Abstract:BackgroundMaternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women’s empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women’s advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-in… Show more
“…The fertility rate rose from 7. 61 in 1980;at 6.62 in 1990;at 5.86 in 2000;at 5.23 in 2010and 4.94 in 2015(Lan and Tavrow, 2017. The decline in fertility in Côte d'Ivoire is not necessarily explained by the successful of the family planning policy because the prevalence rate of modern contraception remains low.…”
Section: The Decline In Fertility In Côte D'ivoirementioning
confidence: 95%
“…Children are also presented as a source of physical security (Vlassoff, 1982). Thus, from 1960 to 1970, the fertility rate went from 7.35 to 7.88 (Lan and Tavrow, 2017). From 1980, the number of children per woman has decreased.…”
Section: The Decline In Fertility In Côte D'ivoirementioning
This research analyzes the impact of decision making in couples on the usage of modern contraception and identifies the other relevant socioeconomic and cultural determinants. From "Côte d'Ivoire Demographic and Health Surveys 2012", the statistics results showed that the percent of women who have knowledge on contraception is very low. The usage of contraception is higher among young than older and is two times higher among urban than rural. The Probit regression results showed that decision-making power in couples has a strong positive significantly impact on using contraceptive methods. Furthermore, education, knowledge on methods, living environment and age are major determinants of the contraceptive practice. In contrast, Muslim religion has a negative significantly impact on the probability of using contraception. The reproductive health workers must involve couples and religious leaders, especially the Muslim authorities in advocacy and activities of sensitization for better usage of modern contraception in households. The health authorities must also reduce the regional gap concerning free distribution of the products of modern contraception. Similarly, the providers must play their role to increase access to the products of modern contraception to better meet the needs and satisfaction of women in family planning.
“…The fertility rate rose from 7. 61 in 1980;at 6.62 in 1990;at 5.86 in 2000;at 5.23 in 2010and 4.94 in 2015(Lan and Tavrow, 2017. The decline in fertility in Côte d'Ivoire is not necessarily explained by the successful of the family planning policy because the prevalence rate of modern contraception remains low.…”
Section: The Decline In Fertility In Côte D'ivoirementioning
confidence: 95%
“…Children are also presented as a source of physical security (Vlassoff, 1982). Thus, from 1960 to 1970, the fertility rate went from 7.35 to 7.88 (Lan and Tavrow, 2017). From 1980, the number of children per woman has decreased.…”
Section: The Decline In Fertility In Côte D'ivoirementioning
This research analyzes the impact of decision making in couples on the usage of modern contraception and identifies the other relevant socioeconomic and cultural determinants. From "Côte d'Ivoire Demographic and Health Surveys 2012", the statistics results showed that the percent of women who have knowledge on contraception is very low. The usage of contraception is higher among young than older and is two times higher among urban than rural. The Probit regression results showed that decision-making power in couples has a strong positive significantly impact on using contraceptive methods. Furthermore, education, knowledge on methods, living environment and age are major determinants of the contraceptive practice. In contrast, Muslim religion has a negative significantly impact on the probability of using contraception. The reproductive health workers must involve couples and religious leaders, especially the Muslim authorities in advocacy and activities of sensitization for better usage of modern contraception in households. The health authorities must also reduce the regional gap concerning free distribution of the products of modern contraception. Similarly, the providers must play their role to increase access to the products of modern contraception to better meet the needs and satisfaction of women in family planning.
“…Little information is available on the influence of women's empowerment on the mode of childbirth [12]. In most studies, the social context appears to be a crucial determinant of the impact of empowerment on women's health and well-being throughout the childbirth process [13][14][15]. One study that focused on vaginal delivery demonstrated the difficulty of ensuring that women's autonomy is respected and the crucial role of women's empowerment in childbirth regarding access to information, the presentation of self-assertion and a woman's relationship with midwives [16].…”
Background
Women’s empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women’s empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns.
Methods
We hypothesized that in the context of the developing biomedicalization of childbirth, women’s empowerment increases the use of ECS due to a woman’s enhanced ability to decide her mode of delivery. By using microdata from the 2013–2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women.
Results
Among the indicators of women’s external resources, which include a higher level of education, having worked during the previous 12 months, and having one’s own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women’s empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS.
Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women.
Conclusions
These results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.
“…To overcome this problem, studies either: 1) examine cross-country or regional data [2–4] or combine household surveys from several countries [5], both of which can make it difficult to clearly identify determinants as there is a great deal of heterogeneity across regions/countries; 2) examine factors affecting uptake of maternal health services rather than maternal death directly [6–13]; or 3) identify cases of maternal death and then append these with a random sample of births (controls) that have not resulted in death [14–20]. Collection of the case data is costly and time-consuming and often only feasible over a limited geographic range and many of these studies are restricted to cases and controls admitted to hospitals or health centres, which are likely to be biased to particular demographics.…”
Background
For countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households’ socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces.
Methods
The 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics.
Findings
Health service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies.
Conclusion
Indonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using cens...
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