Abstract
Objectives
To determine the association between Peruvian women’s autonomy and place of delivery.
Methods
An analytical cross-sectional study of secondary data from the Demographic and Family Health Survey 2019 was carried out. The dependent variable was institutionalized childbirth, and the independent variable was women’s autonomy. Likewise, the association between women’s autonomy and institutionalized childbirth was evaluated using Poisson family generalized linear models with logarithmic link function, and crude (PR) and adjusted prevalence ratios (aPR) with their respective 95% confidence interval (CI) were estimated.
Results
The analysis included 15,334 women aged 15–49 years. It was found that a high proportion of women had a low level of autonomy (42.6%; 95% CI: 41.5–43.7), while 92.1% (95% CI: 91.3–92.9) had institutionalized childbirth. Moderate (PR: 1.10; 95% CI: 1.08–1.12) and high (PR: 1.13; 95% CI: 1.12–1.15) levels of women’s autonomy were found to be associated with institutionalized childbirth, and the same association was found in the adjusted analysis.
Conclusion
Being a woman with a higher level of autonomy was related to a higher prevalence of institutionalized childbirth. Therefore, as decision-making is a multifactorial characteristic, it is necessary to study in depth the determinants of non-institutionalized childbirth in women with less autonomy.
Significance
What is already known on this subject? Women’s autonomy is a strategy to improve health conditions and various socioeconomic aspects of women’s lives and their environment. Several studies have found that women with high autonomy are positively associated with their health and access to maternal health services, such as institutionalized childbirth.
What this study adds? This study found that Peruvian women with a high level of autonomy were more likely to have an institutionalized childbirth. This finding can contribute to government institutions to guide the strategies already in place to improve various aspects of women’s lives and enhance their autonomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Data Availability
The databases used in this study are freely accessible from the website of the INEI (http://iinei.inei.gob.pe/microdatos/).
References
Adhikari, R. (2016). Effect of women’s autonomy on maternal health service utilization in Nepal: A cross sectional study. BMC Women’s Health, 16(1), 26. https://doi.org/10.1186/s12905-016-0305-7
Akter, S., Davies, K., Rich, J. L., & Inder, K. J. (2019a). Indigenous women’s access to maternal healthcare services in lower- and middle-income countries: A systematic integrative review. International Journal of Public Health, 64(3), 343–353. https://doi.org/10.1007/s00038-018-1177-4.
Akter, S., Rich, J. L., Davies, K., & Inder, K. J. (2019b). Access to maternal healthcare services among indigenous women in the Chittagong hill tracts, Bangladesh: A cross-sectional study. British Medical Journal Open. https://doi.org/10.1136/bmjopen-2019b-033224
Aliyu, A. A., & Dahiru, T. (2017). Predictors of delayed antenatal care (ANC) visits in Nigeria: Secondary analysis of 2013 Nigeria demographic and health survey (NDHS). The Pan African Medical Journal. https://doi.org/10.11604/pamj.2017.26.124.9861
Asaolu, I. O., Alaofè, H., Gunn, J. K. L., Adu, A. K., Monroy, A. J., Ehiri, J. E., Hayden, M. H., & Ernst, K. C. (2018). Measuring women’s empowerment in Sub-Saharan Africa: Exploratory and confirmatory factor analyses of the demographic and health surveys. Frontiers in Psychology, 9, 994. https://doi.org/10.3389/fpsyg.2018.00994.
Basu, A. M., & Koolwal, G. B. (2005). Two Concepts of Female Empowerment: Some Leads from DHS Data on Women’s Status and Reproductive Health. In A Focus on Gender: Collected Papers on Gender Using DHS Data.
Castillo-Contreras, O., & Flores-Flores, C. (2019). Mortalidad por enfermedades digestivas no neoplásicas en la población adulta del Perú, 2010–2015. Anales de La Facultad de Medicina. https://doi.org/10.15381/anales.v80i1.15868.
Cecchini, S., Filgueira, F., & Robles, C. (2014). Social protection systems in Latin America and the Caribbean: A comparative view. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2532622
Chol, C., Negin, J., Agho, K. E., & Cumming, R. G. (2019). Women’s autonomy and utilisation of maternal healthcare services in 31 sub-saharan african countries: Results from the demographic and health surveys, 2010–2016. British Medical Journal Open, 9(3), e023128. https://doi.org/10.1136/bmjopen-2018-023128.
Danielsson, K. C., Gilhus, N. E., Borthen, I., Lie, R. T., & Morken, N. H. (2019). Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort. PLoS One, 14(11), e0225334–e0225334. https://doi.org/10.1371/journal.pone.0225334.
Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown, A. (2016). Access to primary health care services for indigenous peoples: A framework synthesis. International Journal for Equity in Health, 15(1), 163. https://doi.org/10.1186/s12939-016-0450-5.
Del Mastro, N., Tejada-Llacsa, I., Reinders, P. J., Pérez, S., Solís, R., Alva, Y., I., & Blas, M. M. (2021). Home birth preference, childbirth, and newborn care practices in rural peruvian Amazon. PloS One, 16(5), e0250702. https://doi.org/10.1371/journal.pone.0250702.
Enríquez Canto, Y. (2022). Desigualdades en la cobertura y en la calidad de la atención prenatal en Perú, 2009–2019. Revista Panamericana De Salud Publica, 46, e47. https://doi.org/10.26633/RPSP.2022.47.
Girum, T., & Wasie, A. (2017). Correlates of maternal mortality in developing countries: An ecological study in 82 countries. Maternal Health Neonatology and Perinatology, 3, 19. https://doi.org/10.1186/s40748-017-0059-8.
Graham, H., Bell, J., & Bullough, C. (2001). Can Skilled Attendance at Delivery Reduce Maternal Mortality in Developing Countries ? Safe Motherhood Strategies A Review of the Evidence, Studies in.
Guerra-Reyes, L., & Iguiñiz-Romero, R. A. (2019). Performing purity: Reproductive decision-making and implications for a community under threat of zika in iquitos, Peru. Culture Health & Sexuality, 21(3), 309–322. https://doi.org/10.1080/13691058.2018.1469790.
Hamilton, P., Lawrence, P., Jaggon, J., Greaves, V., Reece-Mills, M., Hazrati, L. N., & Eisenring, C. V. (2021). Embryonal tumour with multi-layered rosettes a case based review of the literature. Interdisciplinary Neurosurgery-Advanced Techniques and Case Management. https://doi.org/10.1016/j.inat.2021.101245
Hernández-Vásquez, A., Chacón-Torrico, H., Vargas-Fernández, R., & Bendezu-Quispe, G. (2021). Factors associated with home births in Peru 2015–2017: A cross-sectional population-based study. Heliyon, 7(3), e06344. https://doi.org/10.1016/j.heliyon.2021.e06344.
Hug, L., Alexander, M., You, D., & Alkema, L. (2019). National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: A systematic analysis. The Lancet Global Health, 7(6), e710–e720. https://doi.org/10.1016/S2214-109X(19)30163-9.
Instituto Nacional de Estadística e Informática (2019). Ficha técnica. In INEI. https://proyectos.inei.gob.pe/endes/2018/documentos_2018/FICHA_TECNICA_ENDES_2018.pdf
Instituto Nacional de Estadística e Informática (2020a). Perú: “Brechas de Género, 2020: Avances hacia la igualdad de mujeres y hombres” (p. 558).
Instituto Nacional de Estadística e Informática (2020b). Perú: Maternidad en la adolescencia, 2018. 54. https://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1733/libro.pdf
Mganga, A. E., Renju, J., Todd, J., Mahande, M. J., & Vyas, S. (2021). Development of a women’s empowerment index for Tanzania from the demographic and health surveys of 2004-05, 2010, and 2015-16. Emerging Themes in Epidemiology, 18(1), 13. https://doi.org/10.1186/s12982-021-00103-6.
Ministerio de la Mujer y Poblaciones Vulnerables (2021). Resolución Ministerial N.° 196-2021-MIMP - LINEAMIENTOS TÉCNICOS PARA PROMOVER LA AUTONOMÍA ECONÓMICA DE LAS MUJERES EN SU DIVERSIDAD. https://www.gob.pe/institucion/mimp/normas-legales/2035492-196-2021-mimp
Mondal, D., Karmakar, S., & Banerjee, A. (2020). Women’s autonomy and utilization of maternal healthcare in India: Evidence from a recent national survey. PloS One, 15(12), e0243553. https://doi.org/10.1371/journal.pone.0243553.
Muluwas Amentie, B., Abdulahi, M., Amentie, M., & Abdulahi, M. (2016). Utilization of Institutional delivery care services and influencing factors among women of child bearing age in Assosa District, Benishangul Gumuz Regional State, West Ethiopia. Global Journal of Medical Research: E Gynecology and Obstetrics, 4, 52–9.
Nigusie, A., Azale, T., Yitayal, M., & Derseh, L. (2021). Institutional delivery and associated factors in rural communities of Central Gondar Zone, Northwest Ethiopia. PloS One, 16(7), e0255079. https://doi.org/10.1371/journal.pone.0255079.
Pimentel, J., Ansari, U., Omer, K., Gidado, Y., Baba, M. C., Andersson, N., & Cockcroft, A. (2020). Factors associated with short birth interval in low- and middle-income countries: A systematic review. BMC Pregnancy and Childbirth, 20(1), 156. https://doi.org/10.1186/s12884-020-2852-z.
Ram, R., Kumar, M., & Kumari, N. (2022). Association between women’s autonomy and unintended pregnancy in India. Clinical Epidemiology and Global Health, 15, 101060. https://doi.org/10.1016/j.cegh.2022.101060.
Rettig, E. M., Fick, S. E., & Hijmans, R. J. (2020). The female empowerment index (FEMI): Spatial and temporal variation in women’s empowerment in Nigeria. Heliyon, 6(5), e03829. https://doi.org/10.1016/j.heliyon.2020.e03829.
Situ, K. C., & Neupane, S. (2016). Women’s autonomy and skilled attendance during pregnancy and delivery in Nepal. Maternal and Child Health Journal, 20(6), 1222–1229. https://doi.org/10.1007/s10995-016-1923-2.
Sivertsen, N., Anikeeva, O., Deverix, J., & Grant, J. (2020). Aboriginal and Torres Strait Islander family access to continuity of health care services in the first 1000 days of life: A systematic review of the literature. BMC Health Services Research, 20(1), 829. https://doi.org/10.1186/s12913-020-05673-w.
UNICEF (2021a). Delivery care. https://data.unicef.org/topic/maternal-health/delivery-care/
UNICEF (2021b). Key demographic indicators. UNICEF. https://data.unicef.org/country/per/
United Nations (2021). Goals 3 - Ensure healthy lives and promote well-being for all at all ages. https://sdgs.un.org/goals/goal3
Wado, Y. D. (2018). Women’s autonomy and reproductive health-care-seeking behavior in Ethiopia. Women & Health, 58(7), 729–743. https://doi.org/10.1080/03630242.2017.1353573.
Webster, P. (2018). Language barriers restricting access to health care for Indigenous populations. CMAJ: Canadian Medical Association Journal, 190(24), E754–E755. https://doi.org/10.1503/cmaj.109-5613
World Health Organization (WHO) (2021). Births attended by skilled health personnel. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/births-attended-by-skilled-health-personnel-()
World Health Organization (2015). Success factors for women’s and children’s health. World Health Organization. https://apps.who.int/iris/handle/10665/178636.
WHO, UNICEF, UNFPA, World Bank Group & UNDESA/Population Division. (2023) Trends in maternal mortality 2000 to 2020 Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. https://www.who.int/publications/i/item/9789240068759.
Yajahuanca, R., del Fontenele, S. A., Sena, C. V., & Diniz, S. G. (2013). Birth at the health center or at home: An analysis of birthing care among the Kukamas Kukamirias women of Peru. Journal of Human Growth and Development, 23, 322–330.
Acknowledgements
The authors are grateful to Donna Pringle for reviewing the language and style.
Funding
Self-financed.
Author information
Authors and Affiliations
Contributions
RVF: had the research idea, designed the study, collected, processed, and analyzed the data. All authors participated in the interpretation of the data, drafting of the manuscript and approved the final version.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
The study did not require the approval of an ethics committee because it was an analysis of aggregated secondary data that is in the public domain and does not allow the identification of the participants evaluated.
Consent to Participate
Not applicable.
Consent for Publication
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Cueva, G.A.H., Ramírez, R.G.N., Visconti-Lopez, F.J. et al. Association Between the Autonomy of Peruvian Women and the Choice of the Place of Delivery: Analysis of a National Survey, 2019. Matern Child Health J 27, 1823–1833 (2023). https://doi.org/10.1007/s10995-023-03740-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03740-2