Place Matters: Community Level Effects of Women’s Autonomy on Ethiopian Children’s Immunization Status

Ebot, Jane Ofundem

doi:10.11564/28-0-568

Cited by 7 publications

(5 citation statements)

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“…This may be because social interactions in Ethiopia are often intertwined and therefore, the effect of group group-level autonomy on individual behavior may exceed the individual’s autonomy [ 30 ]. The group level may indicate that even though Ethiopian women have low decision-making power, living in a strong decision-making society for women can lead to increased use of shared information and resources and ultimately, help improve the quality of life for women and their family members as well [ 18 ]. Female decision-making power at the group level had a beneficial effect on lowering the risk of anemia, implying that gender disparity, as measured by low decision-making power, may influence the development of anemia among married women.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies indicated that the decision-making capabilities of women in a society might have also an effect on their health and health-related behavior, more than the effect of individual women’s autonomy for two major reasons [ 18 ]. The first reason is that the presence of high numbers of a greater proportion of empowered women in a community could contribute to the information distribution related to better health outcomes to those with lower autonomous levels through formal and informal social networks [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Decision-making autonomy of women and other factors of anemia among married women in Ethiopia: a multilevel analysis of a countrywide survey

et al. 2021

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Background Anemia is one of the world’s public health problem, especially in developing nations. The majority of women of childbearing age (15–49) are affected by anemia. Women’s role in the decision-making process is significant for their health and related issues such as anemia. So far, there is no evidence of women’s decision-making autonomy on anemia. Consequently, this study aimed to robustly examine both individual- and group-level women’s decision-making autonomy and other determinants of anemia among married women in Ethiopia. Methods We examined data from an Ethiopian demographic and health survey conducted in 2016. Our analysis included 9220 married women of childbearing age (15–49 years). For bivariate analysis, we applied the chi-squared (X2) test. The relationship between individual and group-level women’s decision-making autonomy and anemia was assessed using multilevel binary logistic regression models while adjusting other socio-demographic and economic characteristics. Results In this study the magnitude of anemia was 30.5% (95% CI; 29.5–31.4). According to our multilevel analysis, group-level women’s autonomy was found to be negatively related with anemia than individual-level women’s autonomy (AOR = 0.53, 95% CI = 0.41–0.69). In addition, the indicator of women’s wealth index at group level was a protective factor (AOR = 0.68, 95% CI =0.51–0.90) to develop anemia. Among individual-level indicators women’s age (AOR = 0.73, 95% CI = 0.60–0.89), use of contraceptive (AOR = 0.66, 95% CI = 0.55–0.81), BMI (AOR = 0.71, 95% CI = 0.59–0.86) and employment status (AOR = 0.88, 95% CI = 0.79–0.98) were negatively related with anemia. While women who follow Muslim religion (AOR = 1.62, 95% CI = 1.32–1.97,), women who had five and above number of children (AOR = 93, 95% CI = 1.53–2.46), and who were pregnant (AOR = 1.21, 95% CI = 1.04–1.40) were positively associated with anemia. Our final model showed that around 27% of the variability of having anemia was because of group-level differences (ICC = 0.27, P < 0.001). In addition, both individual and group-level factors account for 56.4% of the variance in the in the severity of anemia across communities (PCV = 56.4%). Conclusions Our study showed that empowering women within households is not only an important mechanism to reduce anemia among married women but also serves as a way to improve the lives of other women within the society.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Decision-making autonomy of women and other factors of anemia among married women in Ethiopia: a multilevel analysis of a countrywide survey

et al. 2021

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“…A study conducted in four countries, namely Namibia, Kenya, Nepal, and India, revealed that opposing attitudes toward wife beating measured at the community level affected maternal reproductive healthcare service utilization [ 40 ]. In 2014, Ebot et al also reported a strong association of community-level women’s autonomy on healthcare service utilization and indicated that the preventative healthcare service utilization of Ethiopian women with low individual-level autonomy was significantly increased if they lived in a community with a high level of women’s autonomy [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Women’s autonomy and maternal healthcare service utilization in Ethiopia

Tiruneh

Chuang

2017

BMC Health Serv Res

126

133

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BackgroundMost previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia.MethodsWe analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women’s decision-making power and permissive gender norms associated with wife beating. We used Spearman’s correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women’s autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics.ResultsOur multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics.ConclusionsOur study shows that women’s autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2670-9) contains supplementary material, which is available to authorized users.

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“…In contrast, a study in Ethiopia showed that community-level factors were associated with the number of childhood immunizations, net of individual-level covariates. Children who lived in communities with high average education had almost 20% more immunizations compared with children from communities with low education ( 36 ). A study in Malawi found that regions with a high percentage of deliveries attended by health personnel were also characterized by a higher coverage of vaccination ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Timely immunization completion among children in Vietnam from 2000 to 2011: a multilevel analysis of individual and contextual factors

et al. 2016

Global Health Action

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BackgroundSince the beginning of 2014, there have been nearly 6,000 confirmed measles cases in northern Vietnam. Of these, more than 86% had neither been immunized nor was their vaccination status confirmed.ObjectiveTo establish the likelihood that children under five in Vietnam had ‘timely immunization completion’ (2000–2011) and identify factors that account for variations in timely immunization completion.DesignSecondary data from the Multiple Indicator Cluster Survey (MICS), which sampled women aged 15–49 from the 1999 Vietnamese Population and Housing Census frame, were analyzed. Multilevel analysis using Poisson regression was undertaken.ResultsProportions of children under five who had timely immunization completion were low, especially for HBV dose 2 and HBV dose 3, which decreased between 2000 and 2011. Among seven vaccines used in the National Expanded Program of Immunization (EPI) in 2000, 2006, and 2011, measles dose 1 had the highest timely immunization completion at 65.3%, 66.7%, and 73.6%, respectively, and hepatitis B dose 1 had the lowest at 17.5%, 19.3%, and 45.5%, respectively. Timely immunization completion was less common among children whose mothers had relatively less household wealth, were from ethnic minorities, lived in rural areas, and had less education. At the community level, the child's region of residence was the main predictor of timely immunization completion, and the availability of hospital delivery and community prenatal care in the local community were also determinants.ConclusionThe EPI should include ‘timely immunization completion’ as a quality indicator. There should also be greater focus and targeting in rural areas, and among women who have relatively low education, belong to minority groups, and have less household wealth. Further research on this topic using multilevel analysis is needed to better understand how these factors interact.

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Place Matters: Community Level Effects of Women’s Autonomy on Ethiopian Children’s Immunization Status

Abstract: Abstract

Cited by 7 publications

References 40 publications

Decision-making autonomy of women and other factors of anemia among married women in Ethiopia: a multilevel analysis of a countrywide survey

Decision-making autonomy of women and other factors of anemia among married women in Ethiopia: a multilevel analysis of a countrywide survey

Women’s autonomy and maternal healthcare service utilization in Ethiopia

Timely immunization completion among children in Vietnam from 2000 to 2011: a multilevel analysis of individual and contextual factors

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