Women decision-making capacity and intimate partner violence among women in sub-Saharan Africa

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Study Justification:
– Violence against women is a common form of human rights violation, and intimate partner violence (IPV) is a significant component of this violence.
– Understanding the association between women’s decision-making capacity and IPV in Sub-Saharan Africa is crucial for addressing this issue.
– The study aims to provide insights into the socio-demographic factors that influence IPV among women in Sub-Saharan Africa.
Study Highlights:
– The odds of experiencing IPV were higher among women with decision-making capacity.
– Young women were less likely to experience IPV.
– Women belonging to other religious groups and Christians were more likely to experience IPV compared to Muslims.
– Women whose partners had lower education levels were more likely to experience IPV.
– Employed women were more likely to experience IPV compared to unemployed women.
– Cohabiting women were more likely to experience IPV compared to married women.
– Women with lower education levels and lower wealth status were more likely to experience IPV.
Study Recommendations:
– Promote women’s decision-making capacity to reduce IPV.
– Focus on empowering young women to prevent IPV.
– Address the socio-cultural factors that contribute to IPV among women of different religious groups.
– Improve access to education and promote gender equality to reduce IPV.
– Implement policies and programs to support unemployed women and address economic factors contributing to IPV.
– Provide support and resources for women in cohabiting relationships to prevent IPV.
– Address the intersectionality of education and wealth status in relation to IPV.
Key Role Players:
– Researchers and academics in the field of gender-based violence and public health.
– Non-governmental organizations (NGOs) working on women’s rights and violence prevention.
– Government agencies responsible for implementing policies and programs related to gender equality and violence prevention.
– Community leaders and activists advocating for women’s rights and safety.
Cost Items for Planning Recommendations:
– Research funding for further studies and data collection.
– Funding for educational programs and campaigns promoting women’s decision-making capacity and gender equality.
– Resources for training and capacity-building for NGOs and government agencies.
– Financial support for implementing policies and programs addressing unemployment and economic factors contributing to IPV.
– Funding for support services for women experiencing IPV, including counseling and shelters.
– Budget allocation for monitoring and evaluation of interventions and programs addressing IPV.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized pooled data from a large sample size and employed both univariate and multivariate logistic regression models to analyze the relationship between the explanatory variables and the outcome variable. The study also provided odds ratios with 95% confidence intervals. However, the abstract does not mention any limitations or potential biases in the study design or data collection process. To improve the strength of the evidence, it would be helpful to include a discussion of the study’s limitations and potential sources of bias, as well as any steps taken to address these issues.

Background: Violence against women is a common form of human rights violation, and intimate partner violence (IPV) appears to be the most significant component of violence. The aim of this study was to examine the association between women decision-making capacity and IPV among Women in Sub-Saharan Africa. The study also looked at how socio-demographic factors also influence IPV among Women in Sub-Saharan Africa. Methods: The study made use of pooled data from most recent Demographic and Health Survey (DHS) conducted from January 1, 2010, and December 3, 2016, in 18 countries in Sub-Saharan Africa. For the purpose of the study, only women aged 15-49 were used (N = 84,486). Univariate and multivariate logistic regression models were used to investigate the relationship between the explanatory variables and the outcome variable. Results: The odds of reporting ever experienced IPV was higher among women with decision-making capacity [AOR = 1.35; CI = 1.35-1.48]. The likelihood of experiencing IPV was low among young women. Women who belong to other religious groups and Christians were more likely to experience IPV compared to those who were Muslims [AOR = 1.73; CI = 1.65-1.82] and [AOR = 1.87; CI = 1.72-2.02] respectively. Women who have partners with no education [AOR = 1.11; CI = 1.03-1.20], those whose partners had primary education [AOR = 1.34; CI = 1.25-1.44] and those whose partners had secondary education [AOR = 1.22; CI = 1.15-1.30] were more likely to IPV compared to those whose partners had higher education. The odds of experiencing IPV were high among women who were employed compared to those who were unemployed [AOR = 1.33; CI = 1.28-1.37]. The likelihood of the occurrence of IPV was also high among women who were cohabiting compared to those who were married [AOR = 1.16; CI = 1.10-1.21]. Women with no education [AOR = 1.37; CI = 1.24-1.51], those with primary education [AOR = 1.65; CI = 1.50-1.82] and those with secondary education [AOR = 1.50; CI = 1.37-1.64] were more likely to experience IPV compared to those with higher education. Finally, women with poorest wealth status [AOR = 1.28; CI = 1.20-1.37], those with poorer wealth status [AOR = 1.24; CI = 1.17-1.32], those with middle wealth status [AOR = 1.27; CI = 1.20-1.34] and those with richer wealth status [AOR = 1.11; CI = 1.06-1.17] were more likely to IPV compared to women with richest wealth status. Conclusion: Though related socio-demographic characteristics and women decision-making capacity provided an explanation of IPV among women in sub-Saharan Africa, there were differences in relation to how each socio-demographic variable predisposed women to IPV in Sub-Saharan Africa.

The study made use of pooled data from most current Demographic and Health Survey (DHS) conducted from January 1, 2010, and December 31, 2016, conducted in 18 countries in Sub-Saharan Africa. DHS is a nationwide survey collected every five-year period across low and middle-income countries. DHS focuses on maternal and child health by interviewing women of reproductive age (15–49 years). DHS surveys follow the same standard procedures – sampling, questionnaires, data collection, cleaning, coding and analysis which allows for cross-country comparison. The survey employs a stratified two-stage sampling technique. The first stage involved the selecting of points or clusters (enumeration areas [EAs]). The second stage is the systematic sampling of households listed in each cluster or EA. All women in their reproductive age (15–49) who were usual of selected households or visitors who slept in the household on the night before the survey were interviewed. The response rate varied from 86.2% to 100.0% For the purpose of this, only women who had information on reproduction health decision-making were used (N = 84,486). Women gave oral and written consent. Ethical approval was given by individual national institutions review board and by ICF International institutional review board. Permission to use the data set was sort from MEASURE DHS. Data set is available to the public at www.measuredhs.org. The outcome variable employed for this study was intimate partner violence. The outcome variable was derived from three questions “experienced any sexual violence?”, “experienced any emotional violence?” and “experienced and physical violence?”. The response categories of these variables were: “Yes” and “No”. The ‘Yes’ responses were coded ‘1’ and the ‘No’ responses were coded ‘0’. An index was created with all the “Yes” and “No” answers with scores ranging from 0 to 3. The score 0 was labelled as “No” and 1 to 3 was labelled as “Yes”. A dummy variable was generated with ‘0’ score being females who had not experienced any form of sexual or emotional or physical violence and ‘1’ if females had experienced either sexual or emotional or physical violence. The main explanatory variable, decision-making capacity, was derived from three questions “decision on personal health care”, “decision on large household purchase” and “decision on visits to family or relatives”. These response categories were recoded as “not alone = 0” and “alone = 1”). An index was created with all the “yes” and “no” answers with scores ranging from 0 to 3. The score 0 and 1 were labelled as “no capacity” and 2 and 3 were labelled as “capacity”. A dummy variable was generated with ‘0′ score being females who did not have the capacity and ‘1′ if females who had the capacity. The other explanatory variables consisted of: residence, age, wealth status, education, religion, occupation, marital status, partner’s education and country. Residence was categorized as urban and rural. Age was grouped in 5 – year interval: 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49. Wealth status was derived from the ownership of a variety of household assets and categorized as poorest, poorer, middle, richer and richest. Level of education and partner’s education was captured as no education, primary, secondary and higher education. Religion was recoded as Christian, Muslims and Others. Religion was not available for Niger. Occupation was categorized as not working, working outside the home and working at home. Marital status was captured as married and cohabitation. Descriptive and inferential statistics were conducted. Descriptive figures are reposted in percentages by countries. Univariate and multivariate logistic regression models used to investigate the relationship between the explanatory variables and the outcome variable. Two models were used to access the predictors of intimate partner violence. Model I looked at a bivariate analysis of the main independent variable, thus, decision-making capacity and the outcome variable. Model II looked at a bivariate analysis between decision-making capacity and the outcome variable and controlled for age and country. Model III adjusted for age and country by including them in the model together with all the other independent variables. This was done to find the association between all the independent variables, including age and country and the outcome variable. All frequency distributions were weighted whiles the survey command in Stata was used to adjust for the complex sampling structure of the data in the regression analyses. All results of the logistic analyses were presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health in Sub-Saharan Africa:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and resources related to maternal health, including access to prenatal care, nutrition, and family planning. These apps can also provide reminders for important appointments and medication schedules.

2. Telemedicine: Establish telemedicine programs that allow pregnant women in remote areas to consult with healthcare professionals through video calls or phone consultations. This can help address the shortage of healthcare providers in rural areas and improve access to prenatal care.

3. Community Health Workers: Train and deploy community health workers who can provide education, support, and basic healthcare services to pregnant women in their communities. These workers can help identify and refer high-risk pregnancies, provide prenatal counseling, and promote healthy behaviors.

4. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with financial assistance to access essential maternal health services, such as antenatal care visits, skilled birth attendance, and emergency obstetric care. This can help reduce financial barriers and increase utilization of maternal health services.

5. Public-Private Partnerships: Foster collaborations between the public and private sectors to improve access to maternal health services. This can involve partnering with private healthcare providers to expand service delivery, leveraging private sector expertise in technology and innovation, and exploring innovative financing mechanisms.

6. Maternal Waiting Homes: Establish maternal waiting homes near healthcare facilities to accommodate pregnant women who live far away and need to travel for delivery. These homes can provide a safe and supportive environment for women to stay during the final weeks of pregnancy, ensuring timely access to skilled birth attendance.

7. Transportation Support: Develop transportation initiatives that provide pregnant women with affordable and reliable transportation options to reach healthcare facilities. This can include subsidized transportation vouchers, community-based transportation services, or partnerships with local transportation providers.

8. Maternal Health Education: Implement comprehensive maternal health education programs that target women, their families, and communities. These programs can provide information on prenatal care, nutrition, family planning, birth preparedness, and the importance of skilled birth attendance.

9. Quality Improvement Initiatives: Implement quality improvement initiatives in healthcare facilities to ensure the provision of safe and effective maternal health services. This can involve training healthcare providers, improving infrastructure and equipment, and implementing evidence-based clinical guidelines.

10. Data Collection and Monitoring: Strengthen data collection and monitoring systems to track maternal health indicators and identify areas for improvement. This can involve the use of electronic health records, data analytics, and real-time monitoring tools to inform decision-making and resource allocation.

It is important to note that the specific implementation of these innovations should be tailored to the local context and needs of each country in Sub-Saharan Africa.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health based on the study findings would be to prioritize interventions that focus on enhancing women’s decision-making capacity. This can be achieved through various strategies, including:

1. Empowerment programs: Implement programs that aim to empower women by providing them with knowledge, skills, and resources to make informed decisions about their reproductive health. These programs can include education on sexual and reproductive health, family planning, and gender equality.

2. Legal and policy reforms: Advocate for the implementation and enforcement of laws and policies that protect women’s rights and promote gender equality. This can include laws against domestic violence, sexual assault, and discrimination, as well as policies that support women’s access to healthcare services.

3. Awareness campaigns: Conduct awareness campaigns to educate communities about the importance of women’s decision-making capacity and the negative consequences of intimate partner violence. These campaigns can involve community dialogues, workshops, and media campaigns to challenge harmful gender norms and promote positive attitudes towards women’s autonomy.

4. Health system strengthening: Improve the capacity of healthcare systems to address the needs of women experiencing intimate partner violence. This can involve training healthcare providers on identifying and responding to violence, establishing referral pathways to support services, and integrating gender-based violence screening and counseling into routine maternal health services.

5. Collaborative partnerships: Foster partnerships between government agencies, civil society organizations, and community leaders to collectively address the issue of intimate partner violence and promote women’s decision-making capacity. This can involve collaboration on program development, resource mobilization, and advocacy efforts.

By implementing these recommendations, it is expected that access to maternal health services will be improved, and the prevalence of intimate partner violence among women in Sub-Saharan Africa will be reduced.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations for improving access to maternal health in sub-Saharan Africa:

1. Strengthen women’s decision-making capacity: Promote initiatives that empower women to make informed decisions about their reproductive health, including access to family planning methods, antenatal care, and skilled birth attendance. This can be achieved through education, awareness campaigns, and community engagement.

2. Address intimate partner violence (IPV): Develop comprehensive strategies to prevent and respond to IPV, including awareness programs, legal reforms, and support services for survivors. This can help create a safer environment for women seeking maternal health services.

3. Improve socio-economic conditions: Addressing poverty and inequality can contribute to better access to maternal health. This can be done through poverty reduction programs, job creation, and social protection measures that target vulnerable populations.

4. Enhance healthcare infrastructure: Invest in improving healthcare facilities, particularly in rural areas, by increasing the number of skilled healthcare providers, ensuring the availability of essential medical supplies and equipment, and strengthening referral systems.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify key indicators that reflect access to maternal health, such as the percentage of women receiving antenatal care, skilled birth attendance, or access to family planning services.

2. Collect baseline data: Gather data on the selected indicators from existing sources, such as national health surveys or health facility records. This will provide a baseline against which the impact of the recommendations can be measured.

3. Implement interventions: Implement the recommended interventions in selected regions or communities. This could involve implementing awareness campaigns, training healthcare providers, or establishing support services for survivors of IPV.

4. Monitor and evaluate: Continuously monitor the implementation of interventions and collect data on the selected indicators. This can be done through surveys, interviews, or routine data collection systems.

5. Analyze data: Analyze the collected data to assess the impact of the interventions on the selected indicators. This can be done using statistical methods, such as regression analysis or trend analysis, to determine if there are significant improvements in access to maternal health.

6. Interpret and report findings: Interpret the results of the analysis and report on the impact of the recommendations. This can help inform future decision-making and guide further interventions to improve access to maternal health.

It is important to note that the methodology may vary depending on the specific context and available resources. Collaboration with relevant stakeholders, such as government agencies, NGOs, and healthcare providers, is crucial for the successful implementation and evaluation of these recommendations.

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