Abstract

The dimensions of women’s autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women’s autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women’s autonomy on the use of health care appears to be as important as other known determinants such as education.

The text of this article is only available as a PDF.

References

Abbas, A.A., & Walker, G.J.A. (
1986
).
Determinants of the Utilization of Maternal and Child Health Services in Jordan
.
International Journal of Epidemiology
,
15
,
404
407
. 10.1093/ije/15.3.404
Agresti, A. (
1996
).
An Introduction to Categorical Data Analysis
.
New York
:
Wiley
.
Aiken, L.R. (
1991
).
Psychological Testing and Assessment
. 7th ed.
Boston
:
Allyn & Bacon
.
Balk, D. (
1994
).
Individual and Community Aspects of Women’s Status and Fertility in Rural Bangladesh
.
Population Studies
,
48
,
21
45
. 10.1080/0032472031000147456
Balk, D. (
1997
).
Defying Gender Norms in Rural Bangladesh: A Social Demographic Analysis
.
Population Studies
,
51
,
153
72
. 10.1080/0032472031000149886
Basu, A.M. (
1992
).
Culture, the Status of Women and Demographic Behaviour
.
Oxford
:
Clarendon
.
Basu, A.M. (
1996
).
Girls’ Schooling, Autonomy and Fertility Change: What Do These Words Mean in South Asia?
. In R. Jeffery, & A.M. Basu (Eds.),
Girls’ Schooling, Women’s Autonomy and Fertility Change in South Asia
(pp.
48
71
).
New Delhi & London
:
Sage
.
Becker, S., Peters, D.H., Gray, R.H., Gultiano, C., & Black, R.E. (
1993
).
The Determinants and Use of Maternal and Child Health Services in Metro Cebu, the Philippines
.
Health Transition Review
,
3
,
77
89
.
Bennett, S., Woods, T., Liyange, W., & Smith., D. (
1991
).
A Simplified General Method for Cluster-Sample Surveys of Health in Developing Countries
.
World Health Statistics Quarterly
,
44
,
98
106
.
Bhatia, J.C., & Cleland, J. (
1995
).
Determinants of Maternal Care in a Region of South India
.
Health Transition Review
,
5
,
142
142
.
Bhatia, J.C., & Cleland, J. (
1995
).
Self-Reported Symptoms of Gynecological Morbidity and Their Treatment in South India
.
Studies in Family Planning
,
26
,
203
16
. 10.2307/2137846
Bloom, S.S., Lippeveld, T., & Wypij, D. (
1999
).
Does Antenatal Care Make a Difference to Safe Delivery? A Study in Urban Uttar Pradesh, India
.
Health Policy and Planning
,
14
,
38
48
. 10.1093/heapol/14.1.38
Caldwell, J.C. (
1986
).
Routes to Low Mortality in Poor Countries
.
Population and Development Review
,
12
,
171
220
. 10.2307/1973108
Castle, S.E. (
1993
).
Intra-Household Differentials in Women’s Status: Household Function and Focus as Determinants of Children’s Illness Management and Care in Rural Mali
.
Health Transition Review
,
3
,
137
57
.
Das Gupta, M. (
1987
).
Selective Discrimination Against Female Children in Rural Punjab, India
.
Population and Development Review
,
13
,
77
100
. 10.2307/1972121
Das Gupta, M. (
1990
).
Death Clustering, Mothers’ Education and the Determinants of Child Mortality in Rural Punjab, India
.
Population Studies
,
44
,
489
505
. 10.1080/0032472031000144866
Das Gupta, M. (
1996
).
Life Course Perspectives on Women’s Autonomy and Health Outcomes
.
Health Transition Review
,
6
,
213
31
.
Dharmalingam, A., & Morgan., S.P. (
1996
).
Women’s Work, Autonomy and Birth Control: Evidence From Two South Indian Villages
.
Population Studies
,
50
,
187
201
. 10.1080/0032472031000149296
Dyson, T., & Moore, M. (
1983
).
On Kinship Structure, Female Autonomy and Demographic Behavior in India
.
Population and Development Review
,
9
,
35
60
. 10.2307/1972894
Gertler, P., Rahman, O., Feifer, C., & Ashley, D. (
1993
).
Determinants of Pregnancy Outcomes and Targeting of Maternal Health Services in Jamaica
.
Social Science and Medicine
,
37
,
199
211
. 10.1016/0277-9536(93)90455-D
Goodburn, E.A., Gazi, R., & Chowdhury, M. (
1995
).
Beliefs and Practices Regarding Delivery and Postpartum Maternal Morbidity in Rural Bangladesh
.
Studies in Family Planning
,
26
,
22
32
. 10.2307/2138048
Census of India 1991, Series 1, India, Paper 2 of 1992, Final Population Totals, Brief Analysis of Primary Census Abstract
. (
1992
).
New Delhi
:
Office of the Registrar General and Census Commissioner
.
Henderson, R.H., & Sudaresan, T. (
1982
).
Cluster Sampling to Access Immunization Coverage: A Review of Experience With a Simplified Sampling Method
.
Bulletin of the World Health Organization
,
60
,
253
60
.
Hosmer, D.W., & Lemeshow, S. (
1989
).
Applied Logistic Regression
.
New York
:
Wiley
.
National Family Health Survey (MCH and Family Planning): India 1992-93
. (
1995
).
Bombay
:
International Institute for Population Sciences
.
Uttar Pradesh National Family Health Survey 1992–93
. (
1994
).
Bombay
:
International Institute for Population Sciences and Population Research Center
.
Jeffery, P., Jeffery, R., & Lyon, A. (
1988
).
When Did You Last See Your Mother? Aspects of Female Autonomy in Rural North India
. In J.C. Caldwell, A.G. Hill, & V.J. Hull (Eds.),
Micro-Approaches to Demographic Research
(pp.
321
33
).
London and New York
:
Kegan Paul International
.
Jeffery, P., Jeffery, R., & Lyon., A. (
1989
).
Labour Pains and Labour Power
.
London
:
Zed Books
.
Jeffery, R., & Jeffery., P. (
1993
).
A Woman Belongs to Her Husband: Female Autonomy, Women’s Work and Childbearing in Bijnor
. In A.W. Clark (Ed.),
Gender and Political Economy: Explorations of South Asian Systems
(pp.
66
114
).
Delhi and London
:
Oxford University Press
.
Jejeebhoy, S.J. (
1984
).
Household Type and Family Size in Maharashtra, 1970
.
Social Biology
,
31
,
91
100
.
Jejeebhoy, S.J. (
1991
).
Women’s Status and Fertility: Successive Cross-Sectional Evidence From Tamil Nadu, India
.
Studies in Family Planning
,
22
,
217
30
. 10.2307/1966478
Jejeebhoy, S.J. (
1995
).
Women’s Education, Autonomy and Reproductive Behaviour
.
Oxford
:
Clarendon
.
Jejeebhoy, S.J. 1997. “Women’s Autonomy in Rural India: Its Dimensions, Determinants and the Influence of Context.” Presented at the seminar “Female Empowerment and Demographic Processes Moving Beyond Cairo,” April 21–24, Lund, Sweden.
Khan, A.H.T. (
1997
).
A Hierarchical Model of Contraceptive Use in Urban and Rural Bangladesh
.
Contraception
,
55
,
91
96
. 10.1016/S0010-7824(96)00278-8
Lipsitz, S.R., Kim, K., & Zhao., L. (
1994
).
Analysis of Repeated Categorical Data Using Generalized Estimating Equations
.
Statistics in Medicine
,
13
,
1149
63
. 10.1002/sim.4780131106
Malhotra, A., Vanneman, R., & Kishor., S. (
1995
).
Fertility, Dimensions of Patriarchy, and Development in India
.
Population and Development Review
,
21
,
281
305
. 10.2307/2137495
Mason, K.O. (
1984
).
Gender and Demographic Change: What Do We Know?
.
Liège
:
International Union for the Scientific Study of Population
.
Mason, K.O. (
1993
).
The Impact of Women’s Position on Demographic Change During the Course of Development
. In N. Federici, K.O. Mason, & S. Sogner (Eds.),
Women’s Position and Demographic Change
(pp.
19
42
).
Oxford
:
Clarendon
.
McCarthy, J., & Maine., D. (
1992
).
A Framework for Analyzing the Determinants of Maternal Mortality
.
Studies in Family Planning
,
23
,
23
33
. 10.2307/1966825
McCaw-Binns, A., La Grenade, J., & Ashley., D. (
1995
).
Under-Users of Antenatal Care: A Comparison of Non-Attenders and Late Attenders for Antenatal Care, With Early Attenders
.
Social Science and Medicine
,
40
,
1003
12
. 10.1016/0277-9536(94)00175-S
Miles-Doan, R., & Bisharat., L. (
1990
).
Female Autonomy and Child Nutritional Status: The Extended Family Residential Unit in Amman, Jordan
.
Social Science and Medicine
,
31
,
783
89
. 10.1016/0277-9536(90)90173-P
Morgan, S.P., & Niraula., B.B. (
1995
).
Gender Inequality and Fertility in Two Nepali Villages
.
Population and Development Review
,
21
,
541
61
. 10.2307/2137749
Mosley, W.H., & Chen., L.C. (
1984
).
An Analytical Framework for the Study of Child Survival in Developing Countries
. In W.H. Mosely, & L.C. Chen (Eds.),
Child Survival: Strategies for Research
(pp.
25
45
).
New York
:
Population Council
.
Murthi, M., Guio, A.-C., & Drèze., J. (
1995
).
Mortality, Fertility, and Gender Bias in India: A District-Level Analysis
.
Population and Development Review
,
21
,
745
82
. 10.2307/2137773
Obermeyer, C.M., & Potter., J.E. (
1991
).
Maternal Health Care Utilization in Jordan: A Study of Patterns and Determinants
.
Studies in Family Planning
,
22
,
177
87
. 10.2307/1966644
Pebley, A.R., Goldman, N., & Rodríguez, G. (
1996
).
Prenatal and Delivery Care and Childhood Immunization in Guatemala: Do Family and Community Matter?
.
Demography
,
33
,
231
47
. 10.2307/2061874
Safilios-Rothschild, C., & Youssek, N. (
1982
).
Female Power, Autonomy and Demographic Change in the Third World
. In R. Anker, & M. Buvunic (Eds.),
Women’s Roles and Population Trends in the Third World
(pp.
117
32
).
London
:
Croom Helm
.
Santow, G. (
1995
).
Social Roles and Physical Health: The Case of Female Disadvantage in Poor Countries
.
Social Science and Medicine
,
40
,
147
61
. 10.1016/0277-9536(94)E0069-5
SAS/STAT Software: Changes and Enhancements Through Release 6.12
. (
1997
).
Cary, NC
:
SAS Institute
.
Schuler, S.R., & Hashemi., S. (
1994
).
Credit Programs, Women’s Empowerment, and Contraceptive Use in Rural Bangladesh
.
Studies in Family Planning
,
25
,
65
76
. 10.2307/2138085
Sharma, U. (
1980
).
Women, Work and Property in North-West India
.
London
:
Tavistock
.
Tsui, A.O., Singh, K.K., Buckner, B., Deitrich, J., DeGraft-Johnson, J., Bardsley, P., Talwar, P., Strickland, T., & Betts, L. (
1996
).
Performance Indicators for the Innovations in Family Planning Services Project, 1995 PERFORM Survey
.
Chapel Hill
:
Carolina Population Center, Evaluation Project. Published monograph
.
Visaria, L. (
1993
).
Female Autonomy and Fertility Behavior: An Explanation of Gujarat Data
Meeting of the International Union for the Scientific Study of Population
(pp.
263
75
).
Montreal
:
Liège
.
Visaria, L. (
1996
).
Regional Variations in Female Autonomy and Fertility and Contraception in India
. In R. Jeffery, & A.M. Basu (Eds.),
Girls’ Schooling, Women’s Autonomy and Fertility Change in South Asia
(pp.
235
68
).
New Delhi and London
:
Sage
.
Vlassoff, C. (
1991
).
Progress and Stagnation: Changes in Fertility and Women’s Position in an Indian Village
.
Population Studies
,
46
,
195
212
. 10.1080/0032472031000146196
Vlassoff, C., & Kumar, A. (
1997
).
Gender Relations and Education of Girls in Two Indian Communities: Implications for Decisions About Childbearing
.
Reproductive Health Matters
,
10
,
139
50
.
Reduction of Maternal Mortality
. (
1999
).
Geneva
:
World Health Organization
.
Zeger, S., & Liang, K.Y. (
1986
).
Longitudinal Data Analysis for Discrete and Continuous Outcomes
.
Biometrics
,
42
,
121
30
. 10.2307/2531248