. [PMID: 33639882 PMCID: PMC7916291 DOI: 10.1186/s12884-021-03659-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nigeria is experiencing a high level of urbanization and urban poverty. Within Nigeria maternal and child health and family planning outcomes may differ by residence (capital city, urban/non-capital city and rural) as well as by measures of women’s empowerment and wealth. This paper presents a detailed analysis of maternal and child health and family planning outcomes in Plateau State, Nigeria. Methods Data came from the 2017 Nigerian Urban Reproductive Health Initiative Sustainability Study. Multivariable logistic regression was used to study the associations between the key independent variables of residence, women’s empowerment and wealth with having a skilled birth attendant at childbirth and childhood preventative visits. The women’s empowerment variables included perceptions about household decision-making, financial decision-making, views on wife beating and having a prohibition, defined as a restriction on specific activities imposed by a woman’s husband. Multinomial regression was used to study the association of the same factors with the family planning outcome which had three categories – no use, traditional method use and modern method use. Regressions were also run separately for urban and rural populations. Results Women in the capital city of Jos were significantly more likely to have a skilled birth attendant at childbirth, take a child to a preventative visit and use family planning than women in rural areas of Plateau State. Three of the four measures of empowerment (household decision-making, financial decision-making and having a prohibition) were significantly associated with the family planning outcome, while having a prohibition was negatively associated with having a skilled birth attendant at childbirth. In rural areas, women involved in financial decisions were significantly less likely to use a modern method compared to a traditional method. Wealth was a significant factor for all outcomes. Discussion State-level analyses can provide valuable information to inform programs and policies at a local level. Efforts to improve use of maternal and child health and family planning services in Plateau state, Nigeria, should consider women’s empowerment, residence and poverty. Community education on the effectiveness of modern versus traditional methods and potential side effects of specific modern methods, may help women make informed decisions about contraception. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03659-y.
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Affiliation(s)
- Kavita Singh
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA. .,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Ilene S Speizer
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rashida-E Ijdi
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Lisa M Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kc H, Shrestha M, Pokharel N, Niraula SR, Pyakurel P, Parajuli SB. Women's empowerment for abortion and family planning decision making among marginalized women in Nepal: a mixed method study. Reprod Health 2021; 18:28. [PMID: 33541377 PMCID: PMC7863411 DOI: 10.1186/s12978-021-01087-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Women’s empowerment is multidimensional. Women’s education, employment, income, reproductive healthcare decision making, household level decision making and social status are vital for women’s empowerment. Nepal is committed to achieving women empowerment and gender equality, which directly affects the reproductive health issues. This can be achieved by addressing the issues of the poor and marginalized communities. In this context, we aimed to find the association of women’s empowerment with abortion and family planning decision making among marginalized women in Nepal. Methods A cross sectional study was conducted at selected municipalities of Morang district of Nepal from February 2017 to March 2018. A mixed method approach was used, where 316 married marginalized women of reproductive age (15–49 years) and 15 key informant interviews from representative healthcare providers and local leaders were taken. From key informants, data were analysed using the thematic framework method. Findings obtained from two separate analyses were drawn together and meta inferences were made. Results Women’s empowerment was above average, at 50.6%. Current use of modern contraceptives were more among below average empowerment groups (p 0.041, OR 0.593 C.I. 0.36–0.98). We could not find any statistically significant differences among levels of women’s empowerment, including those women with abortion knowledge (p 0.549); family planning knowledge (p 0.495) and women’s decision for future use of modern contraceptives (p 0.977). Most key informants reported that unsafe abortion was practiced. Conclusions Women’s empowerment has no direct role for family planning and abortion decision making at marginalized communities of Morang district of Nepal. However, different governmental and non-governmental organizations influence woman for seeking health care services and family planning in rural community of Nepal irrespective of empowerment status.
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Affiliation(s)
- Heera Kc
- Department of Nursing, Birat Health College, Purbanchal University, Biratnagar, Nepal.
| | - Mangala Shrestha
- Department of Maternal Health Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nirmala Pokharel
- Department of Maternal Health Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surya Raj Niraula
- School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College Teaching Hospital, Tankisinuwari, Morang, Nepal
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Mekonnen AG, Odo DB, Nigatu D, Sav A, Abagero KK. Women's empowerment and child growth faltering in Ethiopia: evidence from the Demographic and Health Survey. BMC Womens Health 2021; 21:42. [PMID: 33516229 PMCID: PMC7847175 DOI: 10.1186/s12905-021-01183-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite numerous national and international efforts to alleviate child growth faltering, it remains a global health challenge. There is a growing body of literature that recognizes the importance of women's empowerment in a wide range of public health topics, such as the utilization of maternal healthcare services, agricultural productivity, and child nutrition. However, in Ethiopia, the relationship between women's empowerment and child nutritional status is not studied at the national level. This study aimed to determine the association between women's empowerment and growth faltering in under-5 children in Ethiopia. METHODS The data source for this analysis is the 2016 Ethiopian Demographic and Health Survey (EDHS): a nationally representative household survey on healthcare. The EDHS employed a two-stage stratified cluster sampling technique. We computed standard women's empowerment indices, following the Survey-based Women's emPowERment index approach. A multilevel logistic regression model that accounted for cluster-level random effects was used to estimate the association between women's empowerment and child growth faltering (stunting, wasting and underweight). RESULTS Attitude to violence, social independence, and decision-making were the three domains of women's empowerment that were associated with child growth faltering. One standard deviation increase in each domain of empowerment was associated with a reduction in the odds of stunting: attitude towards violence (AOR = 0.92; 95% CI 0.88-0.96; p < 0.001), social independence (AOR = 0.95; 95% CI 0.89-0.99; p = 0.049), and decision-making (AOR = 0.93; 95% CI 0.87-0.99; p = 0.023). Similarly, each standard deviation increase in attitude towards violence (AOR = 0.93; 95% CI 0.89-0.98; p = 0.008), social independence (AOR = 0.91; 95% CI 0.86-0.97; p = 0.002), and decision-making (AOR = 0.92; 95% CI 0.86-0.99; p = 0.020) were associated with a decrease in the odds of having underweight child. CONCLUSIONS Ensuring women's empowerment both in the household and in the community could have the potential to decrease stunting and underweight in a rapidly developing country like Ethiopia. Policymakers and health professionals need to consider women's empowerment in this unique context to improve nutritional outcomes for children and alleviate growth faltering.
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Affiliation(s)
| | | | - Dabere Nigatu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adem Sav
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kiya Kedir Abagero
- Non Communicable Disease Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Abstract
BACKGROUND Although Myanmar is moving to attain UHC in 2030, health care utilization indicators are still low, especially among women. Women's health outcomes are determined by the lack of access to health care, and many factors influence this condition. The objective of the present work was to identify the association between women's empowerment and barriers to accessing health care among currently married women in Myanmar. METHOD We performed a secondary analysis using the Myanmar Demographic and Health Survey (2015-16), including 7759 currently married women aged 15-49 years. The outcome variable, barriers to accessing health care, were asked about in terms of whether the respondent faced barriers to getting permission to go, getting money to go, the distance to the health facility, and not wanting to go alone. The variables were recoded into zero, one, and more than one barrier. After performing the exploratory factor analysis for women's empowerment indicators (decision-making power and disagreement to justification to wife-beating), a multinomial logistic regression was carried out. RESULTS Among currently married women, 48% experienced no barriers when accessing health care services, 21.9% had one barrier, and 30.1% had more than one barrier. After the exploratory factor analysis, scores were recoded into three levels. Women with low and middle empowerment had 1.5 odds (AOR 1.5, 95% CI: 1.2-1.8) and 1.5 odds (AOR 1.5, 95% CI: 1.3-1.9), respectively, to have barriers to accessing health care when compared to those with high empowerment for one barrier group. For the women who had more than one barrier, women with low empowerment were 1.4 times more likely (AOR 1.4, 95% CI: 1.1-1.7) to experience barriers in comparison to women with high empowerment. The barriers were seen to be reduced in the case of women who had a high level of education, had fewer children, came from rich households, and lived in urban areas. CONCLUSION When women are more empowered, they tend to face fewer barriers when accessing health care services. This finding could contribute to the policy formulation for reducing health inequity issues by increasing women's empowerment.
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Affiliation(s)
- Nang Mie Mie Htun
- Department of Preventive and Social Medicine, University of Medicine Mandalay, Ministry of Health and Sports, Mandalay, 100102, Myanmar.
| | - Zar Lwin Hnin
- Department of Preventive and Social Medicine, University of Medicine Mandalay, Ministry of Health and Sports, Mandalay, 100102, Myanmar
| | - Win Khaing
- Department of Preventive and Social Medicine, University of Medicine Mandalay, Ministry of Health and Sports, Mandalay, 100102, Myanmar
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Nkoka O, Lee D, Chuang KY, Chuang YC. Multilevel analysis of the role of women's empowerment on use of contraceptive methods among married Cambodian women: evidence from demographic health surveys between 2005 and 2014. BMC Womens Health 2021; 21:9. [PMID: 33407398 PMCID: PMC7789707 DOI: 10.1186/s12905-020-01141-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
Background The use of contraceptives is an essential public health concept that improves overall safe motherhood and infant health. Women empowerment has been reported to influence health behaviors in women. With recent efforts to increase access to contraceptive methods, uptake of the same remains a challenge in Cambodia. There are limited studies that have examined the role of women’s empowerment at both individual- and community- level on contraceptive use in Cambodia. This study examined the individual- and community-level factors associated with contraceptive use among Cambodian married women between 2005 and 2014. Methods Data from 2005, 2010, and 2014 Cambodia Demographic and Health Surveys were used to analyze 2211; 10,505; and 10,849 women, respectively. Multilevel binary and multinomial logistic regression models were applied to assess the association between individual- and community- level factors, and the use of contraceptive methods. Results The prevalence of using modern contraceptive methods increased over time (i.e., 29.0, 38.1, and 42.3% in 2005, 2010, and 2014, respectively). At the individual level, women who attained secondary and higher education were more likely to use any contraceptives [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI) = 1.22–1.68, and aOR = 1.23, 95% CI = 1.05–1.44 in 2010 and 2014, respectively] compared with those with no formal education. Similarly, having a high workforce participation level was significantly associated with increased likelihood of using any contraceptive methods [aOR = 1.12, 95% CI = 1.00–1.26, aOR = 1.44, 95% CI = 1.29–1.60 and in 2010 and 2014, respectively]. Other factors such as age at first marriage, residence, and having a health insurance were associated with contraceptive use. The proportional change in variance showed that about 14.3% of total variations in the odds of contraceptive use across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 5.2% of the total variation remained unexplained even after adjustments. Conclusion Both individual- and community- level factors influenced contraceptive use in Cambodia. When designing programs to improve contraceptive use, contextual influences should be taken into account for the effectiveness of the programs.
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Affiliation(s)
- Owen Nkoka
- School of Public Health, Taipei Medical University, Taipei City, Taiwan, 110.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daphne Lee
- School of Public Health, Taipei Medical University, Taipei City, Taiwan, 110
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, Taipei City, Taiwan, 110
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, Taipei City, Taiwan, 110.
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Ntoimo LFC, Okonofua FE, Aikpitanyi J, Yaya S, Johnson E, Sombie I, Aina O, Imongan W. Influence of women's empowerment indices on the utilization of skilled maternity care: evidence from rural Nigeria. J Biosoc Sci 2020;:1-17. [PMID: 33261675 DOI: 10.1017/S0021932020000681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is increasing evidence that women with the ability to exercise control over their sexual and reproductive lives have greater access to prompt prevention and treatment of maternal health disorders, resulting in a concomitant reduction in maternal morbidity and mortality. This study assessed the association between indices of women's empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Data were taken from a household survey conducted in July and August 2017, and the study sample comprised 1245 ever-married women currently in a union who had given birth in the 5 years preceding the survey. A Gender Roles Framework guided the selection of independent women's empowerment variables. Using hierarchical logistic regression, the likelihood of receiving all three levels of skilled maternal health care service (antenatal, intrapartum and postnatal) by women's empowerment variables, grouped into resource, decision-making and influencer domains following the model of Anderson and Neuman, was assessed. Of the resource domain variables, respondent's education and respondent's participation in payment for their own health care positively predicted their use of all three levels of skilled maternal care, whereas their ownership of land negatively predicted this. Two decision-making domain variables were significantly associated with respondent's use of all three levels of service: those who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others, while respondent making decisions alone about what food to cook each day was a negative predictor. Of the influencer variables, religion and a large spousal education gap were strong positive factors, whereas living in a consensual union rather than being legally married was a negative factor. Although health system factors are important, interventions geared towards changing gender norms that constrain women's empowerment are critical to achieving maternal health-related development goals in Nigeria. A composite strategy that targets all women's empowerment indices is recommended, as Nigeria strives towards achieving SDG-3.
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Abstract
BACKGROUND Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy's positive effects impact on health-related indicators, the repercussions on women's empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women's empowerment. METHODS A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis of the included articles was conducted using a thematic analysis approach. The material was organized based on the Gender at Work analytical framework. RESULTS Out of the 206 initial records, nine articles were included in the review. The study settings include three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Four of them examine a direct association between user fee policies and women's empowerment, while the others address this issue indirectly -mostly by examining gender equality or women's decision-making in the context of free healthcare. The evidence suggests that user fee removal contributes to improving women's capability to make health decisions through different mechanisms, but that the impact is limited. In the context of free healthcare, women's healthcare decision-making power remains undermined because of social norms that are prevalent in the household, the community and the healthcare centers. In addition, women continue to endure limited access to and control over resources (mainly education, information and economic resources). CONCLUSION User fee removal policies alone are not enough to improve women's healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women's empowerment. A focus on "gender equitable access to healthcare" is needed to reconcile women's empowerment and the efforts to achieve universal health coverage.
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Affiliation(s)
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Thomas Druetz
- University of Montreal School of Public Health, Montreal, Canada.
- Centre de Recherche en Santé Publique, Montreal, Canada.
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA.
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Ward-Peterson M, Fennie K, Baird S, Coxe S, Trepka MJ, Madhivanan P. Multilevel influences of women's empowerment and economic resources on risky sexual behaviour among young women in Zomba district, Malawi. J Biosoc Sci 2021; 53:887-907. [PMID: 33077003 DOI: 10.1017/S0021932020000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Gender disparities are pronounced in Zomba district, Malawi. Among women aged 15-49 years, HIV prevalence is 16.8%, compared with 9.3% among men of the same age. Complex structural factors are associated with risky sexual behaviour leading to HIV infection. This study's objective was to explore associations between multilevel measures of economic resources and women's empowerment with risky sexual behaviour among young women in Zomba. Four measures of risky sexual behaviour were examined: ever had sex, condom use and two indices measuring age during sexual activity and partner history. Multilevel regression models and regression models with cluster-robust standard errors were used to estimate associations, stratified by school enrolment status. Among the schoolgirl stratum, the percentage of girls enrolled in school at the community level had protective associations with ever having sex (OR = 0.76; 95% CI: 0.60, 0.96) and condom use (OR = 1.06; 95% CI: 1.01, 1.11). Belief in the right to refuse sex was protective against ever having sex (OR = 0.76; 95% CI: 0.60, 0.96). Participants from households with no secondary school education had higher odds of ever having sex (OR = 1.59; 95% CI: 1.14, 2.22). Among the dropout stratum, participants who had not achieved a secondary school level of education had riskier Age Factor and Partner History Factor scores (β = 0.51; 95% CI: 0.23, 0.79, and β = 0.24; 95% CI: 0.07, 0.41, respectively). Participants from households without a secondary school level of education had riskier Age Factor scores (β = 0.26; 95% CI: 0.03, 0.48). Across strata, the most consistent variables associated with risky sexual behaviour were those related to education, including girl's level of education, highest level of education of her household of origin and the community percentage of girls enrolled in school. These results suggest that programmes seeking to reduce risky sexual behaviour among young women in Malawi should consider the role of improving access to education at multiple levels.
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Abstract
Agriculture and the food sector are critical to food and nutrition security because they not only produce food but also contribute to economic empowerment by employing a large share of female and male workers, especially in developing countries. Food systems at all levels―globally, domestically, locally, and in the home― are expected to be highly affected by the COVID-19 crisis. Women and men work as food producers, processors, and traders and will likely be impacted differently. Shocks or crises can exacerbate or reduce gender gaps, and so can policy responses to mitigate the impact of these crises or shocks. We offer some perspectives and available country examples on how the COVID-19 crisis and responses to the crisis could be a setback or offer opportunities for gender equality in the food system.
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Kabir A, Rashid MM, Hossain K, Khan A, Sikder SS, Gidding HF. Women's empowerment is associated with maternal nutrition and low birth weight: evidence from Bangladesh Demographic Health Survey. BMC Womens Health 2020; 20:93. [PMID: 32370781 PMCID: PMC7201548 DOI: 10.1186/s12905-020-00952-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
Background The burden of maternal undernutrition and low birth weight (LBW) incurs enormous economic costs due to their adverse consequences. Women’s empowerment is believed to be one of the key factors for attaining maternal and child health and nutritional goals. Our objective was to investigate the association of women’s empowerment with maternal undernutrition and LBW. Methods We used nationally representative data from the Bangladesh Demographic Health Survey for 2011 and 2014. We analysed 27357 women and 9234 mother-child pairs. A women’s empowerment index (WEI) was constructed using principal component analysis with five groups of indicators: a) education, b) access to socio-familial decision making, c) economic contribution and access to economic decision making, d) attitudes towards domestic violence and e) mobility. We estimated odds ratios as the measure of association between the WEI and the outcome measures using generalized estimating equations to account for the cluster level correlation. Results The overall prevalence of maternal undernutrition was 20% and LBW was 18%. The WEI was significantly associated with both maternal undernutrition and LBW with a dose-response relationship. The adjusted odds of having a LBW baby was 32% [AOR (95% CI): 0.68 (0.57, 0.82)] lower in the highest quartile of the WEI relative to the lowest quartile. Household wealth significantly modified the effect of the WEI on maternal nutrition; in the highest wealth quintile, the odds of maternal undernutrition was 54% [AOR (95% CI): 0.46 (0.33, 0.64)] lower while in the lowest wealth quintile the odds of undernutrition was only 18% [AOR (95% CI): 0.82 (0.67, 1.00)] lower comparing the highest WEI quartile with the lowest WEI quartile. However, the absolute differences in prevalence of undernutrition between the highest and lowest WEI quartiles were similar across wealth quintiles (6–8%). Conclusions This study used a comprehensive measure of women’s empowerment and provides strong evidence that low levels of women’s empowerment are associated with maternal undernutrition as well as with delivering LBW babies in Bangladesh. Therefore, policies to increase empowerment of women would contribute to improved public health.
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Affiliation(s)
- Alamgir Kabir
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Level 3, AGSM Building, Sydney, NSW, 2052, Australia. .,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. .,Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh. .,Asian Institute of Disability and Development, Dhaka, Bangladesh.
| | | | - Kamal Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Arifuzzaman Khan
- Asian Institute of Disability and Development, Dhaka, Bangladesh.,School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Heather F Gidding
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,The University of Sydney Northern Clinical School, Sydney, NSW, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
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Anderson EJ, Chebet JJ, Asaolu IO, Bell ML, Ehiri J. Influence of Women's Empowerment on Place of Delivery in North Eastern and Western Kenya: A Cross-sectional Analysis of the Kenya Demographic Health Survey. J Epidemiol Glob Health 2020; 10:65-73. [PMID: 32175712 PMCID: PMC7310812 DOI: 10.2991/jegh.k.200113.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Labor and delivery under the supervision of a skilled birth attendant have been shown to promote positive maternal and neonatal outcomes; yet, more than a third of births in Kenya occur outside a health facility. We investigated the association between measures of women’s empowerment and health facility-based delivery in Northeastern and Western Kenya. Methods: Analysis of 2014 Kenya Demographic and Health Survey data was conducted. Logistic regression adjusting for demographic factors, contraceptive use, and comprehensive HIV knowledge was used to assess the influence of the validated African Women’s Empowerment Index-East (AWEI-E) on the likelihood of women’s most recent birth having occurred in a health facility versus at home. Additionally, we explored the mediating effect of contraceptive use on women’s empowerment and health facility-based delivery. Results: Compared to respondents with low or moderate empowerment scores, those with high empowerment scores were more likely to have given birth at a health facility [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.30, 2.51], although this effect was null in the adjusted model (OR = 0.92, 95% CI = 0.58, 1.45). Respondents with a recent facility birth (n = 372/836) were more likely to have high household-level wealth (40.9% vs 8.6%, p < 0.001) and use a contraceptive method (44.9% vs 27.4%, p < 0.001) than those without facility-based delivery. Current contraceptive use mediated 26.8% of the effect of empowerment on the odds of facility-based delivery. Conclusion: Women’s empowerment, and its comprising three domains as measured by the AWEI-E, may be insufficient to overcome barriers to facility-based delivery for women in North Eastern or Western Kenya. High women’s empowerment is strongly associated with current contraceptive use, which may inform pregnancy planning and location of delivery. Alternatively, higher empowered women who delivered at a facility may have been offered contraceptives at the time of delivery. Future research targeting these regions should explore culturally acceptable approaches to broadening access to skilled supervision of labor.
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Affiliation(s)
- Elizabeth J Anderson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Joy J Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ibitola O Asaolu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - John Ehiri
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Abstract
INTRODUCTION Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women's ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women's empowerment is associated with stillbirths. METHODS Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women's empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted. RESULTS A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22-4.80). Education of mother (aOR 1.48; 0.94-2.33), age of husband (aOR 1.54; 0.86-2.76), household head (aOR 1.51; 0.88-2.59), poor wealth index (aOR 1.62; 0.98-2.68), middle wealth index (aOR 1.37; 0.76-2.47), decision making for healthcare (aOR 1.36; 0.84-2.21) and household purchases (aOR 1.01; 0.61-1.66) had no any significant association with stillbirths. CONCLUSIONS There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.
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Affiliation(s)
| | | | | | - Shyam Sundar Budhathoki
- Golden Community, Lalitpur, Nepal
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Naresh Pratap KC
- Golden Community, Lalitpur, Nepal
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
| | | | - Ashish KC
- Department of Women’s and Children’s Health, International Maternal and Child Health, University Hospital, 751 85 Uppsala, Sweden
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Bapolisi WA, Ferrari G, Blampain C, Makelele J, Kono-Tange L, Bisimwa G, Merten S. Impact of a complex gender-transformative intervention on maternal and child health outcomes in the eastern Democratic Republic of Congo: protocol of a longitudinal parallel mixed-methods study. BMC Public Health 2020; 20:51. [PMID: 31937267 PMCID: PMC6961329 DOI: 10.1186/s12889-019-8084-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background In the eastern part of the Democratic Republic of Congo (DRC) Village Savings and Loan Associations (VSLAs) programs targeting women are implemented. In the context of the ‘Mawe Tatu’ program more equitable intra-household decision-making is stipulated by accompanying women’s participation in VSLAs with efforts to engage men for more gender equality, expecting a positive effect of this combined intervention on the household economy, on child nutritional status, on the use of reproductive health services including family planning, and on reducing sexual and gender-based violence (SGBV). Methods A longitudinal parallel mixed method study is conducted among women participating in VSLAs in randomly selected project areas and among a control group matched for socioeconomic characteristics. Descriptive statistics will be calculated and differences between intervention and control groups will be assessed by Chi2 tests for different degrees of freedom for categorical data or by t-tests for continuous data. Structural equation modelling (SEM) will be conducted to investigate the complex and multidimensional pathways that will affect household economic status, child nutritional status and use of reproductive health services. Analysis will be conducted with STATA V.15. Concomitantly, qualitative data collection will shed light on the intra-household processes related to gender power-relations that may be linked to women’s participation in economic activities and may lead to improvements of maternal and child health. Focus group discussions and in-depth interviews will be conducted. All narrative data will be coded (open coding) with the help of qualitative data analysis software (Atlas TI). Discussion Women’s empowerment has long been identified as being able to bring about progress in various areas, including health. It has been shown that men’s commitment to transforming gender norms is a sinequanone factor for greater equity and better health, especially in terms of reproductive health and child nutrition. This study is one of the first in this genre in DRC and results will serve as a guide for policies aimed at improving the involvement of men in changing attitudes towards gender norms for higher household productivity and better health.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Giovanfrancesco Ferrari
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Clara Blampain
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jean Makelele
- CARE International DRC, Kinshasa, Democratic Republic of the Congo
| | | | - Ghislain Bisimwa
- Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Yaya S, Odusina EK, Uthman OA, Bishwajit G. What does women's empowerment have to do with malnutrition in Sub-Saharan Africa? Evidence from demographic and health surveys from 30 countries. Glob Health Res Policy 2020; 5:1. [PMID: 31956697 PMCID: PMC6961273 DOI: 10.1186/s41256-019-0129-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023] Open
Abstract
Background The reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries. The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development, labour supply, productivity, economic growth and development. This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries. Methods The study utilized secondary datasets of women in their child bearing age (15–49 years) from the latest Demographic and Health Survey (DHS) conducted in 2011–2017 across 30 sub Saharan Africa countries. The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence. Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status. Results Women’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status (stunted and underweight) at p < 0.001. These characteristics were also statistically significantly associated with empowerment status of women (Decision-making, Violence attitudes and Experience of violence) at p < 0.001 except for child age and sex. The association between childhood nutritional statuses and women’s empowerment (all three empowerment measures) was significant after controlling for other covariates that could also influence childhood nutrition statuses at p < 001. Two of the empowerment measures (attitudes towards violence and experience of violence) showed positive association with childhood nutritional statuses while the third (decision-making) showed negative association. Conclusion There is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries. Women’s empowerment was found to be related to childhood nutritional status. Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa.
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Affiliation(s)
- Sanni Yaya
- 1School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada.,2The George Institute for Global Health, The University of Oxford, Oxford, UK
| | | | - Olalekan A Uthman
- 4Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Ghose Bishwajit
- 1School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada
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