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To understand the role of women's input into household decisions as a possible factor contributing to women's undernutrition in settings where HIV/AIDS and drought have constrained household resources.
Three cross-sectional surveys of non-pregnant women in partnerships without a birth in the last 3 months were analysed. Factors associated with chro...
Context in source publication
Context 1
... on the survey, a different set of domains was included in terms of decision-making. The questions for each survey are shown in Table 1. For each of these questions, the women were given the following response options: (1) themselves (respondent), (2) husband/partner, (3) respondent and husband/partner jointly, (4) someone else, and (5) respondent and someone else jointly. ...
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Citations
... [4][5][6] It can be elucidated in various ways, such as the ability to control and organise one's environment independently, allowing for autonomous decision-making regarding livelihood, irrespective of societal opinions. [7,8] It is a multidimensional idea, signifying control over one's resources and thoughts. One must possess self-assurance and the ability to shift internal awareness to transcend obstacles or traditional ideas. ...
Background
Women’s autonomy is defined as the ability to regulate one’s environment with the help of social and material resources. This autonomy is intricately linked to various reproductive health outcomes, including reduced fertility, increased contraceptive usage and access to prenatal care. It can be understood as the ability of women to oversee and manage their surroundings independently, allowing them to make decisions about their lifestyle, irrespective of societal opinions.
Aims and Objectives
This study explored the association between fertility, family planning methods (FPMs) and autonomy amongst women in Delhi.
Materials and Methods
The data for the present study were collected from 400 married women aged 15–45 years old residing in Delhi. A face to face interview was conducted using a semi structured schedule to collect quantitative and qualitative data.
Results: The findings revealed that the autonomy level of women was found to be low (13.75%), medium (56.5%) and high (29.75%). Respondents with low autonomy status (47.27%) were illiterate or had a primary level of education. Women with low autonomy have a more significant number of conceptions than medium and high autonomy women, resulting in increased live births amongst low autonomy women. In addition, participants with low levels of autonomy were less aware of FPMs. The study underscored the influence of women’s social position, as reflected in factors such as education, occupation and the economic status of the family, on fertility and contraceptive usage.
Conclusion
The findings of this study indicate that women exhibiting lower autonomy levels tend to possess lower educational attainment, experience a higher frequency of conceptions, demonstrate limited knowledge about contraception and show lower rates of employment.
... Current evidence related to women's decision making regarding household purchases is mostly available through analysis of Demographic and Health Survey (DHS) questions in various settings, focusing on women's participation in large and daily household purchases. These studies have shown that women having a voice in household purchase decisions (alone or jointly) are associated with better nutritional status for themselves and/or their children (Amugsi et al., 2016;Bhagowalia et al., 2010;Hindin, 2006;Saaka, 2020;Tebekaw, 2011). In addition to the two aforementioned questions, this study's food purchase indicator also focused on nutrition-sensitive decisions by including questions about the purchase of eggs, milk and milk products, meat, poultry, or fish (recognized nutritious food sources for mothers recommended by a health worker); medications; vitamins and supplements for mothers and children; and special food for children. ...
This study examined the relationship between women's empowerment in agriculture (WEA), women's agency in nutrition, and their food security. It aimed to quantify the moderating effect of women's agency in nutrition on the association between WEA and food security. Data from the NutriFish project, a gender‐ and nutrition‐sensitive agricultural intervention in fishing villages in Uganda, were utilized. The study included 380 primary Ugandan female decision makers in dual adult households. WEA was measured using the Project‐level Women's Empowerment in Agriculture Index (pro‐WEAI). Women's agency in nutrition was assessed through measures of agency in regular diet, pregnancy diet, breastfeeding diet, and food purchase. Binary logit regression models were employed to estimate differential associations between WEA and food security, testing three‐way interactions between WEA, agency in regular diet, and food purchase. Results showed that WEA was associated with a 0.18 increase in the predicted probability of food security ( p < .01). Women's participation in food purchase decisions strengthened the WEA‐food security association by 0.33 ( p < .05). The results suggested that promoting women's food purchase agency can enhance the positive link between WEA and food security. Prioritizing interventions empowering women in food purchase decisions improves food security in gender‐ and nutrition‐sensitive programs.
... Given the paucity of published evidence regarding the interrelationship between these phenomena, publications from as early as 1982 were included. The focus of published literature varied widely-from the needs and struggles of urban poor during floods (i.e., climate shocks) [50] to women's input into household decision making and their nutritional status in drought-prone countries (i.e., climate stressors) [51]. The empirical basis for most published literature was diverse (e.g., qualitative, quantitative, mixed methods). ...
Gender-based violence (GBV) is a global public health and human rights problem that is exacerbated by social and environmental stressors for a multitude of interpersonal, cultural, and economic reasons. Through sudden disruptions in the microclimate of a region, climate shocks often have a negative impact on food security, which correlates with increases in GBV. Associations between the various combinations of GBV, climate change, and food insecurity have been documented in the growing international literature, but questions remain about these associations that require further clarification. The impact of the COVID-19 pandemic caused by SARS-CoV-2 provides insight through a real time demonstration into these interactions. This review of the global literature examines the interplay between GBV, climate change, and food insecurity-including recent literature regarding the COVID-19 pandemic. This review covers original research studies employing both quantitative and qualitative methodology, those that conducted secondary analyses of existing data sources and perspective pieces derived from observed evidence. An additional analytic layer of system dynamics modeling allowed for the integration of findings from the scoping review and discovery of additional insights into the interplay between disasters, food insecurity, and GBV. Findings from this review suggest that the development and adaptation of evidence-based, focused interventions and policies to reduce the effects of climate shocks and bolster food security may ultimately decrease GBV prevalence and impact.
... Decisions on nutrition in the household are made by husbands, wives, in-laws and health care providers collectively. For instance, to prevent chronic energy deficiency, a husband and wife determine the diet diversity preferences for individual members in the household (Hindin, 2005). Husbands, wife and mothers-in-law express their preferences on food acquisition, cooking and consumption at different phases of the food preparation process (Pilla and Dantas, 2016). ...
This paper reviews the evidence base on the linkages between decision-making behaviours, resource allocation and health outcomes for humans and livestock in sub-Saharan Africa. Human and livestock health models are intertwined due to trade-offs and complementarities between human and livestock health, through budget constraints and resource priority setting. We systematically reviewed 135 primary studies from five databases, namely Embase, Scopus, PubMed, Web of Science and Google scholar. Information extracted was then thematically and descriptively analysed using a household production of health approach, which we extend to incorporate livestock health. Two alternative modes of household decision-making are discussed: unitary, where the preferences of a single (household head) decision-maker are consulted; and collective, where preferences for several household members are aggregated and then consulted. Our findings demonstrate that decisions on producing healthy infants, children and mothers are typically made collectively, while decisions to produce healthy livestock are most often unitary. Further, most household decisions happen in a 'black box' which can help explain gender and intra-household resource allocation inequalities around health in the region. From a policy perspective, results lead towards a recommendation for 3 interventions that promote both men's and women's empowerment, wider enrolment in insurance schemes and intra-household resource transfers between health consumers and producers.
... Women's body mass index (taken as a measure of women's health) is showing a significant and positive impact on selfesteem, awareness, work status, decision making, and selfconfidence. As compared to the women having their body mass index less than 18.5kg/m 2 , the women with their body mass index equal to or greater than 18.5 kgm 2 seems to be more empowered as compared to those who are in poor health [38]. Abrar ul Haq, Jali [39] also used body mass index as a measure of women health and woman's suffering with any serious ailment was observed to be lowering her empowerment in Table 3. Table 3. Socio-economics and demographic determinants of women empowerment ...
... In addition, researchers in prior investigations have argued that empowerment indicators such as decision-making involvement may not reflect actual empowerment if women still carry the brunt of home responsibilities. 23,66,67 This study has many strengths to consider. First, the large sample size in each country provided enough power to provide more precise estimates in multivariable models. ...
Background: Young women and girls in Eastern and Southern Africa are at elevated risk of acquiring human immunodeficiency virus (HIV) compared with men, largely due to power dynamics within heterosexual relationships that contribute to HIV risk behaviors. Few studies employ a comprehensive framework to examine divisions between men and women and HIV risk behaviors in an African context. Thus, we examined associations between levels of women's empowerment and HIV risk behaviors applying the Theory of Gender and Power.
Methods: We used logistic regression (adjusted odds ratios or AORs) to assess associations between women's empowerment indicators and HIV risk behaviors (multiple sexual partners) and self-efficacy (ability to negotiate sex/sex refusal) with couples data (n = 12,670) from Malawi, Namibia, Zambia, and Zimbabwe.
Results: Specifically, key drivers of high levels of empowerment among women were household decision-making involvement, female economic independence, and rejecting all reasons for wife-beating. Furthermore, higher levels of women's empowerment in coupled relationships was associated with safer sex negotiation in Malawi (AOR = 1.57, p < 0.05) and Zambia (AOR = 1.60, p < 0.0001) and sex refusal in Malawi (AOR = 1.62, p < 0.0001) and Zimbabwe (AOR = 1.29, p < 0.05). However, empowerment was not associated with the likelihood of the male partner having multiple sexual partners across all countries studied.
Conclusions: These findings provide evidence that high levels of women's empowerment were associated with safer sex practices, although this varied by country. Policymakers should incorporate empowerment indicators to address women's empowerment and HIV prevention within African couples.
... Findings are inconclusive. In Malawi and urban Zambia, low input in decision-making was associated with chronic energy deficiency among nonpregnant women, measured as BMI < 18.5 kg/m 2 ; however, similar associations were not observed in Zimbabwe (Hindin, 2006). In Ghana and Bangladesh (Sraboni et al., 2014), women's empowerment, as measured with the WEAI, was not associated with women's BMI. ...
The 2030 Agenda for Sustainable Development prioritizes women's empowerment in Sustainable Development Goal (SDG) #5: to achieve gender equality and empowerment among all women and girls. Research on the relationships of women's empowerment and nutrition has focused on the child's nutrition. Less is known about how women's empowerment influences their own nutritional status. We examined the pathways by which three domains of women's empowerment (WE)—assets, intrinsic agency, and instrumental agency—may influence women's nutritional status (WNS) in East Africa. We used data from 42,721 married non-pregnant women, 15–49 years old interviewed in Demographic and Health Surveys (DHS) from five east Africa countries (2011–2016). WNS was operationalized through body mass index (BMI) and altitude-adjusted blood-hemoglobin level (Hb). A latent factor for women's human/social assets (assets) measured women's enabling resources. Two additional latent factors measured women's intrinsic agency (power within; women's non-justification of intimate partner violence (IPV) against wives) and instrumental agency (power to; influence in household decision-making). We used structural equation models with latent variables to estimate the strength of the hypothesized pathways from women's assets to WNS through measures of intrinsic and instrumental agency. All three domains of WE had direct, positive associations with women's BMI [(estimate (95% CI) (Assets: [0.17 (0.14,0.20)]; Intrinsic Agency: [0.25 (0.22,0.27)]; Instrumental Agency [0.08 (0.03,0.10)])]. Women's instrumental agency was positively associated with women's Hb [0.12 (0.09,0.14)]. Total associations, including direct and indirect effects, with women's BMI were positive through intrinsic agency & instrumental agency. Total associations with women's Hb were positive through instrumental agency. Direct and indirect effects from assets through both components of agency to BMI were higher in magnitude by household wealth category. Domains of WE were positively associated with WNS. Findings indicate that the process of women's empowerment may be an important driver of their nutritional status.
... There are very few studies available to get a standardized list of resilience and adaptation variables relevant to household food security. However, literature shows different types of factors related to food security, such as political, economic and natural indicators, infrastructure, security (Lovendal & Knowles, 2006;Nyariki & Wiggins, 1997); hygiene, sanitation, unsafe water supply (Makinen et al., 2000); isolation from markets (Webb et al., 1992;Negatu, 2006); demography (Baer & Madrigal, 1993;Lino, 1996;Iram & Butt, 2004;Piaseu, 2006); health and nutrition (Myntti, 1993;Pfeiffer et al., 2001;Hindin, 2006;Fartahun et al., 2007); food budget, savings (Cristofar & Basiotis, 1992;Rose et al., 1995;Olson et al., 1997); locality (Maxwell et al., 1999); technology (Nyariki & Wiggins, 1997;Negatu, 2006); access to land, land tenure system, land productively (ECA, 2004); transportation and unemployment (Negatu, 2006); etc. Interestingly, studies also show that many low-income households have food security and many households above the poverty line present indications of food insecurity (Olson et al., 1997;Rose, 1999). ...
Purpose
Sustainable food security at the household level is one of the emerging issues for all nations. It is expected that the patterns of household resilience factors and adaptation practices have a strong linkage with household food security. The purpose of this paper is to seek an effective technique of adaptation for food security and the required types of support for adaptation to food insecurity among the poor and low-income households in Malaysia.
Design/methodology/approach
This study was based on primary data that were collected in July-October 2012 through a questionnaire survey among 460 poor and low-income households from the Pahang, Kelantan, and Terengganu states of Malaysia. The samples were selected from E-Kasih poor household database based on a two-stage cluster random sampling technique. The study considered household food security as household food availability and food accessibility, and ran ordinal regressions to find out the linkages of household food security with household resilience factors, adaptation practices, and expected support for adaptation to food security.
Findings
The study concludes that several resilience factors and adaptation practices were statistically significant to household food security, and several external supports were statistically and significantly needed to ensure household food security. Therefore, to ensure sustainable household food security in Malaysia, the food security programs need to be integrated with sustainable development goals (SDGs) and climatic changes adaptation programs, and the involvement of relevant stakeholders are crucial.
Originality/value
This study is a pioneer work based on primary data that empirically measured the linkages of household food security with household resilience factors, adaptation practices, and expected support for adaptation to food security in Malaysia. This study also discussed some issues related to the climate change linkage, which would help future climate change research. The findings of the study will be beneficial for all the stakeholders, including policy makers related to the food security and climate change adaptation.
... Keywords: Climate Change; Household Food Security; Household Food Insecurity Access (HFIA); Adaptation; Resilience; Poverty; Ordinal Regression; Sustainable Development Goals (SDG); Malaysia
... (Citation :
Alam, M.M., Siwar, C., & Wahid, A.N.M. (2018). Resilience, Adaptation and Expected Support for Food Security among the Malaysian East Coast Poor Households. Management of Environmental Quality, 29(5), 877-902.)
... 46 Also, food insecurity has been associated with poorer decision-making. 47 Finally, food insecurity is likely a surrogate marker for poverty. A better understanding of the way poverty and food insecurity affects cART use and access may be useful to moving forward. ...
Attrition along the cascade of HIV care compromises attainment of the UNAIDS 90-90-90 goals and achievement of desirable treatment outcomes for people living with HIV. Given known gender disparities in HIV care and outcomes, understanding the correlates of attrition at stages of the care cascade for women living with HIV (WLWH) is essential. Among the 1425 WLWH enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), we measured the proportion who reported not being currently on combination antiretroviral therapy (cART) and the proportion who reported a detectable viral load (VL; ≥40 copies/mL) despite cART use. Correlates of these cascade indicators were examined using univariate and multivariable logistic regression. Overall, 14.8% of women were not currently on cART. Of women who were on cART, 9.0% were not virally suppressed. In multivariable analyses, age between 26 and 34, unstable housing, food insecurity, current injection drug use, higher HIV-related stigma, and racial discrimination were associated with increased odds of not being on cART. Factors associated with increased odds of reporting a detectable VL among women on cART included age ≤34 years, less than a secondary education, unstable housing, and incarceration in the previous year. Programmatic efforts to support cART use and viral suppression for WLWH in Canada should focus on social determinants of health, including housing and food insecurity, social exclusion, and education.
... 46 Also, food insecurity has been associated with poorer decision-making. 47 Finally, food insecurity is likely a surrogate marker for poverty. A better understanding of the way poverty and food insecurity affects cART use and access may be useful to moving forward. ...
Attrition along the cascade of HIV care poses significant barriers to attaining the UNAIDS targets of 90-90-90 and achieving optimal treatment outcomes for people living with HIV. Understanding the correlates of attrition is critical and particularly for women living with HIV (WLWH) as gender disparities along the cascade have been found. We measured the proportion of the 1425 WLWH enrolled in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) who had never accessed HIV medical care, who reported delayed linkage into HIV care (>3 months between diagnosis and initial care linkage), and who were not engaged in HIV care at interview (<1 visit in prior year). Correlates of these cascade indicators were determined using univariate and multivariable logistic regression. We found that 2.8% of women had never accessed HIV care. Of women who had accessed HIV care, 28.7% reported delayed linkage and 3.7% were not engaged in HIV care. Indigenous women had higher adjusted odds of both a lack of access and delayed access to HIV care. Also, a younger age, unstable housing, history of recreational drug use, and experiences of everyday racism emerged as important barriers to ever accessing care. Programmatic efforts to support early linkage to and engagement in care for WLWH in Canada must address several social determinants of health, such as housing insecurity and social exclusion, and prioritize engagement of Indigenous women through culturally safe and competent practices.
