Women's Healthcare Decision-Making Autonomy by Wealth Quintile from Demographic and Health Surveys (DHS) in Sub-Saharan African Countries

Rose, Lee

doi:10.23937/2474-1353/1510054

Cited by 8 publications

(7 citation statements)

References 21 publications

(22 reference statements)

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“…This result is higher than the study conducted in Sub-Saharan African countries, where less than 20% of the population participated in maternal health service decision-making. 68 In contrast, the result of this study is lower than those of studies conducted in Canada (95.2%), 69 and low- and middle-income resource countries (61%). 70 This discrepancy might be attributed to existing sociodemographic conditions, the infrastructure of the healthcare system, and methodological variations (including study design).…”

Section: Discussioncontrasting

confidence: 82%

Women decision-making autonomy on maternal health service and associated factors in low- and middle-income countries: Systematic review and meta-analysis

Gebeyehu

Gelaw

Lake

et al. 2022

Womens Health (Lond Engl)

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Objective: This study was done to determine the overall estimate of decision-making autonomy on maternal health services and associated factors in low- and middle-income countries. Method: PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked by forest plot, Begg’s rank test, and Egger’s regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by country, year, and publication. Joanna Briggs Institute quality assessment tool was used to check the quality of each study. We carried out a leave-one-out sensitivity analysis. Results: Out of 1305 articles retrieved, 19 studies (with 104,871 study participants) met eligibility criteria and were included in this study. The pooled prevalence of women’s decision-making autonomy on maternal health services in low- and middle-income countries was 55.15% (95% confidence interval: 44.11–66.19; I2 = 98.6%, P < 0.001). Based on subgroup analysis, decision-making autonomy in maternal health services was the highest in Ethiopia at 61.36% (95% confidence interval: 50.58–72.15) and the lowest in Nigeria at 36.16% (95% confidence interval: 12.99–43.39). It was 32.16% (95% confidence interval: 32.72–39.60) and 60.18% (95% confidence interval: 47.92–72.44) before and after 2016, respectively. It was also 54.64% (95% confidence interval: 42.51–66.78) in published studies and 57.91% (95% confidence interval: 54.80–61.02) in unpublished studies. Age (adjusted odds ratio = 2.67; 95% confidence interval: (1.29–5.55), I2 = 90.1%), primary level of education (adjusted odds ratio = 1.75; 95% confidence interval: (1.39–2.21), I2 = 63.8%), secondary education level (adjusted odds ratio = 2.09; 95% confidence interval: (1.32–3.32), I2 = 87.8%), being urban resident (adjusted odds ratio = 1.80; 95% confidence interval: (1.22–2.66), I2 = 73%), and monthly income (adjusted odds ratio = 3.23; 95% confidence interval: (1.85–5.65), I2 = 97%) were positively associated with decision-making autonomy on maternal health service. Conclusion: Decision-making autonomy on maternal health services in low- and middle-income countries was low. Sociodemographic factors also influenced it. Educational accessibility and income generation should have been recommended, enabling women to decide for themselves.

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Section: Discussioncontrasting

confidence: 82%

Women decision-making autonomy on maternal health service and associated factors in low- and middle-income countries: Systematic review and meta-analysis

Gebeyehu

Gelaw

Lake

et al. 2022

Womens Health (Lond Engl)

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“…These findings were consistent with other studies [ 17 , 30 , 31 ] as wealth is usually connected with other social parameters (e.g., place of residence and/or household level of education). Affluent women have strong decision-making power on harmful traditional practices like FGM on themselves and their daughters because of their wealth status [ 32 ]. Moreover, the association between FGM practice and level of education indicates that educationally empowered women are more likely to turn down any societal pressure to circumcise their daughters.…”

Section: Discussionmentioning

confidence: 99%

Effect of parental attitudes on the practice and medicalization of female genital mutilation: a secondary analysis of Egypt Health Issues Survey, 2015

2022

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Background Despite the observed decrease in female genital mutilation (FGM) prevalence, it is increasingly being medicalized. We examined the attitudes of both parents towards the FGM practice in Egypt, and highlighted the effect of fathers’ decision making and attitudes towards FGM and violence on FGM practice and medicalization. Methods This study is a secondary analysis of Egypt Health Issues Survey (EHIS), 2015. The 2015 EHIS involved a systematic random selection of a subsample of 614 Shiakhas/villages out of the 884 shiakhas/villages that had been chosen as Primary Sampling Units in the 2014 EDHS. Descriptive statistics of the study sample and parents’ attitudes was performed. Three indices were created describing; mothers’ and fathers’ attitudes towards FGM, decision making and rejecting violence against women. Bivariate and multivariable analyses were conducted to identify predictors of FGM practice and medicalization. Results A considerable proportion of EHIS girls; 16.4% were circumcised and 36% of girls were expected to be circumcised. More than two thirds of circumcised girls were circumcised by a physician; namely 67% and 13.5% by nurses. The majority of mothers (88.4%) and fathers (84.8%) believed that FGM practice should continue. They believed that FGM is a religious obligation (72.3% of mothers and 73% of fathers). Parents believed that husbands prefer a circumcised wife (81.1% and 82.5% of mothers and fathers respectively). Being in the poorest wealth quintile (OR = 4.2, p < 0.001) and living in rural Upper Egypt (OR = 4.55, p < 0.001) were the predictors of FGM practice, while medicalization was more likely among the rich and educated parents. Parents’ attitudes supporting FGM was significantly associated with its practice (OR = 1.97, p < 0.001, for mothers and OR = 1.27, p < 0.001, for fathers). Rejecting violence against women was associated with less likelihood of practicing FGM (OR = 0.89, p < 0.05) and more likelihood of its medicalization (OR = 1.25, p < 0.01). Conclusion More attention should be paid to enforce the laws against FGM practice by health care providers. Raising the community awareness on girls’ human rights and elimination of FGM practice which is a severe form of violence against women and gender inequality in sexual rights should be prioritized with targeting men in FGM programs.

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“…Decision-mak ing mea sures have been widely used to assess women's abil i ties to make stra te gic choices that impact per sonal and fam ily well-being (Hindin 2000;Peterman et al 2015;Smith et al 2003). The extent to which women (as opposed to their hus bands) par tic i pate in deci sions about key aspects of their lives has been used as a proxy for women's auton omy (Acharya et al 2010;Hindin 2000;Lee et al 2017;Osamor and Grady 2016), bargaining power (Harari 2019;Mabsout and van Staveren 2010;Peterman et al 2015), and empow er ment (Kishor and Subaiya 2008;Upadhyay and Karasek 2012). Given that auton omy, bargaining power, and empow er ment are deeply com plex and mul ti fac eted con cepts, the demo graphic lit er a ture rec og nizes that no sin gle mea sure fully encap su lates these com pli cated con structs (Kabeer 1999;Oppenheim-Mason 1986).…”

Section: What Do Decision-making Measures Capture?mentioning

confidence: 99%

“…Nonetheless, within Africa, there is sub stan tial var i a tion in the extent of hus bands' deci sion-mak ing dom i nance. For exam ple, in a study of six Afri can countries, the per cent age of women who reported that their hus band alone made their ADVANCE PUBLICATION 2 L. Andriano et al health-related deci sions ranged from a high of 75% of women in Burkina Faso to a low of 22% of women in Burundi and Mozambique (Lee et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Husbands' Dominance in Decision-Making About Women's Health: A Spatial Diffusion Perspective in Sub-Saharan Africa

2021

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This article maps spatial and temporal variation in husbands' dominance in decision-making about their wives' health using pooled Demographic and Health Surveys from 28 countries in sub-Saharan Africa in an earlier (i.e., 2001–2005) and later (i.e., 2010–2014) period. First, we use adaptive bandwidth kernel density estimation to show how aggregate country-level estimates of husbands' decision-making dominance mask enormous spatial heterogeneity within countries. Our maps also reveal a geographic clustering of cells with similar levels of husband's decision-making dominance both within and between countries. Next, we use panel fixed-effects spatial regression methods to show that decreases in husbands' decision-making dominance in neighboring cells are associated with decreases in husbands' decision-making dominance in the reference cell. These findings support a diffusion explanation for declines in husbands' decision-making dominance over time. Our analyses also indicate that schooling and urbanization may be important channels through which diffusion occurs, which we speculate is because these are places where people are exposed to new ideas and gender norms.

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Women's Healthcare Decision-Making Autonomy by Wealth Quintile from Demographic and Health Surveys (DHS) in Sub-Saharan African Countries

Cited by 8 publications

References 21 publications

Women decision-making autonomy on maternal health service and associated factors in low- and middle-income countries: Systematic review and meta-analysis

Women decision-making autonomy on maternal health service and associated factors in low- and middle-income countries: Systematic review and meta-analysis

Effect of parental attitudes on the practice and medicalization of female genital mutilation: a secondary analysis of Egypt Health Issues Survey, 2015

Husbands' Dominance in Decision-Making About Women's Health: A Spatial Diffusion Perspective in Sub-Saharan Africa

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