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Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2015)

Background. Maternal mortality remains unacceptably high in lower- and middle-income countries, with 289,000 women dying every year due to causes related to pregnancy and childbirth. Although the vast majority of deaths are preventable, progress in reducing maternal deaths has stagnated, especially in sub-Saharan Africa. The use of a Skilled Birth Attendant (SBA) at childbirth has been identified as a key intervention to prevent maternal deaths, yet SBA use continues to be limited in Africa.

Method. This study examined the mechanisms and complex pathways linking women's status and power to SBA use in the two distinct African countries - Senegal and Tanzania. This study used the Demographic and Health Survey Datasets in 2010, and conducted regression analysis, mediation analysis, and structural equation modeling. The study sample included all births occurred in the last five years (weighted n=10,688 in SN; 6,748 in TZ) to currently married women (weighted n=7,033 in SN; 4,445 in TZ). Women's education is examined as a proxy of women's status. The structure and multiple dimensions of power were identified in both countries as: age at first marriage, household decision-making power, perceptions of gender norms against violence, and perceptions for sex negotiation.

Results. Overall, there is a significant relationship of SBA use with women's status and power, yet the results demonstrated the disparate influences of women's education on SBA use - directly and indirectly in Tanzania, and indirectly in Senegal. Multiple dimensions of power influence SBA use as a direct and mediating determinant. However, the significant dimensions differ by country: decision-making in Tanzania; perceptions of gender norms against violence and for sex negotiation and age at first marriage in Senegal. The influence of sociodemographic characteristics (e.g., employment, household wealth) also showed variations across settings.

Discussion. This study provides valuable insights in to the potential causal pathways and mechanisms by which women's status and power influence SBA use. Moreover, this study confirms the importance of identifying and using analytic techniques to appropriately model the multidimensional and contextual nature of women's status and power. The results highlighted the need for culturally and contextually tailored policy and program interventions to support advancements in gender equity and women's empowerment, as a means of improving maternal health in Africa.

    Cover page: Investigating Pathways Linking Women's Status and Power to Skilled Birth Attendant Use at Childbirth in Senegal and Tanzania
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2015)

    Background

    Maternal mortality remains unacceptably high in sub-Saharan Africa with 179,000 deaths occurring each year, accounting for 2-thirds of maternal deaths worldwide. Progress in reducing maternal deaths and increasing Skilled Birth Attendant (SBA) use at childbirth has stagnated in Africa. Although several studies demonstrate the important influences of women's status and empowerment on SBA use, this evidence is limited, particularly in Africa. Furthermore, few studies empirically test the operationalization of women's empowerment and incorporate multidimensional measures to represent the potentially disparate influence of women's status and empowerment on SBA use across settings.

    Methods

    This study examined the relationship of women's status and empowerment with SBA use in two African countries--Senegal and Tanzania--using the 2010 Demographic and Health Surveys (weighted births n = 10,688 in SN; 6748 in TZ). Factor analysis was first conducted to identify the structure and multiple dimensions of empowerment. Then, a multivariate regression analysis was conducted to examine associations between these empowerment dimensions and SBA use.

    Results

    Overall, women's status and empowerment were positively related to SBA use. Some sociodemographic characteristics showed similar effects across countries (e.g., age, wealth, residence, marital relationship, parity); however, women's status and empowerment influence SBA use differently by setting. Namely, women's education directly and positively influenced SBA use in Tanzania, but not in Senegal. Further, each of the dimensions of empowerment influenced SBA use in disparate ways. In Tanzania women's higher household decision-making power and employment were related to SBA use, while in Senegal more progressive perceptions of gender norms and older age at first marriage were related to SBA use.

    Conclusions

    This study provides evidence of the disparate influences of women's status and empowerment on SBA use across settings. Results indicate that efforts to increase SBA use and to reduce maternal mortality through the improvement of women's status and empowerment should focus both on improving girls' education and delaying marriage, as well as transforming gender norms and decision-making power. However, given the multi-dimensional and contextual nature of women's status and empowerment, it is critical to identify key drivers to increase SBA use in a given setting for contextually tailored policy and programming.
      Cover page: The relationship of women’s status and empowerment with skilled birth attendant use in Senegal and Tanzania
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