OBJECTIVE: Maternal and child health outcomes remain a challenge in Uganda. Antenatal care (ANC) is effective in mitigating pregnancy and childbirth risks. Women\'s decision-making autonomy and partner support are crucial for adherence to ANC contacts and better pregnancy outcomes. We assessed the impact of women\'s decision-making autonomy and partner support on adherence to the 8 + ANC contact schedule among post-partum mothers in Eastern Uganda.
METHODS: A multicenter cross-sectional study was conducted in four tertiary health facilities in Eastern Uganda, utilizing quantitative techniques to collect data from 1077 postnatal mothers. Eligible participants were those who had given birth within the previous 48 h and had documentation of ANC contacts from their pregnancy. Data was collected using structured questionnaires and analyzed using multivariable logistic regression to assess factors associated with adherence to the WHO-recommended 8 + ANC contacts.
RESULTS: Most women were aged 20-34 years (792; 73.5 %). Only 253 (23.5 %) women adhered to the 8 + ANC contacts. A significant proportion lacked decision-making autonomy (839; 77.9 %), and over half reported partner support (550; 51.2 %). Decision-making autonomy and partner support were significantly associated with adherence to the 8 + ANC contacts (aOR: 1.6, 95 % CI: 1.2 - 2.2, p = 0.005) and (aOR: 1.9, 95 % CI: 1.4 - 2.7, p < 0.001), respectively. Women with at least five children had lower adherence to the 8 + ANC contacts (aOR=0.4, 95 % CI: 0.2 - 0.7, p = 0.002).
CONCLUSIONS: Empowering women and engaging their partners can improve maternal health service utilization and increase ANC contact adherence, leading to better maternal and neonatal health outcomes.

Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women\'s autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women\'s autonomy and modern contraception use among partnered women in Zambia.
This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women\'s autonomy using three indices: women\'s participation in decision-making, women\'s attitude towards wife-beating and women\'s household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR).
The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women\'s autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048-1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013-1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091-1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105-1.766) and age, 15-24 (AOR = 1.266, P value = 0.007, 95% CI 1.182-2.113,) and 25-34 (AOR = 1.163, P value = 0.002, 95% CI 1.052-1.273).
This study argues that increasing women\'s assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women\'s autonomy, which in turn would support gender equality and reproductive health.

BACKGROUND: Exclusive breastfeeding (EBF) is the optimal way to feed young infants. Guidelines recommend that women living with HIV on antiretroviral therapy should EBF for 6 months and continue breastfeeding for up to 24 months or longer. Parents may face social or logistical barriers creating challenges to EBF.
OBJECTIVE: To explore barriers, facilitators and community norms influencing EBF practices in Kenya.
METHODS: This qualitative research was nested within a longitudinal study of intensive maternal counseling to increase EBF among HIV-positive mothers. HIV-negative and HIV-positive mothers were recruited from four public clinics in Nairobi. Women participated in focus group discussions (FGDs) that explored beliefs about and experiences with infant feeding. Conventional content analysis was used to describe and compare barriers and facilitators influencing HIV-positive and HIV-negative women\'s EBF experiences.
RESULTS: We conducted 17 FGDs with 80 HIV-positive and 53 HIV-negative women between 2009 and 2012. Overall, women agreed that breastmilk is good for infants. However, early mixed feeding was a common cultural practice. HIV-positive women perceived that infant feeding methods and durations were their decision. In contrast, HIV-negative women reported less autonomy and more mixed feeding, citing peer pressure and lack of HIV transmission concerns. Autonomy in decision-making was facilitated by receiving EBF counseling and family support, especially from male partners. Low milk production was a barrier to EBF, regardless of HIV status, and perceived to represent poor maternal nutrition.
CONCLUSIONS: Despite challenges, counseling empowered women living with HIV to advocate for EBF with spouses and family.

BACKGROUND: Women have unfair share in the burden of unintended pregnancy outcome and unhealthy interpregnancy intervals. An understanding of the triggers, ideation and motivational factors influencing utilization of modern contraceptives is relevant for efforts aimed at increasing utilization among the general public, specifically sexually active women. The objective of this study is to explore the triggers, ideation and motivational factors influencing the use of modern family planning methods including depot-medroxyprogesterone acetate subcutaneous (DMPA-SC).
METHODS: Qualitative methods which include; Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) were used to elicit information from women of reproductive age and gate-keepers in selected Nigerian states; Rivers, Ogun, Kwara, Niger, Anambra, Delta, Lagos, Enugu and Oyo. The categories of respondents include; unmarried women aged 18-25 years, women in union aged 18-24 years using modern family planning (FP), women in union aged 25-49 years using modern FP, women in union aged 26-49 years non-users of modern FP, community leaders, health facility focal person, husbands of current users of modern FP, husbands of non-users of modern FP, religious leaders, state FP coordinators and women aged 18-49 years who currently use DMPA-SC. Maximum variation sampling techniques was used to enlist participants to participate in both FGDs and IDIs.
RESULTS: Respondents reported being motivated to use FP for reasons such as benefits of the method, economic situation, suitability of the methods, fear of unwanted pregnancy and its convenience. Further analysis showed that the unmarried respondents discussed more about fear of unwanted pregnancy and accessibility and affordability as a key motivator; while women in union discussed more on economic situations, encouragement from partners and benefits of FP when compared with the unmarried. In addition, respondents reported that their partners, health workers and friends influenced their decisions to use FP. Partners\' encouragement, personal experience, accessibility and availability, awareness of FP and its benefits; willingness to space children and costs were notable enablers of FP use. The triggers for FP use were; appointment cards, phone calls from health workers, reminders (text messages, phone alarms and partners\' support).
CONCLUSIONS: Increasing utilization therefore requires a well-planned horizontal approach that considers all enabling factors influencing utilization including women\'s empowerment. Family planning programmes that are client centered, address socio-cultural and gender norms and ensure access to contraceptive mix methods are recommended to improve utilization rate. This study recommends improved care-seeking behaviour through community-based awareness creation to address myths and misconceptions of family planning use, establishment of contraceptive delivery teams to prevent challenges of availability and accessibility, value clarification and tasks shifting among others to deal with the issue of inadequate family planning utilization.

BACKGROUND: Depression, the world\'s leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study\'s objective was to examine the factors influencing women\'s participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community\'s mental health.
METHODS: This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach.
RESULTS: The principal barrier to participating in psychosocial support groups was restrictions on women\'s freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community\'s attitude toward gender relations, the women\'s own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women\'s ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women\'s freedom of movement.
CONCLUSIONS: Mental health access and gender inequality are inseparable in the context of Northern India, and women\'s mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women\'s freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women\'s freedom of movement.

BACKGROUND: Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts.
METHODS: A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multistage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P-value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with P-value <0.05 in multivariable logistic regressions were identified as independent predictors. Odds ratios along with confidence intervals were used to determine the presence of association.
RESULTS: It was determined that 58.4% of women have autonomy, while 40.9% of study participants\' health care decisions were made by their husbands. The husband\'s education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32]), wealth index (AOR =0.62 [0.42, 0.92]), age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22]), family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75]), and occupation (AOR =1.66 [1.14, 2.41]), were predictors of health care decision making autonomy.
CONCLUSIONS: Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care decisions about their own health. Husbands play a major role in making health care decisions about their wives. A comprehensive strategy needs to be implemented in order to empower women, as well as to challenge the traditional male dominance. Special attention has to be given to women living in rural areas in order to reduce their dependency through education and income generating activities.

Women\'s role has been a priority area not only for sustainable development, but also in reproductive health since ICPD 1994. However, very little empirical evidence is available about women\'s role on maternal health service utilization in Nepal. This paper explores dimensions of women\'s autonomy and their relationship to utilization of maternal health services.
The analysis uses data from the Nepal Demographic and Health Survey, 2011. The analysis is confined to women who had given birth in the 5 years preceding the survey (n = 4,148). Women\'s autonomy related variables are taken from the standard DHS questionnaire and measured based on decision in household about obtaining health care, large household purchases and visit to family or relative. The net effect of women\'s autonomy on utilization of maternal health services after controlling for the effect of other predictors has been measured through multivariate logistic regression analysis.
The findings indicate only about a half of the women who had given birth in the past 5 years preceding the survey had 4 or more ANC check up for their last birth. Similarly, 40 % of the women had delivered their last child in the health facilities. Furthermore, slightly higher than two-fifth women (43 %) had postnatal check up for their last child. Only slightly higher than a fourth woman (27 %) had utilized all the services (adequate ANC visit, delivered at health institution and post natal check up) for their last child. This study found that many socio-demographic variables such as age of women, number of children born, level of education, ethnicity, place of residence and wealth index are predicators of utilizing the maternal health services of recent child. Notably, higher level autonomy was associated with higher use of maternal health services [adjusted odds ratio (aOR) =1.40; CI 1.18-1.65].
Utilization of maternal health services for the recent child among women is very low. The study results suggest that policy actions that increase women\'s autonomy at home could be effective in helping assure good maternal health.

Evidence regarding the relationship between married women\'s autonomy and risk of marital violence remains mixed. Moreover, studies examining the contribution of specific aspects of women\'s autonomy in influencing the risk of marital violence using measures of autonomy that incorporate its dynamic nature are rare. We investigated the relationship between women\'s autonomy and their experience of marital violence in rural India using prospective data. We used data on 4,904 rural women drawn from two linked studies: the NFHS-2, conducted during 1998-1999 and a follow-up study for a subgroup of women carried out during 2002-2003. Three dimensions of autonomy were used: financial autonomy, freedom of movement, and household decision-making. Marital violence was measured as experience of physical violence in the year prior to the follow-up survey. Findings indicate the protective effects of financial autonomy and freedom of movement in reducing the risk of marital violence in the overall model. Furthermore, region-wise analysis revealed that in the more gender equitable settings of south India, financial autonomy exerted a protective influence on risk of marital violence. However, in the more gender-stratified settings of north India, none of the dimensions of autonomy were found to have any protective effect on women\'s risk of marital violence. Results argue for an increased focus on strategies aimed at improving women\'s financial status through livelihood skill-building opportunities, development of a strong savings orientation, and asset-building options.