Development of a Maternal Autonomy Questionnaire in Brazil: Pilot Test
Authors: Barrios Pamela L. , Hoffman Daniel J , van der Meulen Rodgers Yana 
Published: November 2023

Autonomy and control of resources gives mothers the ability to play a role in decisions made within the household and the community. Enabling the mother to gain control of and access to resources allows her to provide quality foods and ultimately influence child growth. Several studies have observed specific dimensions of maternal autonomy and its impact on child growth. However, the specific aspects of women's autonomy in Latin American that are important for childcare practices and nutritional status remain poorly understood with limited studies performed in the region. Our aim was to develop a maternal autonomy questionnaire to improve research on this topic. The study was conducted at CREN (Center for Recovery and Nutritional Education), located in São Paulo Brazil. CREN is a center that offers outpatient assistance to children from zero to 71 months of age with mild undernutrition and day hospital care for those exhibiting moderate to severe undernutrition in low‐income areas of São Paulo. A comprehensive list of survey items previously used to assess maternal autonomy was developed and then reviewed by an expert panel to assess the validity of each question for the six dimensions of autonomy. Survey development steps included focus group interviews (N=18), cognitive interviews (n=5) and reliability testing (n=44). Descriptive coding was used to analyze the group and individual interviews. The new survey was pilot tested with a convenience sample of 44 mothers of children <60 months of age. Standardized Cronbach's α was used to assess internal reliability. Mothers were 29.9 ± 7.9 SD years and had completed 11.3 ± 3.1 SD years of education. Only half of them were working at the time of interview and 77% were married or living with a partner. Overall, participants believed that it is a mother's responsibility to look after their children and that men do not have enough knowledge about childcare or household needs to make any type of decision. In regards to family structure, who the mother lives with, has a great impact on their perception of autonomy. They identified that there is a power struggle within their household when sharing the living space with other relatives. Two dimensions of autonomy were omitted after focus group interviews when it was determined that participants did not consider them as an expression of autonomy (ownership and participation in the labor market) since they did not represent a “choice” but a “need” in order to improve their current living situation. The remaining dimensions of the questionnaire had an internal consistency with Cronbach's α ranging from 0.59 to 0.80. The dimension with the highest reliability was household decision making and the lowest was family planning. We successfully developed a maternal autonomy questionnaire in Brazil. The development of the questionnaire in Latin America is a first step toward evaluating a woman's decision‐making power within her household.Support or Funding InformationThe Institute for Women's Leadership Consortium at Rutgers