Alhassan Nurudeen
Population Dynamics and Demographic Dividend Thematic Area, African Institute for Development Policy (AFIDEP), Lilongwe, Malawi.
Front Glob Womens Health. 2024 Jun 4;5:1264190. doi: 10.3389/fgwh.2024.1264190. eCollection 2024.
Female sterilisation is the most common contraceptive method used globally. The use of female sterilisation is disproportionately low in sub-Sahara Africa (SSA) at just 1%. Nonetheless, the prevalence of sterilisation among married women in Malawi is quite high at about 11%. While a few recent studies in SSA have examined the relationship between women's decision-making autonomy and use of long-acting contraceptives, very few have investigated whether different dimensions of decision-making autonomy predict the use of female sterilisation differently. The objective of this study was therefore to examine the relationship between health care and contraceptive decision-making autonomy and the use of female sterilisation in Malawi.
The study relied on secondary data from the 2015-16 Malawi Demographic and Health Survey. The sample comprised 9,164 married women in Malawi that were using a modern contraceptive. Multinomial logistic regression analysis was used to examine the association between health care and contraceptive decision-making autonomy and the use of female sterilisation, controlling for key socio-demographic characteristics.
The study revealed that the percentage of married women that made health care and contraceptive decisions independently was quite low. The main finding of this study was that contraceptive decision-making autonomy increased the relative likelihood of using female sterilisation while health care autonomy was associated with a lower likelihood of being sterilized. The socio- demographic characteristics that significantly predicted the use of female sterilisation included age, place of residence, household wealth and the number of children a woman had.
This study demonstrates that health care and contraceptive decision making have different effects on the use of female sterilisation among married women in Malawi. Specifically, women with autonomy in health care decision making had a relatively lower likelihood of using female sterilisation while those with contraceptive decision-making autonomy had a higher likelihood of using female sterilisation. This suggests that intervention aimed at increasing the uptake of female sterilisation in Malawi need to focus on empowering women in the contraceptive decision-making domain.
女性绝育是全球使用最普遍的避孕方法。撒哈拉以南非洲地区（SSA）女性绝育的使用率极低，仅为1%。尽管如此，马拉维已婚女性中绝育的普及率相当高，约为11%。虽然近期在撒哈拉以南非洲地区有一些研究探讨了女性决策自主权与长效避孕方法使用之间的关系，但很少有研究调查决策自主权的不同维度对女性绝育使用的预测是否存在差异。因此，本研究的目的是考察马拉维医疗保健与避孕决策自主权以及女性绝育使用之间的关系。
本研究依赖于2015 - 16年马拉维人口与健康调查的二手数据。样本包括9164名使用现代避孕方法的马拉维已婚女性。采用多项逻辑回归分析来考察医疗保健与避孕决策自主权以及女性绝育使用之间的关联，并控制关键的社会人口特征。
研究表明，能够独立做出医疗保健和避孕决策的已婚女性比例相当低。本研究的主要发现是，避孕决策自主权增加了使用女性绝育的相对可能性，而医疗保健自主权则与较低的绝育可能性相关。显著预测女性绝育使用的社会人口特征包括年龄、居住地点、家庭财富以及女性子女数量。
本研究表明，医疗保健和避孕决策对马拉维已婚女性的女性绝育使用有不同影响。具体而言，在医疗保健决策方面具有自主权的女性使用女性绝育的可能性相对较低，而在避孕决策方面具有自主权的女性使用女性绝育的可能性较高。这表明，旨在提高马拉维女性绝育使用率的干预措施需要侧重于增强女性在避孕决策领域的权能。
