Who decides? Joint decision making leads to better obstetric choices

Type Working Paper
Title Who decides? Joint decision making leads to better obstetric choices
URL https://paa.confex.com/paa/2016/mediafile/ExtendedAbstract/Paper6358/completed paper (currently​under review).pdf
Sub-Saharan Africa has the highest maternal mortality ratio of any region in the world (World Health
Organization & UNICEF, 2014). Maternal mortality arises from both inadequate maternal health services
and inadequate uptake of existing services (Wilunda et al., 2015). Many women receive fewer than the
recommended number of antenatal care visits or deliver without skilled assistance; appropriate obstetric
care is less often obtained by unmarried women, those with lower household income, less education, or
less educated partners, and those who have more children and have not had complications with previous
pregnancies (Gabrysch & Campbell, 2009; Simkhada, Teijlingen, Porter, & Simkhada, 2008).
Decision-making autonomy is another important determinant of the uptake of maternal health services.
Women in developing countries are often precluded from household decision making, and this exclusion
may also extend to reproductive health (Blanc, 2001). Power imbalances within relationships can interfere
with women’s ability to access reproductive health services (Blanc, 2001; Upadhyay, Dworkin, Weitz, &
Foster, 2014). Women, especially poor, uneducated women, are more likely to be in unequal relationships
and have limited autonomy in accessing obstetric care (Beegle, Frankenberg, & Thomas, 2001; Blanc,
2001). In contexts of limited female autonomy and poor maternal health, facilitating joint decision
making for obstetric choices may improve obstetric outcomes. Involving male partners in maternal health
education has been found to improve obstetric outcomes in India and Nepal (Bhalerao, Galwankar,
Kowli, Kumar, & Chaturvedi, 1984; Mullany, Becker, & Hindin, 2007).
In this paper, we analyze data collected as part of the baseline survey of a cohort study of sexual and
reproductive health in rural Lilongwe District, Malawi. Questions of maternal health and access to health
services are especially relevant in Malawi, where more than a quarter (29%) of women still deliver
without skilled assistance (National Statistical Office & ICF Macro, 2010). In this paper, we provide an
overview of reported obstetric care, examining location of delivery, assistance at delivery, delivery
complications, and birthweight. We then examine the relationships between who made obstetric decisions
(woman, partner, joint) about the woman’s most recent delivery and two outcomes of interest (delivery
location and complications) to assess whether facilitating joint decision making could be a useful
reproductive health intervention in the region.

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