Abstract
BackgroundHow socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly studied in Nepal. This study aims to explore the links between women's household position and their autonomy in decision making.MethodsWe used Nepal Demographic Health Survey (NDHS) 2006, which provided data on ever married women aged 15-49 years (n = 8257). The data consists of women's four types of household decision making; own health care, making major household purchases, making purchase for daily household needs and visits to her family or relatives. A number of socio-demographic variables were used in multivariable logistic regression to examine the relationship of these variables to all four types of decision making.ResultsWomen's autonomy in decision making is positively associated with their age, employment and number of living children. Women from rural area and Terai region have less autonomy in decision making in all four types of outcome measure. There is a mixed variation in women's autonomy in the development region across all outcome measures. Western women are more likely to make decision in own health care (1.2-1.6), while they are less likely to purchase daily household needs (0.6-0.9). Women's increased education is positively associated with autonomy in own health care decision making (p < 0.01), however their more schooling (SLC and above) shows non-significance with other outcome measures. Interestingly, rich women are less likely to have autonomy to make decision in own healthcare.ConclusionsWomen from rural area and Terai region needs specific empowerment programme to enable them to be more autonomous in the household decision making. Women's autonomy by education, wealth quintile and development region needs a further social science investigation to observe the variations within each stratum. A more comprehensive strategy can enable women to access community resources, to challenge traditional norms and to access economic resources. This will lead the women to be more autonomous in decision making in the due course.
Highlights
How socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly studied in Nepal
Almost half (47.1%) of ever-married women took decisions on their own health care alone or jointly with their husband. This proportion compares with 52.8% on making major household purchases, 57.6% for making daily household purchases and 56.6% for visits to family/friends
Similar age-related decision-making power can be observed for major household purchases (15.5%-71.3%), daily purchases (18.0%-74.6%) and visits to family and friends (20.1%-77.0%)
Summary
How socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly studied in Nepal. Women's autonomy in health-care decisionmaking is extremely important for better maternal and child health outcomes [3], and as an indicator of women's empowerment. The socio-cultural context conditions the relationship of women's individual-level characteristics to decisionmaking, and autonomy is a key intervening mediator between women's status and reproductive outcomes [6]. Women have little autonomy in many cultures, so it is important to get (1) a better understanding of the determinants of their decision-making autonomy; (2) and variations across regions and socio-cultural contexts in the same country. Previous work has shown that women who have a significant say in reproductive matters tend to be more educated, spend more time on household economic activities and marry later [7]. Another study emphasises that compared to their husbands' report, wives tend to under-report their household decision-making power. Population and development programmes are most effective when steps have simultaneously been taken to improve the status of women in the decision making process [1]
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