Women's Autonomy and Pregnancy Care in Rural India: A Contextual Analysis

OBJECTIVES: Assess whether women's autonomy is associated with pregnancy care by using a contextual approach.

METHODS: Currently married women with a singleton birth within 3 years selected from National Family Health Survey (NFHS) 1998-99 (N=11,648). Adequacy of prenatal care utilization (APCU), delivery by trained birth attendant, institutional delivery and postnatal checkup were examined. Women's autonomy included decision-making autonomy (DM), freedom of movement (FM), and financial autonomy (FA). Village factors included electrification, all weather roads, health facility within 2 kilometers, economic development (i.e. proportion of households with medium or high living standard according to NFHS index), etc. Multilevel logistic regression was used to account for individual and village factors.

RESULTS: Adequacy of prenatal care associated with DM (OR=1.08, 95% CI=1.04-1.13) and FM (OR=1.11, 95% CI=1.04-1.19). Delivery by trained attendant associated with FA (OR=1.25, 95% CI=1.13-1.39). Institutional delivery associated with FM (OR=1.13, 95% CI=1.05-1.21) and FA (OR=1.30, 95% CI=1.15-1.47). Postnatal checkup associated with DM (OR=1.09, 95% CI=1.04-1.14), FM (OR=1.14, 95% CI=1.07-1.22) and FA (OR=1.18, 95% CI=1.06-1.32).

Higher economic development (e.g. APCU:OR=3.54, 95%CI=2.29-4.72) and closer distance to health facility (e.g. APCU:OR=1.21, 95%CI=1.03-1.43) were consistently associated with each measure of pregnancy care, and village electrification was positively associate with each measure (e.g. APCU:OR=1.68, 95%CI=1.36-2.09) except postnatal checkup.

CONCLUSIONS: Women's autonomy is determinant of pregnancy care from the prenatal to postnatal period despite controls for individual- and village-level factors. To ensure safe motherhood in rural India programs and policies should promote women's autonomy and build adequate public health infrastructure, particularly health facilities, electrification and roads.