Constructs of power and equity and their association with contraceptive use among men and women in rural Ethiopia and Kenya

Abstract

Using samples of reproductive aged men and women from rural Ethiopia and Kenya, this study examines the associations between two scales measuring balances of power and equitable attitudes within relationships and modern contraceptive use. The scales are developed from the Sexual and Reproductive Power Scale (SRPS) and Gender Equitable Male (GEM) scale, which were originally developed to measure relationship power (SRPS) among women and gender equitable attitudes (GEM) among men. With the exception of Ethiopian women, a higher score on the balance of power scale was associated with significantly higher odds of reporting modern contraceptive use. For men and women in both countries, a higher score on the equitable attitudes scale was associated with significantly higher odds of reporting modern contraceptive use. However, only the highest categories of the scales are associated with contraceptive use, suggesting a threshold effect in the relationships between power, equity and contraceptive use. The results presented here demonstrate how elements of the GEM and SRPS scales can be used to create scales measuring balances of power and equitable attitudes within relationships that are associated with self-reporting of modern contraceptive use in two resource-poor settings. However, further work with larger sample sizes is needed to confirm these findings, and to examine the extent to which these scales can be applied to other social and cultural contexts.

Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa

“…These and similar inequalities are found throughout sub-Saharan Africa; they are reproduced informally, aim to maintain male dominance and are thought to be prejudicial to women's status (Heise, 1998;Moursund and Kravdal, 2003;Desai and Andrist, 2010;Wang, 2010). Several studies have shown that these gender inequalities have a negative effect on women's reproductive health practices and outcomes by limiting their access to information, increasing their vulnerability to gender-based violence and also by limiting their access to health services (Mason, 1987;Riley, 1998;Blanc, 2001;Dodoo and Frost, 2008;Stephenson et al, 2012).…”

“…Specific norms regarding violence are essential to consider, as they are directly related to the exercise of violence against women (Moore, 1999;Koenig et al, 2006;Sarkar, 2008;OECD, 2010;Stephenson et al, 2012) and are more susceptible to "create a climate of fear and intimidation" (Gilfus et al, 2010;Nanda et al, 2013). Intimate-partner violence (IPV) is said to be grounded in patriarchal society that gives primacy and privilege to men (Amoakohene, 2004;Kishor and Subaiya, 2008), and "serves to maintain the unequal balance of power" between men and women (Watts and Zimmerman, 2002;Wilson-Williams et al, 2008).…”

“…Recently, the research agenda on maternal and infant health has shifted to consider women's autonomy or empowerment, defined as "women's ability to make decisions which affect outcomes of importance to themselves and their families" (Malhotra and Schuler, 2005, p.5), as a fundamental factor for understanding their reproductive behaviour in developing countries (Bloom et al, 2001;Stephenson et al, 2012;Singh et al, 2013). However, most previous studies have not considered the broad context of gender inequality and the social norms under which women live, which define and structure their status (Kritz and Makinwa-Adebusoye, 1999;Dixon-Mueller and Germain, 2000;Blanc, 2001;Desai and Johnson, 2005).…”

Gendered power dynamics and women’s negotiation of family planning in a high HIV prevalence setting: a qualitative study of couples in western Kenya

“…A variety of validated scales have been developed with the goal of measuring gender-based power; though these scales have varying relevance to populations and contexts and cannot be compared (C-Change, FHI360, and USAID 2015). For example, Stephenson, Bartel, and Rubardt (2012) examined the associations between two validated scales of gendered power and contraceptive use among men and women in Kenya and Ethiopia. They found that higher scores on men’s equitable attitudes scale correlated with higher reporting of contraceptive use.…”

Maternal Mortality in India: An Overview of social causes

“…The key factor to reduce maternal mortality is not just the availability of a well-functioning health care system but also its access to the most vulnerable section of women in the society. Several studies have shown the negative effects of gender inequalities on women's reproductive health practices and outcomes by limiting their access to health services and information and increasing their vulnerability to gender-based violence (Blanc, 2001;Dodoo & Frost, 2008;Stephenson, 2012). At the household levels, gender inequality affects the family size, contraceptive use, age at marriage (Woldemicael 2009;Desai and Andrist, 2010).…”