Alemayehu Mihiretu, Meskele Mengistu
School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
Int J Womens Health. 2017 Apr 19;9:213-221. doi: 10.2147/IJWH.S131139. eCollection 2017.
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.
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 -value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with -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.
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.
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.
在许多文化和部落中，数百万女性几乎没有医疗保健决策自主权。非洲女性通常被认为很少参与医疗保健决策。然而，对于导致决策自主权的因素，人们几乎没有进行过调查。因此，获取有关决策自主权的促成因素以及不同社会文化背景下的差异信息非常重要。
2015年2月至3月，在埃塞俄比亚南部的沃莱塔和达沃罗地区进行了一项横断面研究。通过多阶段抽样共选取了967名女性。通过面对面访谈的形式进行调查。分别使用EpiData v1.4.4.0和SPSS 20版软件录入和分析数据。采用比例和均值来描述研究人群。在双变量分析中P值<0.2的变量被选入多变量回归分析。最后，在多变量逻辑回归中P值<0.05的变量被确定为独立预测因素。使用比值比及置信区间来确定关联的存在。
结果显示，58.4%的女性拥有自主权，而40.9%的研究参与者的医疗保健决策由其丈夫做出。丈夫的教育程度（调整后的比值比[AOR]=1.91[1.10,3.32]）、财富指数（AOR=0.62[0.42,0.92]）、年龄（AOR=2.42[1.35,4.32]以及AOR=7[3.45,14.22]）、家庭规模（AOR=0.53[0.33,0.85]以及AOR=0.42[0.23,0.75]）和职业（AOR=1.66[1.14,2.41]）是医疗保健决策自主权的预测因素。
尽管每位女性都有权参与自身的医疗保健决策，但超过五分之二的女性在关乎自身健康的医疗保健决策中没有话语权。丈夫在为妻子做出医疗保健决策方面起着主要作用。需要实施一项全面战略，以增强女性权能，并挑战传统的男性主导地位。必须特别关注农村地区的女性，通过教育和创收活动来减少她们的依赖性。
