Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement.


Gabrysch, S; McMahon, SA; Siling, K; Kenward, MG; Campbell, OM; (2016) Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement. Sci Rep, 6. p. 22578. ISSN 2045-2322 DOI: 10.1038/srep22578

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Abstract

It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman's ability to act upon her own preferences. How autonomy should be constructed and measured - namely, as an individual or cluster-level variable - has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman's autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Centre for Statistical Methodology
PubMed ID: 26931301
Web of Science ID: 371174600001
URI: http://researchonline.lshtm.ac.uk/id/eprint/2534315

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