Measuring Women's Empowerment in Sub-Saharan Africa: Exploratory and Confirmatory Factor Analyses of the Demographic and Health Surveys

Asaolu, Ibitola O.; Alaofè, Halimatou; Gunn, Jayleen K. L.; Adu, Akosua; Monroy, Amanda J.; Ehiri, John E.; Hayden, Mary H.; Ernst, Kacey C.

doi:10.3389/fpsyg.2018.00994

Cited by 101 publications

(121 citation statements)

References 29 publications

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“…Two factors could explain our findings. First self-employment could enhance women's participation in household decision-making for their own healthcare [41]. Secondly, self-employment increases women's economic empowerment, which means that women can effectively demand better maternity care [21,41].…”

Section: Discussionmentioning

confidence: 99%

“…First self-employment could enhance women's participation in household decision-making for their own healthcare [41]. Secondly, self-employment increases women's economic empowerment, which means that women can effectively demand better maternity care [21,41]. As perception of PCMC varies with socio-economic status [8,11], an increase in women's labour participation that promotes self-employment is needed to improve person-centred maternity care.…”

Section: Discussionmentioning

confidence: 99%

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Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Ogbuabor

Nwankwor

2020

Preprint

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Background Women are not getting adequate person-centred maternity care (PCMC) in low-income and middle-income countries despite being important in reducing maternal morbidity and mortality. This study assessed perceptions and predictors of PCMC among childbearing women in Enugu State, South-east Nigeria.Methods The study was conducted in two health districts in Enugu State using a descriptive, cross-sectional survey design. We conveniently selected 450 childbearing women, within 9 weeks post-partum, from 11 health facilities purposively selected based on high maternal and child health attendance. Data was collected from women using an interviewer administered 30-item PCMC scale (scores 0–90) consisting of: dignity and respect (6 items, scores 0–18), communication and autonomy (9 items, scores 0–27), and supportive care (15 items, scores 0–45). We categorized full PCMC and each sub-scale into “low, medium and high” using 25th and 75th percentile of the summative scores. The questionnaire also collected data on women characteristics, facility characteristics and service type. Data were analysed using descriptive statistics, t- tests, analysis of variance and Generalized Linear Models.Results Women had medium scores on full PCMC scale and sub-scales. The lowest score was in communication and autonomy. A quarter of women perceived PCMC as high. Marrying at age 20–29 years (β = 5.83, ρ = 0.002), self-employed women (β = -10.23, ρ = 0.004), starting antenatal care in the third trimester (β = -7.93, ρ = 0.008), high participation in household decisions (β = -4.98, ρ = 0.011), domestic violence experience (β = 5.41, ρ = 0.002), delivery at health centre (β = 7.09, ρ = 0.000), delivery at private/mission hospital (β = 17.47, ρ = 0.000), delivery by non-skilled attendant (β = -9.61, ρ = 0.001); delivery by community health workers (β = -7.65, ρ = 0.001), and experience of pregnancy complication (β = 6.20, ρ = 0.028) predicted PCMC.Conclusions Person-centred maternity care was generally inadequate. Improving PCMC would entail sustaining dignified care, enhancing provider-patient communication, addressing facility-level drivers, increasing women’s personal empowerment and self-employment, timely initiation of antenatal care, and paying attention to women with pregnancy complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Ogbuabor

Nwankwor

2020

Preprint

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“…In this study, women's empowerment was assumed to show gender equality in the household, in which gender equality could be achieved if both women and men had equal access to health services (Asaolu et al, 2018). Less empowered women had more chance to be discriminated against and often had little access to health services and health resources, including access to antenatal care services (Ki-moon, 2015).…”

Section: Discussionmentioning

confidence: 99%

The Association Between Women’s Empowerment and Antenatal Care Coverage in Indonesia in 2017

Lamiday

Machmud

2019

JBE

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Background: Antenatal care coverage (ANC) in Indonesia has been constantly increasing over the years according to the country’s national survey data; however, there is a huge gap in coverage between women with different background characteristics. Purpose: The objective of this study is to determine the association between women’s empowerment and ANC coverage in Indonesia in 2017. Methods: This study used data sourced from the Indonesian Demographic Health Survey (IDHS) 2017 with a cross-sectional study design. The population study was married women aged 15–49 years who had delivered children in the two years before the survey was conducted. About 6,397 samples were obtained by a total sampling method that met inclusion and exclusion criteria. Variables analysed in this study were women’s empowerment and antenatal care coverage. The data analysis used were chi square and multiple logistic regression analysis. This study was conducted in February–April 2019 in all provinces in Indonesia which were the location of the IDHS 2017. Results: The result of multivariate analysis claimed an association that was statistically significant (p value = 0.00) between women’s empowerment and ANC coverage, with adjusted prevalence ratio = 1.05 (95% CI: 1.02–1.08). Conclusion: The conclusion of this study is that less empowered women were 1.05 times more likely to not receive complete and standardised antenatal care compared to women who were more empowered.

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“…A recently validated instrument, the African Women's Empowerment Index (AWEI), uses three distinct domains of women's empowerment for East Africa (AWEI-E), which it defines as "a multifaceted process of change that involves individual and collective awareness, behavior, institutions, and outcomes embedded in distinct social and cultural contexts" [25]. The validated instrument was informed by previous literature on factors contributing to women's empowerment and can be used to associate women's empowerment with other health and social indicators such as birth outcomes.…”

Section: Introductionmentioning

confidence: 99%

Influence of Women’s Empowerment on Place of Delivery in North Eastern and Western Kenya: A Cross-sectional Analysis of the Kenya Demographic Health Survey

Anderson¹,

Chebet²,

Asaolu³

et al. 2020

JEGH

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KeywordsWomen's empowerment facility delivery childbirth North Eastern and Western Kenya A B S T R A C TBackground: Labor and delivery under the supervision of a skilled birth attendant have been shown to promote positive maternal and neonatal outcomes; yet, more than a third of births in Kenya occur outside a health facility. We investigated the association between measures of women's empowerment and health facility-based delivery in Northeastern and Western Kenya.Methods: Analysis of 2014 Kenya Demographic and Health Survey data was conducted. Logistic regression adjusting for demographic factors, contraceptive use, and comprehensive HIV knowledge was used to assess the influence of the validated African Women's Empowerment Index-East (AWEI-E) on the likelihood of women's most recent birth having occurred in a health facility versus at home. Additionally, we explored the mediating effect of contraceptive use on women's empowerment and health facility-based delivery.Results: Compared to respondents with low or moderate empowerment scores, those with high empowerment scores were more likely to have given birth at a health facility [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.30, 2.51], although this effect was null in the adjusted model (OR = 0.92, 95% CI = 0.58, 1.45). Respondents with a recent facility birth (n = 372/836) were more likely to have high household-level wealth (40.9% vs 8.6%, p < 0.001) and use a contraceptive method (44.9% vs 27.4%, p < 0.001) than those without facility-based delivery. Current contraceptive use mediated 26.8% of the effect of empowerment on the odds of facility-based delivery. Conclusion:Women's empowerment, and its comprising three domains as measured by the AWEI-E, may be insufficient to overcome barriers to facility-based delivery for women in North Eastern or Western Kenya. High women's empowerment is strongly associated with current contraceptive use, which may inform pregnancy planning and location of delivery. Alternatively, higher empowered women who delivered at a facility may have been offered contraceptives at the time of delivery. Future research targeting these regions should explore culturally acceptable approaches to broadening access to skilled supervision of labor.

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Measuring Women's Empowerment in Sub-Saharan Africa: Exploratory and Confirmatory Factor Analyses of the Demographic and Health Surveys

Cited by 101 publications

References 29 publications

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

The Association Between Women’s Empowerment and Antenatal Care Coverage in Indonesia in 2017

Influence of Women’s Empowerment on Place of Delivery in North Eastern and Western Kenya: A Cross-sectional Analysis of the Kenya Demographic Health Survey

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