Abstract
Imbalance of power and equality in sexual relationships is linked to health in various ways, including (1) reduced ability to get information or take action, (2) increased violence between partners, and (3) influence on the reduced use of health services. While there has been research assessing multiple social and economic variables related to gender inequality, studies have used many different definitions of gender inequality, and there is a lack of this research within a pregnancy context. Here, we attempt to identify social and economic predictors of gender inequality (measured by decision-making power and acceptance of intimate partner violence) within heterosexual couples expecting a child in central Kenya. We ran a secondary data analysis using data from a three-arm individually randomized controlled HIV self-testing intervention trial conducted in 14 antenatal clinics in central and eastern Kenya among 1410 women and their male partners. The analysis included Cochran Mantel-Haenszel, logistic regression, proportional odds models, and generalized linear mixed model (GLMM) framework to account for site-level clustering. Overall, we show that there are significant social and economic variables associated with acceptance of intimate partner violence including higher age, being married, “other” religion, lower partner education, higher wealth status, and variables associated with decision-making power including lower partner education and lack of equality in earnings. This study contributes to the literature on the influence of social and economic factors on gender inequality, especially in Kenya which has a high burden of HIV/AIDS. Our results show some areas to improve these specific factors (including education and employment opportunities) or create interventions for targeted populations to potentially improve gender equality in heterosexual pregnant couples in Kenya.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.In most societies, including African societies, males have more power over females (Organization for Social Science Research in Eastern and Southern Africa 2013)
After the women provided informed consent, they were randomized into one of three arms: Arm 1, the standard Kenyan Ministry of Health card inviting the male partner to come to the health clinic for a discussion on family health but nothing mentioning HIV; Arm 2, an improved invitation card describing the benefits of male HIV testing to prevent motherto-child transmission of HIV; and Arm 3, the improved invitation card plus the delivery of two OraQuick HIV self-testing (HST) kits to the woman with instructions for testing the male partner at home
Regarding the bivariate analyses between the demographic characteristics and gender equality, we found that lower scores on the Gender Equitable scale were significantly associated with the following
Summary
In most societies, including African societies, males have more power over females (Organization for Social Science Research in Eastern and Southern Africa 2013) This imbalance is associated with violent and risky behaviors that can have a negative impact on many aspects of health (MacPherson et al 2014). The balance of power in sexual relationships is linked to sexual and reproductive health in various ways, including directly through reduced ability to get information or take action, increased violence between partners, and through its influence on the reduced use of health services (Blanc 2001). In South Africa and Botswana, there were a few social and economic predictors that were associated with lower female gender equality
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