Kundu Satyajit, Rahman Md Hafizur, Chowdhury Syed Sharaf Ahmed, Hagan John Elvis, Dey Susmita Rani, Dey Rakhi, Karmoker Rita, Sharif Azaz Bin, Ahmed Faruk
School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4222, Australia.
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Mohakhali, Dhaka 1212, Bangladesh.
Healthcare (Basel). 2024 Dec 10;12(24):2494. doi: 10.3390/healthcare12242494.
Knowing the spatial variation and predictors of women having sole autonomy over their healthcare decisions is crucial to design site-specific interventions. This study examined how women's sole autonomy over their healthcare choices varies geographically and what factors influence this autonomy among Bangladeshi women of childbearing age. Data were obtained from the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The final analysis included data from a total of 18,890 (weighted) women. Spatial distribution, hot spot analysis, ordinary Kriging interpolation, and multilevel multinomial regression analysis were employed. The study found that approximately one in ten women (9.62%) exercised complete autonomy in making decisions about their healthcare. Spatial analysis revealed a significant clustering pattern in this autonomy (Moran's I = 0.234, < 0.001). Notably, three divisions-Barisal, Chittagong, and Sylhet-emerged as hot spots where women were more likely to have sole autonomy over their healthcare choices. In contrast, the cold spots (poor level of sole healthcare autonomy by women) were mainly identified in Mymensingh and Rangpur divisions. Women in the age group of 25-49 years, who were highly educated, Muslim, urban residents, and had not given birth recently were more likely to have sole autonomy in making healthcare decisions for themselves. Conversely, women whose husbands were highly educated and employed, as well as those who were pregnant, were less likely to have sole autonomy over their healthcare choices. Since the spatial distribution was clustered, public health interventions should be planned to target the cold spot areas of women's sole healthcare autonomy. In addition, significant predictors contributing to women's sole healthcare autonomy must be emphasized while developing interventions to improve women's empowerment toward healthcare decision-making.
了解女性在医疗保健决策方面拥有完全自主权的空间差异及预测因素，对于设计因地制宜的干预措施至关重要。本研究调查了孟加拉国育龄妇女在医疗保健选择上的完全自主权在地理上如何变化，以及哪些因素影响这种自主权。数据取自2017 - 2018年孟加拉国人口与健康调查（BDHS）。最终分析纳入了总共18,890名（加权）妇女的数据。采用了空间分布、热点分析、普通克里金插值法和多水平多项回归分析。研究发现，约十分之一的妇女（9.62%）在做出医疗保健决策时行使完全自主权。空间分析显示这种自主权存在显著的聚集模式（莫兰指数I = 0.234，< 0.001）。值得注意的是，巴里萨尔、吉大港和锡尔赫特这三个行政区成为热点地区，在这些地区妇女更有可能在医疗保健选择上拥有完全自主权。相比之下，冷点地区（妇女完全医疗保健自主权水平较低）主要集中在迈门辛和朗布尔行政区。年龄在25 - 49岁、受过高等教育、穆斯林、城市居民且近期未生育的妇女更有可能在为自己做出医疗保健决策时拥有完全自主权。相反，丈夫受过高等教育且有工作的妇女，以及孕妇，在医疗保健选择上拥有完全自主权的可能性较小。由于空间分布呈聚集状，公共卫生干预措施应针对妇女完全医疗保健自主权的冷点地区进行规划。此外，在制定干预措施以增强妇女在医疗保健决策方面的权能时，必须强调有助于妇女完全医疗保健自主权的重要预测因素。
