Governments in sub-Saharan African countries aim to increase married women\'s household decision-making autonomy as it remains a critical determinant of desirable health behaviours such as healthcare utilisation, antenatal care visits, and safer sex negotiation. However, very few studies explore how household structure (i.e., monogamous or polygamous) is associated with married women\'s household decision-making autonomy. Our paper seeks to address this gap. Using the 2019-20 Mauritania Demographic and Health Survey, a nationally representative dataset, and applying logistic regression analysis, we explore how married women\'s household structure is associated with their household decision-making autonomy. We find that 9% of married women are in polygamous marriages, while 63% and 65% are involved in decision-making about their health and large household purchases, respectively. Additionally, 76% and 56% are involved in decision-making about visiting family or relatives and household expenditures. After accounting for socio-economic and demographic factors, we find that compared to women from monogamous households, those from polygamous households are less likely to participate in decision-making about their health (OR=0.65, p < 0.001), making large household purchases (OR=0.65, p < 0.001), visiting family or relatives (OR=0.72, p < 0.001), and household expenditure (OR=0.58, p < 0.001). Based on our findings, we recommend the urgent need to review and re-evaluate policies and approaches seeking to promote gender equality and women\'s autonomy in Mauritania. Specifically, it may be critical for intervention programmes to work around reducing power imbalances in polygamous household structures that continue to impact married women\'s household decision-making autonomy adversely. Such interventions should centre married women\'s socio-economic status as a central component of their empowerment strategies in Mauritania.

Women\'s autonomy in decision making has important sexual and reproductive health implications. This study uses a nationwide analysis in Nepal to examine women\'s autonomy, attitude toward intimate partner violence (IPV) behaviors, and HIV-related knowledge in the execution of HIV protective behaviors such as having one sexual partner or getting an HIV test to prevent HIV transmission. Secondary data analysis was conducted using the nationally represented Nepal Demographic and Health Survey (2016-2021) dataset. The sample included 9,904 women ages 15 to 49 who self-identified as ever married. Factor analysis for women\'s autonomy, attitude toward IPV behaviors, and HIV-related knowledge were conducted based on social dominance theory. Structural equation modeling was conducted, and the results indicated that higher autonomy decreased the risk of HIV infection through having one sexual partner. Factors related to multiple sex partners included unemployment, religious affiliation, and age. Similarly, higher autonomy, HIV-related knowledge, having a formal job, and urban residence increased women\'s likelihood of taking an HIV test. Women\'s higher education, greater wealth, religious affiliation, and youth also correlate with HIV testing. Future HIV prevention interventions should include strategies that support women\'s social and economic empowerment and enhance women\'s ability to make informed choices about their health and risks.

In some cultures, giving birth and marriage adds value to women, while being single can cause women to be exposed to social and individual pressures. There are currently no instruments available in the literature for assessing how pressure women feel to be married and have children. This study aimed to develop the Marriage and Fertility Pressure Scale (PSMF) by measuring the marriage and fertility pressure on single women. The study contacted 360 single women via women\'s health and social groups on social networking sites. Cronbach\'s alpha values of the marriage pressure and fertility pressure were 0.94 and 0.82, respectively. The factor analysis of the marriage and fertility pressure subscales revealed a six-dimensional structure explaining 59.26 percent and 60.54 percent of the total variance, respectively. In conclusion, this study was important in developing a highly reliable and valid PSMF measurement tool to measure the pressure on women in terms of marriage and fertility. The widespread use of the scale in public health research will increase the sensitivity and awareness of the people about the pressure on single women. Moreover, this scale will contribute to the evaluation of the social and individual pressure differences in the research to be carried out on marriage and childbirth between societies.

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.

Power inequality within the household and sexual relationships is linked to poor reproductive health. Malawi Government through National Sexual and Reproductive Health and Rights policy is committed to women empowerment as well fertility reduction. However, there is limited evidence in Malawi regarding whether women\'s autonomy in the household is an independent determinant of fertility. With this background, the aim of this study is to investigate whether women\'s autonomy in the household is a determinant of fertility in a poor socioeconomic and cultural setting.
This study used Malawi Demographic and Health Survey, 2015-2016. A multivariable Poisson regression model was used to investigate if women\'s autonomy in the household in Malawi determines fertility. The outcome measure, children ever born, was used as a measure of fertility. Women\'s autonomy was measured with two dimensions, such as women\'s household related decision makings and women\'s sexual autonomy. The individual recode and household recode were merged for the analysis. The final study sample was 15,952 women who were cohabiting or married at the time of the survey.
The level of autonomy among women in the household related decisions and sexual autonomy was 49.1% and 64.0% respectively. Controlling for covariates, the study found no significant association between women\'s autonomy dimensions in the household and number of children ever born. On the other hand, living in urban area (IRR = 0.91, CI 0.88-0.93); having less than tertiary education thus, no education (IRR = 1.83, CI 1.67-1.99) or primary education (IRR = 1.55, CI 1.42-1.69) or secondary education (IRR = 1.23, CI 1.13-1.33); poor households (IRR = 1.05, CI 1.01-1.09), starting cohabiting at the age of 19 years or less (AIRR = 1.15, CI 1.13-1.18) and not using modern contraceptive methods (AIRR = 1.17, CI 1.15-1.19) were significantly associated with fertility.
Though women\'s autonomy does not have independent effect on fertility, it may be interacting with other sociocultural norms prevailing in the society. The study recommends that the Government of Malawi should come up with economic hardship emancipation policy for poor households. The government should also come up with a girl-child secondary school completion policy. Furthermore, the government should accelerate the implementation, monitoring and evaluation of National Gender Policy to ensure the women empowerment/autonomy is having positive effect at all level including the household.

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.