Women's involvement in decision-making and receiving husbands’ support for their reproductive healthcare: a cross-sectional study in Lalitpur, Nepal

Abstract

Background Sociocultural factors remain an important determinant for women's involvement with decision making and getting husbands’ support for their reproductive healthcare. Therefore this study was conducted to examine sociodemographic factors associated with women's involvement in decision making and getting husbands’ support for their reproductive healthcare. Methods An institutional-based cross-sectional study was conducted in Lalitpur, Nepal. A total of 600 respondents were selected from 15 immunization clinics. Participants were women ≥18 y of age who came to the child's immunization clinic. The association between sociodemographic variables and women's involvement in decision making and getting husbands’ support for their reproductive healthcare was analysed through multivariate logistic regression models. Results While women's involvement in decision making was greater for childcare, it was less in the area related to financial matters. In contrast, husbands supported more in the area related to finances than for childcare and accompanying to health facilities. The significant determinants for women's involvement in decision making and getting husbands’ support were the woman's caste, education level, employment status, household income, age group and number of children. Madhesi/Muslim/other women were less likely (adjusted odds ratio [AOR] 0.31 [95% confidence interval {CI} 0.12 to 0.73]) to decide the number of babies and birth spacing. These women were also less likely (AOR 0.18 [95% CI 0.02 to 0.86]) to be accompanied by their husbands to the family planning (FP) clinic. Janajati, Dalit and Madhesi/Muslim/other women were less likely to receive their husbands’ support for birth preparedness. Women who were <20 y of age and had a single child were less likely to get involved in decision making and getting their husbands’ support for FP services. Conclusions The findings call for reproductive health programs that encourage women's involvement in decision making and receiving husbands’ support in women's reproductive healthcare. When designing such a program in the FP area, the woman's caste, age and parity should be given special consideration. Also, caste should be considered when designing such a program related to birth preparedness.

“Can’t live willingly”: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia

“…Current conceptualisations of experiences of pregnancy following early marriage focus on the importance of education [136][137][138][139][140]. This is supported by quantitative evidence from South Asia which has found associations between education, knowledge of reproductive health [19,[109][110][111], and decision-making [127,131,135,141]. However, this review found that even educated girls were generally unable to speak up and be listened to within their households due to restrictive household hierarchies, meaning that education does not translate into improved experiences.…”

“…We found that newly married women and girls in particular had their decision-making restricted, as they have not yet gained status through their reproductive role. However, quantitative evidence from Nepal and Bangladesh suggests that the household status of women and girls does not increase with time or with the delivery of a child [ 131 – 134 ]. These nuances are context-specific and difficult to measure, requiring research at a local level, which we were unable to undertake in this regional review [ 135 ].…”

“…However, we also found that socioeconomic reasons were often given for not seeking care or following recommended nutritional practices, despite services and supplements being offered for free [ 44 , 49 , 56 , 85 , 90 ]. Inconsistencies within the quantitative literature on associations between socioeconomic status and pregnancy decision-making [ 131 , 144 , 145 ] may be explained by household dynamics, as sociodemographic factors are understood to be less important in contexts where women’s agency is more restricted [ 146 ]. These conflicting findings highlight the importance of understanding the local contexts in which women and girls live when undertaking research and designing programs.…”

Determinants of institutional delivery service utilization in Nepal

“…In certain instances, husbands may be the sole available support for transporting their wives to healthcare institutions for delivery. Consequently, their perception of maternal needs is of critical importance as it can influence delays in seeking maternal health services [ 44 , 45 ]. Given that husband’s involvement directly affects access to and utilization of maternal healthcare services by pregnant women, further investigation of this dimension is imperative in future research, particularly within predominantly patriarchal societies like Nepal.…”

Impact of Socio-Economic and Demographic Factors on Women Decision Making while making the household Purchasing - Evidence from Pakistan

“…Active participation of women in decision-making at all levels is a crucial aspect in achieving equality and fostering peace within families and countries. However, in many third-world nations, especially in Pakistan, women's decision-making power is often limited due to the predominance of male control over both decision-making authority and economic resources within households (Reshi, 2023;Pokharel, 2023). Women in Pakistan are frequently deprived of decision-making power, particularly concerning their own concerns.…”