Background
Methods
Study design & intervention background
Quantitative data collection
Quantitative data analysis
Measures
Regression modeling
Qualitative data collection
Qualitative data analysis
Results
Quantitative results
Population characteristics and decision-making outcomes
Variable | freq (%) or Mean (SD) or Median (Range) |
---|---|
Self-efficacy | 29.6 (4.4) |
Intervention arm | 230 (50.3%) |
Pregnant or given birth in past 2 years | 169 (37.0%) |
Child ≥ 6 months of age in household | 361 (79.0%) |
Religiona | |
Muslim | 331 (72.4%) |
Hindu | 126 (27.6%) |
Parity† | 3 (1-10) |
Agea | 24.9 (4.2) |
Age at time of marriagea | 17.9 (2.4) |
Age gap (husband-wife)a | 8.2 (5.5) |
Education gap in class years completed (husband-wife)a | -1.1 (3.4) |
Years since marriagea | 7.1 (4.1) |
Household size | 5.6 (1.9) |
Family typea | |
Joint | 196 (42.9%) |
Nuclear | 261 (57.1%) |
Women’s educationa | |
No formal education | 86 (18.8%) |
Part primary | 103 (22.5%) |
Full primary | 96 (21.0%) |
Part secondary | 172 (37.6%) |
Husband’s educationa | |
No formal education | 193 (42.2%) |
Part primary | 76 (16.6%) |
Full primary | 76 (16.6%) |
Part secondary | 112 (24.5%) |
Decision-making category | n | Decision-making type freq (% out of n) | Autonomous decision-makinga (% of sole and joint decision-makers) | Decision-making confidence (SSE) freq. (% of joint decision-makers) | ||
---|---|---|---|---|---|---|
Sole | Joint | Not at all orsomewhat confident | Very confident | |||
Personal health and diet | ||||||
Rest when ill | 457 | 283 (61.9) | 169 (37.0) | 286 (63.3) | 70 (41.4) | 99 (58.6) |
Foods to prepare | 457 | 319 (69.8) | 134 (29.3) | 274 (60.5) | 47 (35.0) | 87 (65.0) |
Foods to eat | 457 | 386 (84.5) | 68 (14.9) | 366 (80.6) | 27 (39.7) | 41 (60.3) |
Personal diet during pregnancy | ||||||
Eat eggs during pregnancyc | 169 | 80 (47.3) | 84 (49.7) | 87 (53.0) | 37 (44.0) | 47 (56.0) |
Consume milk during pregnancyc | 169 | 63 (37.3) | 104 (61.5) | 81 (48.5) | 58 (55.8) | 46 (44.2) |
Eat meat during pregnancyc | 169 | 50 (29.6) | 118 (69.8) | 67 (39.9) | 79 (67.0) | 39 (33.0) |
Personal health during pregnancy | ||||||
Work during pregnancyc | 169 | 60 (35.5) | 106 (62.7) | 81 (48.8) | 52 (49.0) | 54 (51.0) |
Rest during pregnancyc | 169 | 79 (46.7) | 85 (50.3) | 94 (57.3) | 38 (44.7) | 47 (55.3) |
Consult a doctor during pregnancyc | 169 | 7 (4.1) | 157 (92.9) | 29 (17.7) | 108 (68.8) | 49 (31.2) |
Child’s diet | ||||||
Feed child eggsd | 361 | 168 (46.5) | 182 (50.4) | 207 (59.3) | 84 (46.4)b | 97 (53.6)b |
Feed child milkd | 361 | 137 (37.9) | 221 (61.2) | 205 (57.3) | 108 (48.9) | 113 (51.1) |
Feed child meatd | 361 | 102 (28.2) | 252 (69.8) | 143 (40.5) | 162 (64.5)b | 89 (35.5)b |
Healthcare seeking | ||||||
Go to the doctor when ill | 457 | 15 (3.3) | 437 (95.6) | 72 (15.9) | 300 (68.7) | 137 (31.3) |
Take sick child to doctore | 434 | 16 (3.7) | 412 (94.9) | 110 (25.7) | 223 (54.1) | 189 (45.9) |
Take child for well visitse | 434 | 57 (13.1) | 373 (85.9) | 153 (35.6) | 200 (53.6) | 173 (46.4) |
Associations between GSE and decision-making autonomy
Decision-making autonomy index | |||||
---|---|---|---|---|---|
Personal health and diet (N= 445) | Personal diet during pregnancy (N= 161) | Personal health during pregnancy (N= 159) | Child’s diet (N= 347) | Healthcare seeking (N= 424) | |
General self-efficacy | |||||
OR (95 % CI) | 1.07 (1.02-1.12) | 1.05 (0.96-1.14) | 1.01 (0.94-1.09) | 1.14 (1.08-1.21) | 1.15 (1.10-1.21) |
p-value | 0.004 | 0.33 | 0.70 | <0.001 | <0.001 |
Influence of GSE vs SSE on autonomy among joint decision-makers
Variable | Decision-making autonomy index | ||||
---|---|---|---|---|---|
Personal health and diet (N= 44) | Personal diet during pregnancy (N= 73) | Personal health during pregnancy (N= 79) | Child’s diet (N= 159) | Healthcare seeking (N= 365) | |
General self-efficacy | |||||
OR (95 % CI) | 1.01 (0.86-1.17) | 1.03 (0.92-1.15) | 1.03 (0.89-1.19) | 1.13 (1.06-1.22) | 1.15 (1.09-1.22) |
p-value | 0.94 | 0.66 | 0.70 | <0.001 | <0.001 |
SSE Category (Referent category: very confident in 0 of 3 activities) | Decision-making autonomy index | |||||
---|---|---|---|---|---|---|
Personal health and diet (N= 44) | Personal diet during pregnancy (N= 73) | Personal health during pregnancy (N= 79) | Child’s diet (N= 159) | Healthcare seeking (N= 365) | ||
Domain-specific self-efficacy for some activities (very confident in 1-2 of 3 activities) | OR (95% CI) | 1.06 (0.13-8.55) | 0.47 (0.13-1.61) | 1.37 (0.29-6.42) | 2.05 (0.81-5.22) | 2.69 (1.54-4.72) |
p-value | 0.95 | 0.23 | 0.69 | 0.13 | 0.001 | |
Domain-specific self-efficacy for all activities (very confident in 3 of 3 activities) | OR (95% CI) | 6.46 (1.27-32.71) | 4.23 (1.24-14.42) | 7.54 (1.47-38.54) | 8.87 (3.84-20.51) | 11.62 (6.26-21.56) |
p-value | 0.02 | 0.02 | 0.02 | <0.001 | <0.001 |
Qualitative results
Perceptions of self-efficacy in decision-making
“Earlier when I took any decision, I needed to ask my husband first. And now he understands that if I take these decisions by myself then it will be better, better for the family. So, he does not say anything now if I take decisions by myself. I do it in a good way. [...] Now he sees the income and expenditure that is happening in our family. Decisions that I take, he sees that they become fruitful for our family.”(Woman from Settlement A; intervention; nuclear family)
Socio-cultural influences on self-efficacy and decision-making
“He [my husband] said that’s my job to decide what they [the children] will eat. What they will like to eat, it’s your job to take care. He will bring what they need.”(Woman from Settlement B; intervention; joint family)
“Participant (P): There is some difference between a man’s word and a woman’s word. About important topics, if any elder man is saying anything, then I am younger than him. If I give any decision instead of hearing it, I will have to keep his word because I am younger than him. If [the] work’s output will be good, then there is nothing elder and younger. [...] Then he says she can be younger, but she didn’t say anything wrong. Then we can do it.
Interviewer (I): At the time of taking a decision whose decision always gets importance?
P: Most of the time, what he will say [gets importance].”
(Woman from Settlement B; intervention; joint family)
“It is [more] beneficial in [a] single family than in an extended family. In an extended family, everyone takes joint decisions and eats together, I don’t want that. If the mother-in-law will agree then the father-in-law will disagree. Also, if someone agrees then the brothers-in-law will disagree. But in a single family nothing like this happens. Both of us can take a decision together. What we will think [will be] good for us, we can take that decision. We take our decision. For this reason, a single family is good.”
(Woman from Settlement A; intervention; nuclear family)
The role of adaptive preference
“If I need something and if he scolds me then I just sit down and shut my mouth. [...] When I need something, he give[s it to] me. Then I also don’t have any say. If he gives me after 2 days, I also tolerate this. Then I don’t say anything, and everything has been solved.”
(Woman from Settlement B; intervention; joint family)
“I: If there is a difference of opinion in case of spending money, what do you do?
P: I don’t have any opinion regarding the financial matters, my husband takes care of it.”
(Woman from Settlement C; intervention; nuclear family)
“The husband in a family has more power than anyone. He runs the family on his own decisions. [...] I have to agree even if I don’t want to. There is no point in arguing with him. If the husband orders [me] to do something, I have to do that.”
(Woman from Settlement D; control; joint family)