Skip to main content

06.03.2018

Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan

verfasst von: Kristine R. Hearld, Jami L. Anderson, Henna Budhwani

Erschienen in: Maternal and Child Health Journal | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction The Islamic Republic of Pakistan’s maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women’s empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012–2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women’s empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both—education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.
Literatur
Zurück zum Zitat Budhwani, H., Hearld, K., & Harbison, H. (2015). Individual and area level factors associated with prenatal, delivery, and postnatal care in Pakistan. Maternal and Child Health Journal, 19(10), 2138–2146.CrossRefPubMed Budhwani, H., Hearld, K., & Harbison, H. (2015). Individual and area level factors associated with prenatal, delivery, and postnatal care in Pakistan. Maternal and Child Health Journal, 19(10), 2138–2146.CrossRefPubMed
Zurück zum Zitat Budhwani, H., Shivkumar, P., Purandare, C., Cataldo, N., Desai, S., Bhatt, P., Baswal, D., & Bhardwaj, A. (2017). Limitations of magnesium sulfate use to treat pregnant women with pre-eclampsia and eclampsia: Results of a sample survey on emergency obstetric care (EmOC) conducted in India. Journal of Obstetrics and Gynecology, 67(5), 330–336. Budhwani, H., Shivkumar, P., Purandare, C., Cataldo, N., Desai, S., Bhatt, P., Baswal, D., & Bhardwaj, A. (2017). Limitations of magnesium sulfate use to treat pregnant women with pre-eclampsia and eclampsia: Results of a sample survey on emergency obstetric care (EmOC) conducted in India. Journal of Obstetrics and Gynecology, 67(5), 330–336.
Zurück zum Zitat Endeley, J. (2001). Conceptualising women’s empowerment in societies in Cameroon: How does money fit in? Gender and Development, 9(1), 34–41.CrossRef Endeley, J. (2001). Conceptualising women’s empowerment in societies in Cameroon: How does money fit in? Gender and Development, 9(1), 34–41.CrossRef
Zurück zum Zitat Fikree, F., Ali, T., Durocher, J., & Rahbar, M. (2004). Health service utilization for perceived postpartum morbidity among poor women living in Karachi. Social Science and Medicine, 59(4), 681–694.CrossRefPubMed Fikree, F., Ali, T., Durocher, J., & Rahbar, M. (2004). Health service utilization for perceived postpartum morbidity among poor women living in Karachi. Social Science and Medicine, 59(4), 681–694.CrossRefPubMed
Zurück zum Zitat Gill, R., & Stewart, D. (2011). Relevance of gender-sensitive policies and general health indicators to compare the status of South Asian women’s health. Womens Health Issues, 21(1), 12–18.CrossRefPubMed Gill, R., & Stewart, D. (2011). Relevance of gender-sensitive policies and general health indicators to compare the status of South Asian women’s health. Womens Health Issues, 21(1), 12–18.CrossRefPubMed
Zurück zum Zitat Helova, A., Hearld, K., & Budhwani, H. (2017). A multilevel analysis of neonatal, infant, and child mortality in Pakistan using the 2012–2013 Demographic Health Surveys. Maternal and Child Health, 21(2), 367–375.CrossRef Helova, A., Hearld, K., & Budhwani, H. (2017). A multilevel analysis of neonatal, infant, and child mortality in Pakistan using the 2012–2013 Demographic Health Surveys. Maternal and Child Health, 21(2), 367–375.CrossRef
Zurück zum Zitat Hunt, J., & Kasynathan, N. (2001). Pathways to empowerment? Reflections on microfinance and transformation in gender relations in South Asia. Gender and Development, 9(1), 42–52.CrossRef Hunt, J., & Kasynathan, N. (2001). Pathways to empowerment? Reflections on microfinance and transformation in gender relations in South Asia. Gender and Development, 9(1), 42–52.CrossRef
Zurück zum Zitat Jayaweera, S. (1997). Women, education and empowerment in Asia. Gender and Education, 9(4), 411–424.CrossRef Jayaweera, S. (1997). Women, education and empowerment in Asia. Gender and Education, 9(4), 411–424.CrossRef
Zurück zum Zitat Jennings, L., Na, M., Cherewick, M., Hindin, M., Mullay, B., & Ahmed, S. (2014). Women’s empowerment and male involvement in antenatal care: Analyses of Demographic and Health Surveys (DHS) in selected African countries. BMC Pregnancy and Childbirth, 14(1), 297.CrossRefPubMedPubMedCentral Jennings, L., Na, M., Cherewick, M., Hindin, M., Mullay, B., & Ahmed, S. (2014). Women’s empowerment and male involvement in antenatal care: Analyses of Demographic and Health Surveys (DHS) in selected African countries. BMC Pregnancy and Childbirth, 14(1), 297.CrossRefPubMedPubMedCentral
Zurück zum Zitat Leach, F. (1998). Education and training: An international perspective. Gender and Development, 6(2), 9–18.CrossRefPubMed Leach, F. (1998). Education and training: An international perspective. Gender and Development, 6(2), 9–18.CrossRefPubMed
Zurück zum Zitat Malhotra, A., Schuler, S., & Boender, C. (2002). Measuring women’s empowerment as a variable in international development. In Background paper prepared for the World Bank workshop on poverty and gender: New perspectives. Geneva: World Bank. Malhotra, A., Schuler, S., & Boender, C. (2002). Measuring women’s empowerment as a variable in international development. In Background paper prepared for the World Bank workshop on poverty and gender: New perspectives. Geneva: World Bank.
Zurück zum Zitat March, C., Smyth, I., & Mukhopadhyay, M. (1999). A guide to gender-analysis frameworks. Oxford: Oxfam Publishing.CrossRef March, C., Smyth, I., & Mukhopadhyay, M. (1999). A guide to gender-analysis frameworks. Oxford: Oxfam Publishing.CrossRef
Zurück zum Zitat Matsumura, M., & Gubhaju, B. (2001). Women’s status, household structure and the utilization of maternal health services in Nepal: Even primary-level education can significantly increase the chances of a woman using maternal healthcare from a modern facility. Asia-Pacific Population Journal, 16(1), 23–44.CrossRef Matsumura, M., & Gubhaju, B. (2001). Women’s status, household structure and the utilization of maternal health services in Nepal: Even primary-level education can significantly increase the chances of a woman using maternal healthcare from a modern facility. Asia-Pacific Population Journal, 16(1), 23–44.CrossRef
Zurück zum Zitat Mosedale, S. (2005). Assessing women’s empowerment: Towards a conceptual framework. Journal of International Development, 17(2), 243–257.CrossRef Mosedale, S. (2005). Assessing women’s empowerment: Towards a conceptual framework. Journal of International Development, 17(2), 243–257.CrossRef
Zurück zum Zitat National Institute of Population Studies (NIPS) [Pakistan] and ICF International. (2013). Pakistan Demographic and Health Survey 2012–2013. Islamabad, Pakistan, and Calverton, Maryland: NIPS and ICF International. National Institute of Population Studies (NIPS) [Pakistan] and ICF International. (2013). Pakistan Demographic and Health Survey 2012–2013. Islamabad, Pakistan, and Calverton, Maryland: NIPS and ICF International.
Zurück zum Zitat Qureshi, N., & Shaikh, B. (2007). Women’s empowerment and health: The role of institutions of power in Pakistan. Eastern Mediterranean Health Journal, 13(6), 1459–1465.CrossRefPubMed Qureshi, N., & Shaikh, B. (2007). Women’s empowerment and health: The role of institutions of power in Pakistan. Eastern Mediterranean Health Journal, 13(6), 1459–1465.CrossRefPubMed
Zurück zum Zitat Senarath, U., & Gunawardena, N. (2009). Women’s autonomy in decision making for healthcare in South Asia. Asia Pacific Journal of Public Health, 21(2), 137–143.CrossRefPubMed Senarath, U., & Gunawardena, N. (2009). Women’s autonomy in decision making for healthcare in South Asia. Asia Pacific Journal of Public Health, 21(2), 137–143.CrossRefPubMed
Zurück zum Zitat Shaikh, B., & Hatcher, J. (2004). Health seeking behaviour and health service utilization in Pakistan: Challenging the policy makers. Journal of Public Health, 27(1), 49–54.CrossRefPubMed Shaikh, B., & Hatcher, J. (2004). Health seeking behaviour and health service utilization in Pakistan: Challenging the policy makers. Journal of Public Health, 27(1), 49–54.CrossRefPubMed
Zurück zum Zitat Simkhada, B., van Teijlingen, E., Porter, M., & Simkhada, P. (2006). Major problems and key issues in maternal health in Nepal. Kathmandu University Medical Journal, 4(2), 258–263. Simkhada, B., van Teijlingen, E., Porter, M., & Simkhada, P. (2006). Major problems and key issues in maternal health in Nepal. Kathmandu University Medical Journal, 4(2), 258–263.
Zurück zum Zitat United Nations Development Programme. (2014). Human development report-sustaining human progress: Reducing vulnerabilities and building resilience, Pakistan. New York, NY: UN Development Programme. United Nations Development Programme. (2014). Human development report-sustaining human progress: Reducing vulnerabilities and building resilience, Pakistan. New York, NY: UN Development Programme.
Zurück zum Zitat Woldemicael, G., & Tenkorang, E. (2010). Women’s autonomy and maternal health-seeking behavior in Ethiopia. Maternal and Child Health Journal, 14, 988–998.CrossRefPubMed Woldemicael, G., & Tenkorang, E. (2010). Women’s autonomy and maternal health-seeking behavior in Ethiopia. Maternal and Child Health Journal, 14, 988–998.CrossRefPubMed
Zurück zum Zitat World Bank. Annex 6: Conceptual frameworks for gender analysis and planning. Adapted from: Training workshop for trainers in women, gender and development, June 9–21, 1996, Programme Handbook, Royal Tropical Institute, The Netherlands. Geneva: World Bank. World Bank. Annex 6: Conceptual frameworks for gender analysis and planning. Adapted from: Training workshop for trainers in women, gender and development, June 9–21, 1996, Programme Handbook, Royal Tropical Institute, The Netherlands. Geneva: World Bank.
Metadaten
Titel
Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan
verfasst von
Kristine R. Hearld
Jami L. Anderson
Henna Budhwani
Publikationsdatum
06.03.2018
Verlag
Springer US
Erschienen in
Maternal and Child Health Journal / Ausgabe 9/2018
Print ISSN: 1092-7875
Elektronische ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-018-2512-3