Women's Decision-making Capacity Research Articles

IJCM_56A: What determines decision making among women? Insights from National Family Health Survey-5

Background: Women’s empowerment is a critical driver for economic growth and social prosperity. Broadly, the term refers to an improvement in women’s political, social, educational, economic, and health status. Decision making is an integral component of women’s empowerment. Objective: This secondary data analysis from NFHS 5 aims to measure the level of women decision-making capability and its determinants among women aged 15-49 years in India. Methodology: We have analyzed the latest available data from the National Family Health Survey-5 (NFHS-5) gathered from the Demographic Health Survey program after obtaining permission. Descriptive statistics were applied to determine the decision making among women. Logistic regression was applied to compute adjusted odds ratio (AOR) for determining the associated factors of women decision-making capability and p-values < 0.05 were considered statistically significant. Results: The total women respondents in the NFHS 5 dataset were 721145, of which data regarding women decision making was available for 77729 (10.7%). Total 68942(88.7%) women were involved in decision-making. Decision-making capacity was found to be significantly associated with age, education level, working status. Women aged more than 30 years were found to have more involvement in decision making as compared to those aged less than 30 years (AOR=1.76; CI=1.684-1.842; p< 0.05). Decision making was significantly associated with education (AOR=0.847; CI=0.807-0.889; p< 0.05). Working women were involved more in decision making as compared to non-working (AOR=1.494; CI=1.414-1.578; p< 0.05). Conclusion: This study sheds light on the relationship between women decision-making capacity and its association with sociodemographic variables. Several factors were found to be significantly associated with women decision making capability.

Domestic Violence Against Women in Nepal: A Systematic Review of Risk Factors.

A systematic review was conducted to examine the factors that put women at risk of domestic violence in Nepal. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, Cochrane, MEDLINE, CINAHL, and PsycINFO were searched supplemented by searching of the reference list manually. Of the 143 studies identified 24 were included in the final review. Search strategy was developed, and studies were included if they considered female participants (age 15-49 years) in heterosexual relationship, with exposure of different factors and whose outcomes were the magnitude of any form of violence (physical, sexual, and emotional/psychological). The Mixed Methods Appraisal Tool was used to assess the quality of the studies included. The findings are categorized based on the four levels of the ecological framework. At the individual level, the alcohol consumption level of husband, education level of both women and men, women's age at the time of marriage and childhood exposure to violence were found to be highly prevalent risk factors. At the relationship level, most prevalent risk factors were controlling husband and decision-making capacity of women. At the community level, belonging to underprivileged community or low caste system and living in Terai region were the risk factors. At the societal level, patriarchal belief and norms supporting violence were the risk factors. The complex nature of violence against women in Nepal requires culturally sensitive interventions along with organized efforts from the local and intra government to improve the status of Nepalese women at all levels of the ecological framework.

Gender-based roles, psychosocial variation, and power relations during delivery and postnatal care: a qualitative case study in rural Ethiopia.

The World Health Organization (WHO) strongly encouraged men to support women in receiving maternal healthcare. However, especially in developing countries, maternal healthcare has traditionally been viewed as an issue in women, with men making little or no contribution, even though sexuality and children are shared products. The study aims to understand how gender-based roles, psychosocial variation, and power relations are related to child delivery and postnatal care (PNC) services. The study was conducted in three rural districts of Oromia regional state, Jimma Zone, Ethiopia. An in-depth interview and focus group discussion were held with carefully chosen health professionals, health extension workers, community health development armies, and religious leaders. The data was collected, translated, and transcribed by experienced men and women qualitative researchers. For data analysis, ATLAS.ti version 9 was used. The data were coded and categorized concerning delivery and PNC service utilization. Independent and shared gender-based roles were identified as a means to improve maternal healthcare service delivery. The result obtained three categories, namely, gender-based roles, psychosocial variation, and power relations. Men can persuade pregnant women to use delivery services and PNC. The place of delivery is determined by the levels of gender-based power relations at the household level, but women are usually the last decision-makers. The belief of the community that giving birth in a health facility makes women look clean and neat, as opposed to home delivery, increases their intention to use maternal healthcare services. The study contributes that the role of a man as a husband is crucial in mobilizing others to carry pregnant women to health facilities, contributing to early intervention during labor. The decision-making capacity of women has improved over time, with men accepting their right to make decisions about their health and fetuses. Home delivery and men not being present during delivery are perceived as signs of backwardness, whereas giving birth in health institutes is seen as a sign of modernization and the rights of women.

Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework.

Low women empowerment, is a known contributing factor to unmet needs for contraception by limiting access to health services through negative cultural beliefs and practices. However, little is known about the association between unmet needs and domains of women empowerment in Sub-Saharan African (SSA) countries. Hence, this study aimed at assessing the influence of women empowerment domains on the unmet need for contraception in the region using the most recent Demographic and Health Survey (DHS) data (2016-2021). The data for the study was derived from the appended women's (IR) file of eighteen SSA countries. A weighted sample of 128,939 married women was analyzed by STATA version 16. The Harvard Institute's Gender Roles Framework, which comprised of influencer, resource, and decision-making domains was employed to identify and categorize the covariates across three levels. The effects of each predictor on the unmet need for spacing and limiting were examined using a multivariable multilevel mixed-effect multinomial logistic regression analysis. Adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. The pooled prevalence of unmet needs for contraception was 26.36% (95% CI: 24.83-30.40) in the region, with unmet needs for spacing and limiting being 16.74% (95% CI: 16.55, 17.02) and 9.62% (95% CI: 9.45, 12.78), respectively. Among variables in the influencer domain, educational level, family size of more than five, parity, number of children, attitude towards wife beating, and media exposure were substantially linked with an unmet need for spacing and limiting. Being in the poorest wealth quintile and enrollment in health insurance schemes, on the other hand, were the two variables in the resource domain that had a significant influence on unmet needs. The overall decision-making capacity of women was found to be the sole significant predictor of unmet needs among the covariates in the decision-making domain. Unmet needs for contraception in SSA countries were found to be high. Reproductive health program planners and contraceptive service providers should place due emphasis on women who lack formal education, are from low-income families, and have large family sizes. Governments should collaborate with insurance providers to increase health insurance coverage alongside incorporating family planning within the service package to minimize out-of-pocket costs. NGOs, government bodies, and program planners should collaborate across sectors to pool resources, advocate for policies, share best practices, and coordinate initiatives to maximize the capacity of women's decision-making autonomy.

Help-seeking behaviors among survivors of intimate partner violence during pregnancy in 54 LMICs

Abstract Background Intimate partner violence (IPV) experienced by pregnant women is pervasive worldwide. As survivors rarely seek help, there exists a paucity of research on their help-seeking behaviors. The present study provides a multi-national perspective into the nature of help-seeking behaviors among survivors of IPV during pregnancy. Methods Population-based data from 54 LMICs were abstracted from the Demographic and Health Surveys Program between 2005 and 2020 (N = 359,027). Bivariate and multivariable logistic regression were used to analyze the extent to which - and from whom - survivors of IPV during pregnancy sought help and assess associated factors. Results Half of respondents (51.87%) sought help following IPV while pregnant (ranging from 39.02% in Asia and Oceania to 63.18% in sub-Saharan Africa). Support was primarily obtained from informal contacts (44.02%), such as family, neighbors, and friends, and rarely from formal institutions (10.45%), such as law enforcement, social and medical services. Help-seeking behaviors were positively associated with higher education, employment, earnings exceeding that of their spouse, exposure to mass media, intimate partner's alcohol consumption, fear of their intimate partner, parental violence, richer wealth status, partner's controlling behaviors, and facing barriers to access health care. Conversely, being married, and justifying wife beating were negatively associated with help-seeking. Conclusions The research findings highlight the need for interventions, ranging in scope from the individual to familial and societal levels, to increase and improve help-seeking opportunities for IPV survivors. Efforts should be made on strengthening women's decision-making capacity, reducing poverty, ensuring educational attainment, improving employment opportunities, disseminating information about help sources, IPV screening within health care, and promoting the diffusion of gender equality by engaging communities as a whole. Key messages • IPV during pregnancy is still pervasive in LMICs, and only half of survivors seek help. Women’s individual, partner’s/family’s, and community’s factors are associated with IPV survivors’ help-seeking. • The research findings highlight the need for interventions, ranging in scope from the individual to familial and societal levels, to increase and improve help-seeking opportunities for IPV survivors.

The Lived Experience of Women Using Bilateral Tubal Ligation Service in Rural Southern Ethiopia: A Phenomenological Study

BackgroundBilateral tubal ligation is a highly safe and effective form of permanent contraception for couples who want no more children. However, it is the least known and used form of contraception in Ethiopia.ObjectiveTo explore the lived experience and perception of women using the bilateral tubal ligation method in Southern Ethiopia.MethodsQualitative phenomenological study design was employed. The study participants were recruited by purposive sampling. The data were collected through in-depth interviews and supportive field notes from March 25 to April 24, 2021. All Interviews with the participants were recorded using a digital audio recorder. Inductive thematic analysis was done using Colaizzi’s (1978) seven-step phenomenological analysis framework. Data coding was done using Open code software version 4.03.ResultsA total of fifteen participants were included in the study. Women’s satisfaction, male partner involvement, perception of women using bilateral tubal ligation, socio-cultural influences, client follow-up, and socio-economic impact of bilateral tubal ligation use are the major themes identified in the study. Findings revealed that most of the participants are satisfied with the method and became more productive and got the freedom to participate income-generating activities. The dominance of socio-cultural influences, male partner’s involvement, and client follow-up after the procedure are the common themes that emerged which determine the user’s experience.ConclusionLack of supportive involvement of partners, community pressure, lack of women’s decision-making capacity and inadequate follow-up of women in the post bilateral tubal ligation use by healthcare workers are emergent experiences in the current study. Hence, promoting behavioral change communication for community members regarding bilateral tubal ligation use, empowerment of women’s economic, educational, and decision-making capability and healthcare workers’ follow-up of women in the post bilateral tubal ligation period are recommended.

“If you don't find anything, you can't eat” – Mining livelihoods and income, gender roles, and food choices in northern Guinea

Artisanal and small-scale mining (ASM) continues to grow as a viable economic activity in sub-Saharan Africa. The health and environmental impacts of the industry, notably linked to the use of potentially toxic chemicals, has been well documented. What has not been explored to the same extent is how pressures associated with ASM affect food choices of individuals and families living in mining camps. This paper presents research conducted in 18 mining sites in northern Guinea exploring food choices and the various factors affecting food decision-making practices. Two of the most influential factors to emerge from this study are income variability and gender roles. Results from this study suggest that through artisanal mining, women have the opportunity to earn a larger income that would otherwise be unavailable through agriculture. However, this benefit of potentially earning a larger income is often reduced or constrained by existing gender roles both at the mines and in the home, such as disparity in pay between men and women and increased pressures on women's time. This limits the potential benefit to household food decision-making that could have been gained from higher income. These results do not seek to establish one livelihood as superior; rather, they demonstrate that even when presented with opportunities to earn higher incomes, women still face many of the same barriers and challenges that they would in other economic activities. Additionally, while work and time demands on women change upon arrival in the mining camps, existing gender roles and expectations do not, further restricting women's decision-making capacity.

Knowledge Management by Women for Climate Change Adaptation in Agriculture

Bangladesh is one of the most vulnerable countries to climate change. Changes in rainfall pattern and intensity of extreme events are evident. Due to the male migration caused by climate change and development drive there occurs huge feminization in agriculture. The perception and impact of climate change is completely gender differentiated; women are seemed to be disproportionately affected by climate change. Moreover, to cope with the climate change the community is now cultivating new crops and varieties. Besides, they are using different new cultivation methods and techniques to adapt with climate change. For newly introduced crops the traditional knowledge is not sufficient. Use of mobile phones for knowledge and information sharing in agriculture is gaining popularity among farmers. Growing interest on climate change adaptive agriculture among the female farmers and easy availability of mobile phones and network service created an opportunity of knowledge management on adaptive agriculture. The mobile phone use efficiency and ICT self-efficacy among the rural women are significant. The decisionmaking capacity of women is limited and there are number of challenges though the farming responsibility is gradually shifting towards them. The study was conducted in the Charland of Nilphamari District of Bangladesh from June 2017 to December 2019 to know the scopes and requirements of adaptation knowledge management in agriculture.
 Res. Agric., Livest. Fish.7(2): 225-233, August 2020

Can women in labor give informed consent to epidural analgesia?

There are reasons to believe that decision-making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women's decisional capacity. Decision-making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to 'understanding' alone. A systematic literature search identified a total of 20 empirical studies focused on women's decision-making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women's autonomy. To fill in the significant gap in clinical knowledge about laboring women's decision-making capacity, well-designed prospective and retrospective studies may be required.

The impact of women’s agency and autonomy on their decision-making capacity in Nuevo Leon, Mexico

Women’s decision-making capacity is central for promoting their wellbeing. When women are unable to decide for themselves independently means to promote their wellbeing, scarce r esources are likely to be underutilized. Women’s capacity to make decisions especially on matters that influence their wellbeing is of central concern for the provision of social services as well as health care services. Thus, determinants of women’s decision-making capacity are essential for improving their status in society and households. The aim of this work is to analyze relationship between level of autonomy and agency of women in conjunc tion with their effects on their decision-making ability using structural equation modeling in Nuevo Leon, Mexico. Participants of this study are women older than 15 years old resid ing in Nuevo Leon, Mexico. Results reveal that women’s agency positively influences their decision-making capacity. Also, autonomy has a significant and positive indirect effect on women's decision-making capacity, but its direct effect decreases when agency is included.

Women's perception of self-worth and access to health care

Objective: Research has shown differences in health status and health care utilization related to culture, economic status, and health care development. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in health care utilization and inequities in health status. Method: A questionnaire, administered to 100 women in each of Yemen, Uganda and Canada, explored women's perception of their own health and health care seeking behavior. Result: Women's perception of themselves as worthy of care was positively related to utilization. The ability to make one's own health care decisions varied with her country's development level. Implementation strategies must consider women's decision-making capacity. Conclusion: To achieve improved health status, policies and programs must commit to encouraging appropriate social and cultural changes, using a ‘cross-sectoral approach’, involving both gender and development issues.

Investigating the decision-making needs of HIV-positive women in Africa using the Ottawa Decision-Support Framework: Knowledge gaps and opportunities for intervention

Objective To examine HIV-positive women's decision making in the context of pregnancy and HIV/AIDS and to explore interventions that may enhance and develop women's decision-making capacity in the sub-Saharan African context. Methods The Ottawa Decision-Support Framework was used to assemble evidence of women's decision-making needs. Several electronic databases were searched and an Internet search of the World Wide Web was conducted to search grey literature sources. An evidence-based approach to assessing benefits, harms and current practices was employed. Results Several gaps in our knowledge about women's decision making in the context of pregnancy and HIV were identified. The availability of evidence varied for each decision; however, significant gaps included: evidence around testing for ones status, advanced directives for self and child, disclosure (specifically, the impact of), others perceptions of antiretroviral use and data on termination of pregnancies. Conclusion Decision making as a concept was generally not addressed in the MTCT literature. Evidence regarding the perceptions of women and others regarding the various decisions was often not available and subsequently an important aspect of MTCT interventions neglected. Practice implications Incorporating a multi-disciplinary decision-support framework may prove useful to promote women's autonomy and involvement in MTCT-related decision making.