This study aims to examine how gender power dynamics affect the reproductive health decisions among educated and uneducated married women of reproductive age in Pakistan. It was quantitative in nature. A purposive sampling of 100 (50 educated and 50 uneducated) married women of reproductive age was selected from Lahore and suburbs of Lahore. The Aida Ghazaryan and Zain Khadija questionnaire was used for data collection. Data was analyzed by using t-test and one-way anova.The results showed that there were no significant results in women’s level of autonomy in household decisions, work status of women and contraceptive use, influence of women’s age on birth control methods. But there were significant results between educated and uneducated married women of reproductive age in contraceptive use. In Pakistan, there was high demand for contraception among but usage was quite low(Tabassum,Manj, Gunjial, & Nazir, n.d.).Women don’t practice contraceptive methods, not because of the desire to have a child, just because of social and cultural pressure related to the Family Planning method.Gender Power Dynamics is a huge hurdle on reproductive health decisions in Pakistan.Therefore, in Pakistani society, education can change the perception of women about contraceptive use.
Basically the fertility rate has been decreased in both underdeveloped and developing countries but in 2017 the fertility rate in Pakistan is 2.68. Sixty-Six years ago, Pakistan was the thirteenth biggest country ,but now it was the sixth country regarding population. It is assumed that if the population increases by this proportion, then 2050 Pakistan will turn into the third biggest country after China and India regarding population (FERTILITY RATE IN PAKISTAN 2017 POPULATION GROWTH, n.d.).
In Pakistan,28 thousand women die annually because of pregnancy and childbirth complications. The fertility rate is quite high i.e. 6 to 7 children (2004-5). Contraceptive rate is really low with 34% only (Khan, Zafar, Ali, ; Ahmad, 2009). The maternal health is poor in Pakistan. It is calculated that about 500 maternal deaths occur per 100,000 live births annually in Pakistan. Recent World Health Organization ; UN agency puts the figures around 270/100,000 live births however it actually might be higher as the consequences of under registration and absence of reason behind death information (Safdar, 2009).
According to the Population Council fact sheet 2015, it is estimated that annually on an average 14,000 mothers die within the country. But out of those 4,500 maternal deaths are often simply prevented through strengthening health care system, particularly at primary level. Approximately 6,000 women expire annually due to pregnancy-related issues in Punjab, 3,000 in Balochistan, 2,800 in Sindh and 1,700 in K-P (Wasif, 2015).
However, there is a huge decline in the Pakistan’s Total Fertility Rate (TFR), in 1990-91, 5.4 children per woman and 4.1 children in 2006-07 – a drop of over one child in the previous 16 years. However, in the rural areas TFR is much higher in uneducated women and in the poorest group, i.e. 4.5, 4.8 and 5.8 respectively. Condoms, withdrawal and pill are the most preferred method of family planning among women under age 30, commonly referred to as traditional methods. Women in their early 30s are likely to use condoms and sterilization, although among women in their late 30s and 40s, female sterilization may be the most widely used methods. Use of reliable modern family planning methods remains far from their potential in Pakistan. With such poor reproductive health indicators, Pakistan ranks as one of the lowest and so much populated country in the world with almost 177 million people. Where, 50% of the population are female 88 and approximately 28 million are married women of reproductive age. Additionally, more than 73% of the community isn’t fully protected from health and seeks responsibility due to health expenditure. Furthermore, 30% of the First Care Level Facilities (FCLF) such fundamental health units are non-operational. The Poverty is increased by high maternal mortality rates, with almost 30,000 women dying each year in Pakistan as a result of pregnancy or childbirth related issues. Moreover, our community is not fully aware about their rights, especially in their Sexual and Reproductive Health (SRH). As a result, access to high quality Sexual and Reproductive Health services and knowledge still
Therefore, it is needed to improve mothers and children’s health in Pakistan. Recent study in other developing nations has indicated that maternal deaths may be decreased by the supply of maternal care treatments. In 2012 ,a study of Lavasani explained that improve the accessibility of maternal and family planning services, Human Development Foundation (HDF’s) provides awareness and education about family planning and have reduced Maternal Deaths by over 46%. Mothers are inspired to get positive and protective measures to benefit healthy lifestyles, such as for instance nourishment in pregnancy and delivery conditions (Reduce Maternal ; Infant Mortality in Pakistan, n.d.).
As a woman becomes empowered, it raises her ability to space and limit children which eventually has positive impacts on her health. There exists an imminent need to change the focus of population planning programs from lesser emphasis on reduction in the number of children per couple to the autonomy of females to control their own bodies. Thus a clear focus of the state-run population planning programs in Pakistan needs to be placed upon reproductive autonomy and not primarily on fertility reduction (Ombelet, 2012).
Reproductive decision making is the most powerful indicator of women’s empowerment and women’s reproductive autonomy is the best method to improve maternal mortality health care and to use contraception for family planning because it is best for women health (Okonkwo, Uchenna,Ezumah, Nkoli, 2017).
Family Planning is one of the most important reproductive methods that is the freedom of spacing of births and desired family size and use of contraceptive methods. To improve reproductive health of both men and women,family planning methods can be helpful to overcome maternal and mortality care. (Lanre, 2011).
World Health Organization (WHO) describes that “the term family planning does not mean to abort the child.It is the ability of couples to decide the spacing of births and gap between children by using contraceptive methods and infertility treatments. Family planning is also overcome the unsafe abortions” (PODOWSKI, 2012).
A literature review suggests that there are some hurdles in the use of maternal health and family planning services including socio-cultural factors such as maternal age, husband’s opposition and mother’s education. These factors are especially relevant to the Pakistani context where younger Pakistani women don’t have the autonomy to go outside without permission from male members and even they don’t use use of health care and family planning methods. In Pakistan, older women may have more autonomy in reproductive health as compared to younger women. Husband’s opposition and dominancy are the most important obstacles to the use of health services and family planning methods within Pakistan,Egypt,India and Guatemala. Much of the time, spouse’s dissatisfaction could reflect fertility preference or social beliefs regarding using health services (Mumtaz and Salway 2005).
Pakistan is patriarchal and male-dominated society. Rural and urban areas of Pakistan are linked with cultural and traditional norms such as based on male dominance and female submissiveness. In Pakistan mostly male members of the households take decisions as well as reproductive rights of women. In Pakistan, there are some obstacles that cause hurdles in modern cotraceptives such as husband’s dominancy,fear of side effects, lack of awareness and even dissatisfaction with sexuality.In particular, women were ten times more likely to have used a family planning service if her husband approved (Tabassum, Khan, Arif, & Ali, n.d.).
In particular, a pregnant woman may feel shame therefore they may avoid leaving the home to access services. A study in rural Punjab found that only 23% of mothers were able to travel alone to health services (Mumtaz and Salway 2005).
By this, these community norms affect a person’s thoughts and behaviors towards family planning, spacing between children and reproductive decisions. For instance, in some culture, most women don’t have right to use modern contraceptive methods because pregnancy and childbearing are the path to respect in the community. In either country, most women use contraception because having small families is the norm (Lanre, 2011).
Although in most countries, son’s preference may not have a greater impact on contraceptive use or infertility, but in Pakistan, son preference has influence on women’s reproductive autonomy both historically and in the present. Nag (1991) found that a preference for sons was higher in Pakistan than in neighboring India and Bangladesh, based on the evidence that the number desiring no more children was higher for those with more sons, as well as the higher mortality for female than male children of 1 to 4 years old. As for the role of son’s mortality in influencing contraceptive use behavior, the limited evidence for Pakistan suggests that the two variables are negatively related (Mahmood, ; Ringhiem, n.d.).
Pakistan’s legal systems and social structures are often influenced by religion and culture. It has been shown in some studies, that the husband’s desire for more children and the women’s poor education level are the important factors that adversely affect the contraceptive use in Pakistan. Living patterns and life styles also has an impact to women’s autonomy like in extended family women is oppressed with multiple relations and in the nuclear family is little flexible in term of taking decision of family planning. The situation of economic dependency is also an important factor in women’s autonomy to plan family size. Men are often treated as the breadwinners and women who enter the labor market are treated as supplementing to families’ incomes. Working women plan their careers around their family responsibilities. Women had low participation in the labor force in Crude Activity 15.6 % and refined activity 21.7 % of total employment in Pakistan (Lanre, 2011).
In addition, the dynamics of decision-making between a husband and wife also create barriers to the use of contraceptive methods. Many researches showed that social and cultural factors have greater impact on contraceptive use in Pakistan. These studies have emphasized the influence of the mother-in-law and the husband on family planning, decision-making and have highlighted the importance of communication between spouses regarding the use of contraception. Additionally, family planning is one of the most least discussed topic in Pakistan because men have the final decision-making power regarding most issues, including reproductive health (Mustafa et al., 2015).
World Fertility Report (2001) found that education has great impact on modern contraceptive use. In Nkole, Uganda and Ntonzi (2001) found that women’s low education causes low use of modern family planning methods. Finally, Bulatao (1984) examined that both the wives’ and husbands’ education is fundamental to increase the contraceptives and family planning methods. However, the author noted that the wives’ education has a larger effect than the husbands.
Earlier studies in socio-demographic characteristics have shown that age influences modern contraception practice. Contraceptive use patterns differ substantially by age in both the developed and developing countries. Muia (2005) found out that in Kenya,women of age group 15 to 19 years use less contraceptive methods than age group 20 to 39 years (Birth Control Essay, n.d.).
A study in South Nyanza district found that 88% of the women are literate in focal region and uneducated women cannot enjoy her contraceptive rights while higher educated women can enjoy her contraceptive methods (Wangui, 2012).
Women’s employment status is one of the most powerful factors among several socio-demographic determinants of contraceptive use. Evidence shows that women’s economic role provides them a lot of autonomy and more control over important decision because women’s employment status is strongly related to contraceptive use (Islam et al, n.d).
In 2011, Demographic and Health Survey Data of Ethiopia, an analysis of 10,204 women. It was reported that, employed women, women in a monogamous relationship and women who visited by a health worker at home are more likely to use modern contraceptive methods while those women who are living in rural areas, older in age, in a polygamous relationship, Muslim are associated with the lowest use of modern contraceptives (Eliason et al.,2014).
The goal of this study is to evaluate the gender power dynamics on reproductive health decisions among educated and uneducated women of reproductive age. The main aim of this research study is to find out the perception of female about the efficiency of various contraceptive techniques, to determine the difference between level of autonomy and work status of women, to examine how cultural norms influence on family planning, decision making among married women of reproductive age, to determine how age factors influence contraceptive preference and choice among married women of reproductive age and to determine how the educational status of women influences contraceptive use among married women of reproductive age in Pakistan. Quantitative methods will be used to find out the results.
Rationale of the Study
The rationale for family planning proliferated throughout the years concentrated essentially on lessening family size to lighten demographic and economic issues facing the country, which many saw as an encroachment by the state to their personal decision-making freedom. We repositioned family planning as a health intervention, presenting the idea of “birth spacing saves lives” in the light of healthy timing and spacing of pregnancies (HTSP) to reduce maternal, infant, and child mortality and morbidity (Mir & Shaikh,2013).Thus, accomplishment of the Millennium Development Goals identified with tutoring is clearly more probable when weights from a consistently expanding school age population are diminished because of fertility decline. Also, obviously, the coming of reproductive decision denotes a substantial and welcome advance in the empowerment of women (BONGAARTS, CLELAND, TOWNSEND, BERTRAND, & GUPTA, n.d.).
One of the important factors in the prediction of family planning outcome is focusing on women’s role in decision making concerning fertility and household affairs. To improve women’s status and reproductive autonomy, it’s important to increase women’s rate ( Kohan, Talebian, & Ehsanpour, 2014). The present study aim is to investigate Gender Power Dynamics on Reproductive Health Decisions among Married Women in Pakistan.
Objectives of the Study
This study was guided by the following specific objectives;
1. To find out the women’s autonomy in household decisions among married women of reproductive age.
2. To determine the difference between level of autonomy and work status of women.
3. To determine how age factors influence contraceptive preference and choice among married women of reproductive age.
4. To determine how the educational status of women influences on birth control methods usage among married women of reproductive age.
Chapter two deal with the review of literature relevant to the research topic entitled Gender Power Dynamics on Reproductive Health Decisions among Married Women in Pakistan.
The level of awareness about contraceptives are high in some community while good knowledge of contraceptive methods is very low (LAWRENCE, D. O., AKINTADE., 2010).Akintade, Pengpid, and Peltzer (2011) determined the level of attention ,use and obstacles on contraceptives and family planning services among young women.The study had taken a quantitative descriptive study, 360 female undergraduate students at the National University of Lesotho responded to hand-delivered self-constructed questions. They found that Consciousness of family planning was high (97. 5%). The condom was the mostly used family planning method. There were a few misguided judgments, e.g. those contraceptives other than the condom, for example, normal family planning (4.7%), the vaginal ring (3.3%) and male or female sanitization (2.8%), can avoid STIs. Married status was related with current utilization of contraceptives, and having been formally educated about family arranging was related with the conviction that it causes cancer. The neglected contraceptive need in the sample was 24.9%. Levels of mindfulness and use of family planning services are high among female understudies at the University of Lesotho. There is a need to present family planning instructing in light of exact certainties into the school educational modules.
Another study concentrated on the socio-cultural variables influencing the married women autonomy in reproductive decisions in Nsukka L.G.A. of Enugu State, Nigeria. Three imperative ideas of reproductive decision making were examined: decision on the size of children, decision on the checkup during pregnancy/childbirth, and decision on the use of contraceptives. Both quantitative and qualitative techniques were used for data collection in Obukpa, Nsukka Local Government Area of Enugu State Nigeria in 2011. The study found that socio-cultural variables like residence, age, educational qualification, religion, occupation, did not influence the autonomy of reproductive decisions of married women in Obukpa, Nsukka L.G.A (Okonkwo,Uchenna, ; Ezumah, Nkoli, 2017).
Over the years, the debate and research on women’s sexual and reproductive health autonomy in particular have largely been genderised within power relations with men playing influential roles in women’s decision making. By extension, women are perceived to be less ’empowered’ to take their own decision as a right.This article investigated healthcare providers? point of view on the traditional patriarchal family structure and its effect on women’s reproductive and contraceptive health decisions in Nepal”. Snowball sampling was used to investigate 15 healthcare workers for data collection in Kathmandu by using content analysis. The patriarchal culture was both a hurdle and a help for women’s decision-making authority regarding sexual and reproductive health. Bits of awareness may be benefited for reproductive women in medicinal services suppliers and advancement specialists, can achieve a comprehension of the complexity in the public eye living in a male dominated society. The study can be utilized for reflections on why worldwide and national conceptive medicinal services arrangements advancing gender equality and enabling women set aside opportunity to execute due to a scope of social points of view(The influence of a patriarchal culture on women’s reproductive decision making: exploring the perceptions of 15 Nepali healthcare providers ,n.d.).
Osmani.,et.al examined the research entitled Information on contraceptive use and impacting factors from Afghanistan Health Survey (AHS) 2012.Qualitative method were used to investigate 13,654 current married women aged 12– 49 years. Odds ratio (OR) and 95% confidence interval (CI) of contraceptive use were assessed by logistic regression analysis. This study found that At the point OR was acquired for equality in socio-cultural factors (OR of at least 6 children with respect to 1 child was 3.45, and the 95%CI 2.54– 4.69), number of living children (OR of at least 5 son in respect to no son was 2.48, and the 95%CI 1.86– 3.29), wealth index (OR of the wealthiest families in respect to the poorest families was 2.14, and the 95%CI 1.72– 2.67), antenatal care participation (OR in respect to no participation was 2.13, and the 95%CI 1.74– 2.62), education (OR of secondary education or above in respect to no education was 1.62, and the 95%CI 1.26–2.08), media exposure (OR of in any event some presentation to electronic media in respect to no exposure was 1.15, and the 95%CI 1.01– 1.30), and children mortality encounter (OR was 0.88, and the 95%CI 0.77– 0.99), and age, home (rural/urban), and area. This secondary examination in view of AHS 2012 demonstrated the discoveries like those from the past investigations in other developing countries (Osmani, Reyer, Osmani, & Hamajima, n.d.).
Another study aims to explore the links between women’s household position and their autonomy in decision making (Acharya.,et al, 2010).Horne., et al (2013) talk about the connection between each hypothetical model for household decision making and reproductive autonomy of Bangladeshi women. A qualitative study was used to investigate 1,500 men and women in Bangladesh by using multi-arrange systematic sampling method in view of 2011 census by the Bangladesh Bureau of Statistics 2011. Using internal reliability testing, a basic decision making capacity, reproductive autonomy, and dispositions on partner violence scale were made from a high caliber, controlled, and cognitively tested questionnaire. Women’s absence of control over their conceptive conduct is a noteworthy general wellbeing worry, since confined reproductive autonomy expands the danger of HIV disease, high richness, and presentation to aggressive behavior at home.In this paper, we concentrated to what degree women’s reproductive autonomy is controlled by social versus auxiliary properties, operational at the individual-or logical level. Our preparatory outcomes recommend that for women’s reproductive autonomy basic characteristics might be more essential than their social partners, and the relevant and individual-level determinants might be commonly critical (Zaidi, Halim, & Rae, n.d.).
Darge (2014) investigated that reproductive decision-making is firmly influenced by gender power relations. It was qualitative in nature and 317 married couples were randomly selected and simple descriptive statistics and multinomial logistic regression methods were used to analyze the data. Accordingly, about 45% and 35% of the respondents announced that their spouses command the contraceptive use and maternal wellbeing administration usage decision making, separately. On the other hand, about 33% and 36% of married women had autonomy to decide on contraceptive use jointly with their husbands. From the multinomial logistic regression analysis results older women, literates, those having less children and media get to settle the contraceptive use decisions by their own particular or together with their spouses. Literates and working women influenced the maternal wellbeing to benefit usage choices by their own or mutually. Women who are not victim of physical harassment or verbal abuse influenced the maternal health service utilization decisions jointly. Empowering women through education and financial activities are prescribed to acknowledge libertarian or women focused reproductive decision-making.
This article analyzed how power dynamics influence neglected requirement for family planning among married women in Bangladesh. Logistic regression analyses using data from the Demographic and Health Survey 2011 of Bangladesh were used by using Logistic regression analyses.About 14 % of currently married women have a neglected requirement for family planning. Muslim women had 54% higher neglected requirement for family planning than their non-Muslim counterparts. Women with more noteworthy help in domestic decision making were modestly more a verse to have neglected requirement for family planning. Regression analyses showed that egalitarian participation in controlling assets instead of women’s sole autonomy was a solid indicator in neglected requirement for family planning models. Besides, age, age at marriage, place of residence, introduction to family planning information, and control over assets were noteworthy indicators of neglected requirement for family planning. The study discovered direct help for the power bases, for example, consensual philosophies and asset control in foreseeing neglected interest for family planning.
According to Social Dominance Theory, power and dominance are characterized as working on singular, gathering, institutional, and basic levels. In a significant part of the writing, the term power? refers to having the capacity to act or behave according to one’s own particular wishes and having the capacity to impact or have control over the activities of others (Wingood and DiClemente 2000).Within the social dominance school of thought, Pratto and Walker (2004) presented four bases of gendered power. These bases include resource control, consensual ideologies, force, and social obligations. These bases of gendered power can be used as a lens to investigate how these four bases determine women’s ability to use contraception in a hierarchical society ruled by patriarchy, religious norms, and ingrained cultural value system. This study along these lines means to investigate SDT’s capacity to use the four bases of gendered power as a lens gives us the capacity to concentrate on the particular ways that neglected requirement for family planning is identified to gendered power dynamics in the family (Uddin, 2014).
Following research hypotheses will be tested to achieve the objectives of the study.
H1: There will be a significant difference between educated and uneducated women’s
autonomy in household decisions.
H1: Employed women are less likely to have autonomy in family planning compared to
H1: There will be a significant difference between age factor and decision making of
H1: There will be a significant difference between educational status and birth control
methods among married women of reproductive age.
The present study was quantitative in nature. The quantitative study was conducted by using the survey design. The survey was involved the administration of a questionnaire which was obtain data on the Gender Power Dynamics on Reproductive Health Decisions among Married Women of Reproductive age in Pakistan.
The population of this study was consisted of educated and uneducated married women of
reproductive age from Maternity Child Welfare Association of Pakistan.
A sample of this study was comprised of 100 (50 educated and 50 uneducated married women of reproductive age) from Lahore and suburbs of Lahore.
The sample is selected through purposive convenient sampling for data collection.
Tools for Data Collection
The Aida Ghazaryan questionnaire used for this research study. This questionnaire is
about the women’s reproductive health, human rights and decision-making in the family (Ghazaryan, n.d.).I selected 10 questions from reproductive rights section and Zain Khadija questionnaire was also used for this research study. This questionnaire is about the Women Power to negotiate the use of contraceptives in patriarchal society (Khadija, 2012).Along this self-constructed questionnaire was also be used for data collection as well. These two questionnaires were based on 24 multiple choice questions.
• Marital Status
• Educational Level
• Occupational Status
Criteria for Sample Selection
Inclusive Criteria for Sample
• Married educated and uneducated working women of reproductive age.
• Married educated and uneducated non-working women of reproductive age.
• Married women of sexually active and fertile.
• Age range: 17-50.
• Area: Lahore and suburbs of Lahore.
Exclusive Criteria for Sample
• Women who are not fertile.
• Divorced and widow women will not be included in this sample.
• Unmarried women will not be included.
• Women who don’t fall under the age group of 17-49 years.
Autonomy is that the ability to create your own choices concerning what to try to do instead of being influenced by some other person or told what to try to do (Definition of ‘autonomy’, n.d.).
Gender dynamics refers to the relationships and interactions between and among girls, boys, women and men. Gender dynamics are informed by sociocultural ideas about gender and the power relationships that define them. Depending upon how they are manifested, gender dynamics can reinforce or challenge existing norms (Gender Dynamics, n.d.).
Procedure of the Study
Firstly, informed consent will be taken from the participants and institutional authorities. The
entire data will be collected from Lahore and suburbs of Lahore. The participants will be
contacted personally in Lahore. Assurance of confidentiality will be provided.
T-test and One-way Anova was used to test the hypotheses of the study. For data analysis,
Statistical Package for Social Sciences will be used.
This section summarizes and describes the results obtained by analyzing the data using SPSS version 22. In order to test the hypothesis, statistical analysis of Independent Sample t- test and One-Way Anova were used. Comparisons were made between Women’s level of autonomy in household decisions, level of autonomy and work status of women, how age factors influence contraceptive preference and choice among married women of reproductive age and how the educational status of women influences on birth control methods usage among married women of reproductive age.
An Independent Sample t-test and One-way Anova were conducted to compare gender power dynamics scores for educated and uneducated married women of reproductive age.
Table 1 shows that educated married women’s level of autonomy (M = 3.8200 , SD = 1.18992) was not significantly differ from uneducated married women’s level of autonomy (M = 23.6400 ,SD = 141.04360),t(98) = 994,p = .323
Table 2 shows that there was no significant difference in the family planning autonomy among employed and unemployed for educated married women (M = 7.8800, SD = 2.67750) and uneducated married women (M=28.2000, SD=140.69579), t(98)=1.021 ,p=.310
Table 3 shows that an one way analysis of variance showed that the effect of age on contraceptive use was insignificant, F(3,96) = .360, p = .782
Table 4 shows that an one-way analysis of variance showed that the effect of education on contraceptive use was significant, F(6,93) = 5.093, p = .000
Differences in the women’s level of autonomy in household decisions among educated and uneducated married women of reproductive age (N=100)
Variables Educated Uneducated
M SD M SD t (df) p
3.8200 1.18992 23.6400 141.04360 994(98) .323
Employed women are less likely to have autonomy in family planning compared to unemployed women. (N=100)
Variables Educated Uneducated
M SD M SD t(df) p
7.8800 2.67750 28.2000 140.69579 1.021(98) .310
Differences in the use of contraceptives among educated and uneducated married women of reproductive age (N=100)
Source df SS MS F p
Between Groups 3 10935.232 3645.077 .360 .782
Within Groups 96 970975.518 10114.328
Total 99 981910.750
Difference in the use of birth control methods among educated women of reproductive age (N=100)
Source df SS MS F p
Between Groups 6 299.009 49.835 5.093 .000
Within Groups 93 909.991 9.785
Total 99 1209.000
roductive age (N=100)
Source df SS MS F p
Between Groups 6 299.009 49.835 5.093 .000
Within Groups 93 909.991 9.785
Total 99 1209.000