BACKGROUND: Currently, caesarean section is the primary mode of birth for a breech presenting fetus, leading to a deskilling of clinicians and limitation of birth choices for women. The aim of this review is to present a synthesized summary of existing literature related to women\'s experiences of breech birth mode decision-making.
METHODS: A systematic search of the literature was conducted in April 2021, utilizing five databases to identify and obtain peer-reviewed articles meeting the predetermined selection criteria.
RESULTS: Four major categories were synthesized from the integrated review: 1) Women who desire a vaginal birth may experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation; 2) Women who experience a breech presentation at term experience significant pressures to conform to expectations of medical professionals and their families due to perceptions of risk related to breech birth; 3) Breech birth decision-making in a limiting system; and 4) Overall satisfaction with the decision to plan a vaginal breech birth.
CONCLUSIONS: Women with a breech presenting fetus at term experience a complex range of emotions and internal and external pressures due to perceptions of risk around breech birth. Midwives were seen as helpful throughout the breech experience. The reduced caesarean section rate for breech, observed in studies exploring specialized care pathways or dedicated services, could reduce the incidence of Severe Acute Maternal Morbidity.

BACKGROUND: Women\'s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women\'s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women\'s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model.
METHODS: The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15-49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women\'s decision-making autonomy on contraceptive use. Akaike\'s information criterion was used to select the best-fitted model.
RESULTS: Overall, 21.6% (95% confidence interval = 20.3%-22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67-3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52-3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36-4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32-3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34-3.87) were positively associated with women\'s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29-0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12-0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23-0.87) were negatively associated with women\'s independent decision on contraceptive use.
CONCLUSIONS: Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women\'s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women\'s decision-making autonomy on contraceptive use. The government should promote women\'s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.

Anemia is one of the world\'s public health problem, especially in developing nations. The majority of women of childbearing age (15-49) are affected by anemia. Women\'s role in the decision-making process is significant for their health and related issues such as anemia. So far, there is no evidence of women\'s decision-making autonomy on anemia. Consequently, this study aimed to robustly examine both individual- and group-level women\'s decision-making autonomy and other determinants of anemia among married women in Ethiopia.
We examined data from an Ethiopian demographic and health survey conducted in 2016. Our analysis included 9220 married women of childbearing age (15-49 years). For bivariate analysis, we applied the chi-squared (X2) test. The relationship between individual and group-level women\'s decision-making autonomy and anemia was assessed using multilevel binary logistic regression models while adjusting other socio-demographic and economic characteristics.
In this study the magnitude of anemia was 30.5% (95% CI; 29.5-31.4). According to our multilevel analysis, group-level women\'s autonomy was found to be negatively related with anemia than individual-level women\'s autonomy (AOR = 0.53, 95% CI = 0.41-0.69). In addition, the indicator of women\'s wealth index at group level was a protective factor (AOR = 0.68, 95% CI =0.51-0.90) to develop anemia. Among individual-level indicators women\'s age (AOR = 0.73, 95% CI = 0.60-0.89), use of contraceptive (AOR = 0.66, 95% CI = 0.55-0.81), BMI (AOR = 0.71, 95% CI = 0.59-0.86) and employment status (AOR = 0.88, 95% CI = 0.79-0.98) were negatively related with anemia. While women who follow Muslim religion (AOR = 1.62, 95% CI = 1.32-1.97,), women who had five and above number of children (AOR = 93, 95% CI = 1.53-2.46), and who were pregnant (AOR = 1.21, 95% CI = 1.04-1.40) were positively associated with anemia. Our final model showed that around 27% of the variability of having anemia was because of group-level differences (ICC = 0.27, P < 0.001). In addition, both individual and group-level factors account for 56.4% of the variance in the in the severity of anemia across communities (PCV = 56.4%).
Our study showed that empowering women within households is not only an important mechanism to reduce anemia among married women but also serves as a way to improve the lives of other women within the society.

UNASSIGNED: Women\'s empowerment and autonomy have been proven to promote women\'s use of modern contraceptives. This study examined women\'s autonomy as a potential factor for modern contraceptive use among Ghanaian women in a union.
UNASSIGNED: We conducted a secondary analysis of data from the 2014 Ghana Demographic and Health Survey. The main outcome measure was current modern contraceptive use from women\'s self-report. Three composite indices were used to assess women\'s autonomy: household decision-making, attitudes towards wife-beating, and property ownership.
UNASSIGNED: A total of 4772 non-pregnant women aged 15-49 years in a union were included in the analysis. The mean age was 34.2(±7.97) years, 53.6% received at least secondary education, 87.7% were employed, and 76.5% received family planning information within the last 12 months. The prevalence of modern contraceptive use was 24.8% (95% CI: 22.9-26.7). Women\'s autonomy was independently associated with modern contraceptive use. Compared with women with low autonomy, women with moderate (AOR= 1.26, 95% CI: 1.02-1.55, p = 0.034) and high autonomy (AOR = 1.34, 95% CI: 1.01-1.79, p = 0.044) had increased odds of modern contraceptive use. Maternal age, education, number of living children, employment, region, and exposure to family planning information were also strongly associated with modern contraceptive use.
UNASSIGNED: The findings from this study support the assertion that women\'s autonomy may be vital in promoting the use of modern contraceptives among women in a union in Ghana and other low-income and middle-income countries and should be considered in family planning programs.

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: Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women\'s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women\'s autonomy.
METHODS: This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects.
RESULTS: Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women\'s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women\'s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively.
CONCLUSIONS: Women\'s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women\'s decision-making power to reduce the negative reproductive health effects of IPV.

BACKGROUND: Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women\'s ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women\'s empowerment is associated with stillbirths.
METHODS: Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women\'s empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted.
RESULTS: A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22-4.80). Education of mother (aOR 1.48; 0.94-2.33), age of husband (aOR 1.54; 0.86-2.76), household head (aOR 1.51; 0.88-2.59), poor wealth index (aOR 1.62; 0.98-2.68), middle wealth index (aOR 1.37; 0.76-2.47), decision making for healthcare (aOR 1.36; 0.84-2.21) and household purchases (aOR 1.01; 0.61-1.66) had no any significant association with stillbirths.
CONCLUSIONS: There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.

The positive effect of women\'s empowerment on the use of contraceptives is well established. However, the reverse effect, i.e. the potential effect of use of contraceptives on women\'s empowerment, is relatively unexplored. This study examined the direct impact of contraceptive use on women\'s empowerment in currently married women aged 15-49 years in India using data from the National Family Health Survey-4 conducted in 2015-16. A two-stage least squares (2SLS) regression model was used to account for the issue of endogeneity that appears in a general logit model. The use of contraceptives by the sample women was found to be associated with greater women\'s empowerment in terms of both their mobility and decision-making power. The pathways to greater women\'s empowerment are often presumed to be factors such as changing perception of their domestic role and sense of control over their own body. While these are integral, this paper highlights how the possible control over family size and birth interval through use of contraception may also be critical pathways to increasing women\'s empowerment.

Women\'s land ownership plays a noteworthy role in improving various development indicators, including her own wellbeing and children\'s food and nutrition security. However, the literature linking women\'s access to land rights to the nutritional security of children in Pakistan is limited, even though it is a country facing enormous challenges of childhood malnutrition and gender discrimination. This paper contributes to the existing literature on the benefits of empowering women by studying the association and pathways between women\'s land rights and child nutrition, using the 2012-2013 Pakistan Demographic and Health Survey. The ordinary least squares (OLS) regression results indicate that women\'s individual land ownership and women\'s autonomy in large-scale family purchases have a positive impact on children\'s food and nutrition security (FNS). The results of quantile regression (QR) show that these effects are more pronounced in cases of children with severe stunted growth. In addition, a structural equation model shows that the positive relationship between women\'s land ownership and child nutrition is partially mediated by women\'s increased decision-making power in large-scale household purchases. Our research concludes that ensuring women\'s land rights can improve women\'s autonomy, which can be an effective policy tool that not only improves women\'s welfare but also improves their children\'s nutritional security.