Household Decision-making Power Research Articles

Women's participation in household decision-making: Qualitative findings from the Shonjibon Trial in rural Bangladesh.

A key element of women's empowerment is the ability to participate in household decision-making. This study presents the qualitative results from the Shonjibon Cash and Counselling Trial baseline process evaluation with the aim of exploring the status of women's decision-making at the trial's outset and to facilitate the exploration of any changes in women's empowerment over the course of the trial. Between January and March 2021, we conducted forty-one in-depth interviews with pregnant women in rural Bangladesh. The research team translated, transcribed, coded, and discussed the interviews. We used thematic analysis to examine women's experience and perceptions on household decision-making. The key findings that emerged; women jointly participated in financial decision-making with their husbands; men made the final decision regarding seeking healthcare, and women solely made choices regarding infant and young child feeding. Our findings revealed that women felt that they needed to discuss their plans to go outside the house with their husbands, many perceived a lack of importance in the community towards women's participation in decision-making. This study documents current contextual information on the status of women's involvement in household decision-making and intrahousehold power dynamics at the start of the Shonjibon Cash and Counselling Trial.

The Practice of Early Marriage of Girls and Its Effects: A Study Conducted in the Nayagarh District of Odisha

Early marriage has many problems for girls in the world in general and in developing countries in particular. It results in the health, and socio-economic aspects of girls; mistreatment, marginalization and denying basic human rights of girls. Early marriage also limits many girls’ mobility, self-esteem, ability to seek profitable employment, and household decision-making power, and increases their vulnerability to violence. Each of these factors has a potent effect on a girls’ ability to access healthcare, compromising not only her health but that of her children, and not being competent in economic and social affairs. This paper aims to examine and investigate the prevalence of early marriage in the study area (Nayagarh District, Odisha); identify the causal factors of early marriage in the study area, and examine its associated problems that its impact on the health and socio-economic condition of girls. In Nayagarh district, children marry early due to different reasons. Among the identified factors some are as a matter of their tribal tradition, fear of premarital sex and pregnancy, parents’ interest in following the consent of relatives, afraid of losing a financially sound bridegroom etc. The low economic status of parents and lack of knowledge are the main causal factors of early marriage in the area. The main consequences of early marriage identified in the study area are girls’ college dropout, marriage instability, early pregnancy, maternal mortality, and increased number of children.

Study of the Impact of Rural Land Transfer on the Status of Women in Rural Households

While the status of rural women in the family has undergone changes, rural land transfer has brought about transformations in both rural production and daily life. This paper adopts the perspective of rural land transfer, follows the research track of Marx and Engels’s theory of women, and based on the theoretical research of the changes in the status of modern women in the family, constructs a framework for analyzing the status of women in rural families. Drawing on the data from the 2014 China Family Panel Studies (CFPS2014), this article utilizes OLS (Ordinary Least Square) and ordered logit models to explore the impact of rural land transfer on the status of women in rural households. The study reveals the following findings: Initially, rural land transfer-out improves women’s household decision-making power and enhances the status of women in rural households. The reliability of these results is further confirmed through robustness tests and endogeneity discussions. Secondly, the heterogeneity analysis indicates that the transfer of agricultural land promotes the status of women in rural households in nonmajor grain-producing areas more than women in major grain-producing areas. The reason is that women in major grain-producing areas lack off-farm employment opportunities compared with women in non-major grain-producing areas and the main grain producing areas may have a strong patriarchal cultural atmosphere. Thirdly, the analysis of mechanisms indicates that rural land transfer-out improves the status of women in rural households by augmenting their independent income. Conversely, rural land transfer-in increases women’s private labor and decreases their independent income without promoting their family status. The study sheds light on rural women’s empowerment, the improvement of intra-household bargaining power, and the comprehensive development of rural women. The conclusion of this paper provides a new understanding and some recommendations for us to explore the change of rural women’s status in the family.

Mediating effects of women’s empowerment on dietary diversity during pregnancy in Central West Ethiopia: A structural equation modelling

ABSTRACT Background Considerable proportions of pregnant women consume inadequately diversified diets in Ethiopia. On the other hand, women’s empowerment is identified as a means of achieving maternal nutrition improvement. However, evidence on the relationship between multiple dimensions of women’s empowerment and dietary diversity during pregnancy is limited in Ethiopia. Objective This study aimed to assess the mediating effects of women’s empowerment in the pathway between women’s education and dietary diversity during pregnancy in West Shewa zone, Ethiopia. Methods A health facility-based cross-sectional study was conducted among 1,383 pregnant women in 2021. Dietary diversity was measured using the minimum dietary diversity for women (MDD-W) tool. Exploratory and confirmatory factor analyses were employed to identify and validate women’s empowerment dimensions. Structural equation modelling (SEM) was used to examine the pathways linking pregnant women’s education and empowerment to dietary diversity during pregnancy. Results From the latent dimensions of women’s empowerment produced by factor analyses, pregnant women’s education was directly associated with household decision-making power, psychological and time dimensions. In turn, household decision-making power, psychological and time dimensions were associated with dietary diversity during pregnancy. The direct relationship between pregnant women’s education and dietary diversity was insignificant, but the total indirect effect and total effect were significant. Household decision-making power, psychological and time dimensions were significant mediators in the relationship between pregnant women’s education and dietary diversity. However, economic dimension was related to neither pregnant women’s education nor dietary diversity. Conclusion This study highlights pregnant women with better education are more likely to be empowered in household decision-making, psychological and time dimensions; and those empowered pregnant women are more likely to consume more diverse diets, suggesting women’s access to higher education could have a positive indirect effect on consumption of more diverse diets during pregnancy by empowering women in the study area.

Gender and Generation: Landownership and Older Indians’ Autonomy

While increased access to household assets has been shown to improve older individuals’ autonomy and bargaining power at home, the role of gender hierarchy in shaping differential impacts of household assets has received far less attention. This article explores the gender asymmetry in the association of older people’s (age 60 years or more) decision-making power at home and survival probability with their ownership of and managerial control over agricultural land in rural India. Using data from the India Human Development Survey, results find that in multi-generational households, landownership at the household level is associated with higher decision-making power and survival probability for older men but not for older women. Among older women, the relationship between household landownership and decision-making power is positive when they have clearly established titles to the land or managerial control but negative when their names are not on the land title. HIGHLIGHTS Landownership is an important source of old age security in India. Agricultural land in India is typically controlled by the patriarch; women rarely own or control household land. The generational power conferred on older men with landownership does not apply to older women to the same degree. It is crucial to register household land under women’s names and recognize women as actual landowners.

Women’s household decision-making power and contraceptive use in Mali

BackgroundUtilization of contraceptives remains low in several countries in sub-Saharan Africa despite evidence of its benefits. Several factors are associated with contraceptive use. However, little is known about the association between women’s decision-making capacity and the utilization of contraceptives in Mali. This study sought to determine the association between women’s household decision-making power and contraceptive use in Mali.MethodsThis study involved a cross-sectional analysis of data from the 2018 Mali Demographic and Health Survey. A total of 7893 married women were included in the final analysis. A binary logistic regression analysis was conducted with statistical significance set at p < 0.05.ResultsContraceptive use among married women in Mali was 17.1%. The odds of using contraceptives were higher among women with joint decision-making with their husbands on how to spend respondent’s earnings [aOR = 1.79; 95% CI = 1.12, 2.85], joint decision-making with their husbands on what to do with their husband’s earnings [aOR = 1.43; 95% CI = 1.12, 1.83], and joint decision-making with their husbands on large household purchases [aOR = 1.32; 95% CI = 1.10, 1.59]. Deciding alone on a visit to family or relatives was associated with lower odds of contraceptive use [aOR = 0.72; 95% CI = 0.58, 0.89].ConclusionThe study has revealed that joint household decision-making is positively associated with contraceptive use. Therefore, to achieve the Sustainable Development Goal 3, the ministry for the advancement of women, children and families and related stakeholders should unearth strategies to empower women in joint decision-making and encourage men’s involvement in contraceptive decision-making.

Household decision-making, women's empowerment, and increasing egg consumption in children under five in rural Burkina Faso: Observations from a cluster randomized controlled trial

Malnutrition is one of the most long-suffering problems facing women and children across the world—it is endemic to many low- and low-middle income countries and is a leading comorbidity in CU5 mortality. Malnutrition and food security are gendered issues; not only are boys and girls differently affected by these issues, but societal norms and differing roles of women and men are often drivers of these different outcomes. The United Nations seeks to address both malnutrition and gender inequality by reaching its Sustainable Development Goals by 2030. Researchers have shown that women's empowerment is inextricably linked to the nutritional outcomes of children. As one dimension of women's empowerment, intra-household decision-making is an important determinant of child health and nutrition outcomes, as it can determine how resources are allocated within the household. To better understand how gender inequalities within household decision-making may contribute to child nutrition, this study examines the association between household decision-making and the adoption of behavior change to increase chicken egg consumption among infants and young children in Burkina Faso, and explores the relationship(s) between the Un Oeuf project and women's empowerment. This study analyzes data collected during the Un Oeuf cRCT (July 2018–April 2019) and additional data that were collected in conjunction with the Un Oeuf endline household survey in April 2019. Significant relationships were found between women's household decision-making about eggs and child egg consumption at the end of the project. This was true for women who did not have decision-making power at baseline (p = 0.006, OR 3.822) as well as for women who indicted having had that power and sustaining it through endline (p = 0.013, OR 6.662). Results indicate that the Un Oeuf project significantly increased women's household decision-making (p &amp;gt; 0.005, OR 4.045). Finally, significant relationships were found between a woman's overall level of empowerment and household decision-making power surrounding (1) what is done with household eggs (p &amp;lt; 0.005, OR 2.87) and (2) how foods are portioned (p = 0.012, OR 6.712). These findings illustrate the importance and potential of women's decision-making as a point of entry to improving nutritional outcomes through changes in empowerment.

Prevalence and factors associated with maternal loneliness during the postpartum period in Gondar city

BackgroundMental health problems have increased worldwide, particularly in developing countries. Currently, loneliness is widely understood as a painful subjective experience when the social connections a person has do not meet their interpersonal needs in respect to the quality or quantity of friendship or social interaction. It has been linked to unpleasant health consequences for both the mother and child. Therefore, this study aimed to assess maternal loneliness during the postpartum period and associated factors in Gondar city. MethodsA community-based cross-sectional study was conducted from July 1st to August 30th, 2021 in Gondar city. A cluster sampling technique was employed to select 858 postpartum women. Data were entered into epidemiological data (EPI data) version 4.6 and exported to SPSS 25 for further cleaning and analysis. The multivariable logistic regression analysis was fitted to identify factors associated with maternal loneliness during the postpartum period. The adjusted odds ratio (AOR) with its 95 % confidence interval (CI) was performed and the level of significance was claimed based on a p-value of ≤0.05. ResultsA total of 858 women were included in the analysis, giving a response rate of 98.4%. Two-fifths (40.9%) of the study participants have experienced loneliness during the postpartum period (95% CI: 37.6, 44.2). Low household decision-making power (AOR = 11.2; 95% CI: 7.59, 16.4) and poor social support (AOR = 2.44; 95 CI: 1.58, 3.76) were significantly associated with maternal loneliness. ConclusionIn this study, 4 out of 10 women have experienced loneliness during the postpartum period. Thus, it highlights the potential risks of the mother’s loneliness on her postnatal well-being, particularly if the woman has poor social support and low household decision-making power. Encouraging women to be involved in all aspects of the household decision-making and promoting the need for social support for all women during the postpartum period may be optimal initial targets to reduce the impact of loneliness.

Attitude towards negotiating safer sexual relations: Exploring power dynamics among married couples in India.

The study primarily focuses on analyzing married women's attitudes towards negotiating safer sex in two contexts. The first context is when a woman refuses to have sex with husband if she knows her husband has a sexually transmitted disease (STD) and the second is when she does so if she knows he has sex with other women. The study examined predictors of Indian women's attitude towards negotiating safer-sex using data on 92,306 ever married women from the state module of the 2015-16, National Family Health Survey 4. Descriptive and multilevel logistic regression was used to understand the interplay between the attitude towards negotiation of safer sexual relationships with husband and the selected background characteristics with a primary focus on controlling behaviour and power relations. About 17% of women did not believe in negotiating safer sexual relations with the husband. An approximately equal proportion of ever-married women (79% each) believed in doing so under the two specific conditions, that is, if they knew the husband had an STD and they knew he had sex with other women. Multilevel regression analysis showed that women who had household decision-making power [AOR=0.71; p<0.01] and those whose husbands displayed low control towards them [AOR=0.91; p<0.05] were more likely to believe in negotiating safer-sex. Our findings suggest that women who have controlling partners or those who live under the umbrella of the husband's authority lack the power to negotiate for safer sex. Interventions promoting sexual well-being must deal with negative male perceptions and expectations that perpetuate unhealthy sexual habits and marriage ties.

Ghanaian Couples’ Perceptions and Attitudes Towards Women’s Participation in Family Fishery Decisions and Practices

In the last few decades, there has been growing scholarly interest about the implications of women’s increased economic role on household decision-making dynamics. Contributing to these conversations, the current paper examines couples (wives and husbands) perceptions and attitudes towards women’s decision-making power in the context of Ghana’s small-scale fishery where both couples engage in the same economic activity, performing different, but complementary roles. The study involved interviews with 20 and 18 married female and male fisherfolk respectively, which was part of a larger study by the first author among fisherfolk in the south-western coast of Ghana. We show that accounts of perceived decision-making power of women varied by spouse. Using a gender lens, we show how both women and men discursively reproduced and challenged hegemonic gender discourses and relations in different contexts. We argue that exploring the gaps in couples’ account of women’s household decision-making power as well as their perceptions and attitudes towards such roles provides important ground to understanding the inconsistencies in the outcomes of programs targeted at women empowerment and gender equality.

Women autonomy and demand for maternal health services in Nigeria: Evidence from the Nigeria Demographic and Health Survey.

Improving women autonomy can be vital in determining the uptake of healthcare services, especially in a patriarchal society with gender rights concerns. Using the 2013 Nigeria Demographic and Health Survey and employing Zero Inflated Negative Binomial regression, the effect of household decision-making power with considerations to women autonomy on the demand for maternal health services in Nigeria was examined. The result of the analysis suggests that women autonomy in deciding expenditures on household healthcare services, and autonomy in deciding their income expenditures significantly increases the likelihood of demand for maternal healthcare services. On the other hand, when the husband/partner makes sole decision, as well as joint decision making concerning expenditure on household healthcare services and expenditure of woman's income reduces the likelihood of demand for maternal healthcare services in the country. This reduction was however much more when husband alone takes the decision than when decisions were taken jointly. Other socioeconomic variables like higher maternal education, and household wealth, also increased the demand for maternal healthcare services. We recommend that government should put in place policies that will help increase women's participation in household decision-making through the sensitization and capacity building initiatives such as improved educational quality for women.

Pregnant women\u2019s decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries

BackgroundAnaemia and related complications during pregnancy is a global problem but more prevalent in sub-Sahara Africa (SSA). Women’s decision-making power has significantly been linked with maternal health service utilization but there is inadequate evidence about adherence to iron supplementation. This study therefore assessed the association between household decision-making power and iron supplementation adherence among pregnant married women in 25 sub-Saharan African countries.MethodsWe used data from the Demographic and Health Surveys (DHS) of 25 sub-Saharan African countries conducted between 2010 and 2019. Women's decision-making power was measured by three parameters; own health care, making large household purchases and visits to her family or relatives. The association between women’s decision-making power and iron supplementation adherence was assessed using logistic regressions, adjusting for confounders. The results were presented as adjusted odds ratio (AOR) with 95% confidence intervals (CIs).ResultsApproximately 65.4% of pregnant married women had made decisions either alone or with husband in all three decisions making parameters (i.e., own health care, making large household purchases, visits to her family or relatives). The rate of adherence to iron medication during pregnancy was 51.7% (95% CI; 48.5–54.9%). Adherence to iron supplementation was found to be higher among pregnant married women who had decision-making power (AOR = 1.46, 95% CI; 1.16–1.83), secondary education (AOR = 1.45, 95% CI; 1.05–2.00) and antenatal care visit (AOR = 2.77, 95% CI; 2.19–3.51). Wealth quintiles and religion were significantly associated with adherence to iron supplementation.ConclusionsAdherence to iron supplementation is high among pregnant women in SSA. Decision making power, educational status and antenatal care visit were found to be significantly associated with adherence to these supplements. These findings highlight that there is a need to design interventions that enhance women’s decision-making capacities, and empowering them through education to improve the coverage of antenatal iron supplementation.

The Effect of Women's Empowerment in the Utilisation of Family Planning in Western Ethiopia: A Structural Equation Modelling Approach.

This study examines the associations between women’s empowerment and family planning use in Jimma Zone, Western Ethiopia. A total of 746 randomly selected married women of reproductive age were interviewed. The data were employed by structural equation modelling (SEM) to investigate the complex and multidimensional pathways to show women’s empowerment domains in family planning utilisation. Results of the study revealed that 72% of married women had used family planning. Younger women, having access to information, having access to health facilities and being aware about family planning methods, living in a rural area, having an older partner and increased household decision-making power were associated with using family planning methods. Women’s empowerment is an important determinant of contraceptive use. Women’s empowerment dimensions included increased household decision-making power, socio-demographic variables and having access to information about family planning and accessible health facilities. These were found to be important determinants of contraceptive use. Future interventions should focus on integrating women’s empowerment into family planning programming, particularly in enhancing women’s autonomy in decision making. Further research is warranted on the socio-cultural context of women that influences women’s empowerment and family planning use to establish an in-depth understanding and equity of women in society.

Age of Marriage and Women’s Political Engagement: Evidence from India

Although decades have passed since most women in the democratic world gained the right to vote and run for election, a large gender gap in political participation persists, particularly in developing countries. This short article considers an important—and previously overlooked—factor limiting the political engagement of many women in the developing world: marriage age. Drawing on nationally representative data from India and instrumenting marriage age with menarche age, we find that delaying marriage has substantial positive effects on women’s everyday political participation. A standard deviation increase in marriage age makes a woman 25% more likely to attend local council meetings and 8% more likely to discuss politics with her husband. Exploring mechanisms, we show that education and time—rather than employment, mobility, and household decision-making power—appear to be the main channels. These findings underscore the critical role of early marriage in impeding women’s participation in the political sphere.

Forest power: The impact of community forest management on female empowerment

Community forest management (CFM) systems have been implemented in developing countries as forest conservation initiatives with community development objectives. Women are often active in CFM by participating in non-timber forest product harvesting and management. Given the increasing presence of women in CFM, this study assesses whether participating in community forest management gives females more household decision-making power, a proxy for empowerment. This is a relevant issue because many development policies are implemented with female empowerment objectives, yet no existing rigorous quantitative studies have examined whether women's participation in CFM empowers them. Using an ordered logistic regression and an instrumental variable method, we analyze a household-level survey of forest-dwelling residents living in the Maya Biosphere Reserve in northern Guatemala. We find that female's participation in CFM increases her intra-household bargaining power on average. The results demonstrate that CFM systems can have development benefits that extend beyond increased household income and welfare.

Does ICT change household decision-making power of the left-behind women? A Case from China

With labor migration, patriarchal families in rural China are changing. Furthermore, informatization is altering family, social, and cultural norms and accessibility to relative resources. Gender differences in information technology, however, may precipitate a digital divide and aggravate gender power gaps in families. Rural families in which males migrate to cities for employment, leaving female spouses behind, are common in China. The influence of informatization on the distance in family power structure between male and female members await further exploration. Employing resource and cultural norm theories and the propensity score matching (PSM) method, this study analyzed effects of male spouse migration and ICT (information and communication technology) use on ‘left-behind’ women's household decision-making power. The results showed that having migrant husbands increased household decision-making power of left-behind women and enhanced gender equality in families. Left-behind women's cellular phone use bolstered their household decision-making power, while using computers had no apparent effect. Left-behind women may lack skills to operate computers except for entertainment and socializing. Thus, they do not reap human capital advantages from using them.

Improvements to Female Autonomy and Household Decision-Making Power from an Intervention Targeting Improved Food Security: A Gender-Based Analysis of the Rajasthan Nutrition Project

In India, women and children continue to experience food insecurity. The purpose of this study is to evaluate whether the Rajasthan Nutrition Project (RNP) led to changes in 1) dietary habits and nutrition, and 2) indicators of gender equality, female autonomy, and empowerment. This study surveyed women belonging to self-help groups who were pregnant or who had young children. Over the course of the intervention, significant improvements were seen in the following indicators: breastfeeding within one hour of birth, exclusively breastfeeding for the first six months, food insecurity of children and mothers, household decision-making, communication, mobility, and domestic violence. These findings suggest that the RNP is a promising intervention for improving nutrition and female autonomy in Rajasthan, India. Additional research is needed to determine if the RNP would be equally as effective in other regions of India, or in populations outside of India.

Older adults’ psychological and subjective well-being as a function of household decision making role: Evidence from cross-sectional survey in India

BackgroundThere will be more than twice as many older persons as children under five years of age by 2050. As people get older, their everyday decision-making abilities seem to be under increasing scrutiny, contributing to low psychological health and low subjective well-being. Therefore, the present study examines the association of improving and declining household decision-making power of older adults with their psychological health and subjective well-being. MethodsData for 9141 older adults from Building a Knowledge Base on Population Aging in India (BKPAI) was utilized. Psychological health and subjective well-being among older adults were the outcome variables. Descriptive statistics and bivariate analysis was used to find the preliminary results. Further, multivariate analysis has been utilized to confirm the findings. ResultsOlder adults whose role declined as decision-makers were 3.01 times and 2.35 times significantly more likely to have low psychological health (AOR: 3.01; CI: 2.66–3.41) and low subjective well-being (AOR: 2.35; CI: 2.08–2.66), respectively, as compared to those whose role as a decision-maker improved/remained same. Other characteristics, such as the respondent's age, education, community involvement, and trust over someone, also improve psychological health and subjective well-being among older adults. ConclusionThis study provides first-hand information on the role of decision-making and its impact on psychological health and subjective well-being among older adults; however, additional studies that replicate, extend, and improve on this research are urgently needed. Evidence that community involvement positively affects psychological health and subjective well-being calls out for improving ways to increase social participation among older adults.

Associations between women's empowerment and children's health status in Ethiopia.

Although women's empowerment has gained attention over the last two decades, our understanding of the associations between different dimensions of women's empowerment and different children's health outcomes is limited. This study aims to measure the extent of women's empowerment and to examine its associations with the children's health status in Ethiopia. Data were obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). The sample is restricted to a sub-sample of 10,641 women from 15 to 49 years old and their children under the age of five years. We used children's height-for-age and weight-for-height Z-scores and pneumonia and anemia experience as indicators of children's health outcome. Women's empowerment is measured by five indices reflecting their participation in decision-making, attitudes towards wife-beating by husband, barriers to health care access, asset ownership, and socio-economic variables. These indicators of empowerment were constructed using exploratory and confirmatory factor analysis. A Multiple Indicators Multiple Causes (MIMIC) model was employed to examine the relationship between women's empowerment and latent child health outcomes, after controlling for relevant covariates. Results suggests that enhancing women's empowerment in the household in terms of their socio-economic status (i.e., increasing women's access to education, information, media, and promoting saving) was associated with less likelihood of the children's being stunted or wasted (p<0.05). Higher women's empowerment in terms of household decision-making power were also associated with better children's health status measured by the children's experience of pneumonia and anemia (p<0.05). All aspects of women's empowerment are not related with children's health indicators. Women's empowerment dimensions related with child health have a varying degree of association with the different children's health indicators. Gender-specific policies focusing on increasing women's access to education, media, information, and promoting saving and their participation in the household decision making are some of the strategies for improving their children's health and wellbeing.

Household Decision-Making and HIV Care Continuum Outcomes Among Women Living with HIV in Mozambique.

Gender inequality has been associated with HIV infection among women. Less is known about the relationship between gender inequality and HIV care continuum outcomes. This study assessed whether household decision-making power (DMP), one component of gender inequality, was associated with linkage to HIV care, antiretroviral therapy (ART) initiation, or retention in care among women living with HIV in Mozambique. The sample included 600 women ≥18 years of age newly diagnosed with HIV in Mozambique. Data were collected between April 2013 and June 2016. DMP was assessed with three questions about participation in decisions regarding: major household decisions, routine household decisions, and visits to family. Women who did not contribute to decision making in any domain were categorized as having low DMP. HIV care information was obtained from electronic medical records. Multivariable log-Poisson regression analyses were conducted to assess the relationship between DMP and HIV care continuum outcomes. Almost half (49%) of participants reported medium DMP, followed by high (39%) and low DMP (12%). In multivariable regression analyses, when compared with respondents with medium DMP, those with low DMP had a lower likelihood of retention in care 12 months after diagnosis [adjusted risk ratio (aRR) 0.69 (95% CI 0.49-0.98)]. There was no significant relationship between low DMP and linkage to HIV care or ART initiation. High DMP was not significantly associated with HIV outcomes assessed. Women who report low DMP may face barriers to long-term engagement in HIV care. Interventions to improve retention in care among women should consider the role of household decision making and gender inequality.