Global Health
Disentangling the associations between women’s decision-making power dynamics and maternal and child health outcomes in 35 sub-Saharan African countries Yun-Jung Eom* Yun-Jung Eom Rockli Kim
Background:So far, most research has treated women’s sole and joint decision-making as having the same nature under the name of women’s empowerment. This paper explores the most effective ways women’s decision-making power might operate to enhance maternal and child health (MCH) in sub-Saharan Africa (SSA).
Methods: We used most recent data from Demographic and Health Surveys across 35 countries in SSA. Decision-making power dynamics were identified by distinguishing women’s sole and joint decision-making. Seven exemplary MCH outcomes were selected: antenatal care contacts, facility deliveries with skilled birth attendants, postnatal care, low birth weight, stunting, full immunization coverage, and child morbidity. A series of logistic regressions were estimated adjusting for covariates with country and survey year fixed effects.
Results: Any decision made by husbands or others consisted of more than half the sample (59.1%), followed by decisions usually made jointly with husbands (32.6%) and decisions made by women alone (8.3%). For all MCH outcomes, decisions made jointly yielded the best health outputs. For example, children whose mothers usually made decisions jointly were 20% (OR=0.80; 95% CIs=0.77-0.83) and 13% (OR=0.77; 95% CI=0.76-0.79) less likely to have one or more morbidities compared to children whose mothers usually made decisions alone and children whose fathers or someone else made any decisions, respectively.
Conclusions: Joint decision-making may reflect more equitable gender beliefs and practices in spousal relationships than women’s sole decision-making. Empowering women through interventions that promote mutual respect and shared responsibility among spouses in household decisions is crucial for shifting the gender power balance and improving health and well-being of women and children in SSA.
