Query: Infant autonomy

title: Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi country analysis
abstract: Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman's ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality.  This was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15 49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of "respondent can refuse sex," "respondent can ask partner to use condom," and "if spouse is justified in asking husband to use condom." Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.  The sampled women were predominantly urban (75% n 5758) and poor (48.7% n 3702) A majority of those that experienced mortality (neonatal mortality 53.5% infant mortality 54.3% under five mortality 55.7% were young (under 20) at the time of their first child's birth while their male partners were older. The multivariate analysis supports the beneficial effects of women's sexual autonomy in East Africa. Women who exercised sexual autonomy experienced significantly lower rates of child mortality at all three stages: neonatal (NHR 0.80, 95% CI: 0.68 0.94, p 0.006) infant (IHR 0.82, 95% CI: 0.72 0.93, p 0.003) and under five (UHR 0.84, 95% CI: 0.75 0.94, p 0.002) net of all other factors. Receiving antenatal care and using contraceptives also contributed significantly to lower child mortality rates.  Our findings suggest that sexual autonomy among East African women is an urgent priority that is crucial to the survival of neonates, infants, and children in East Africa. Women should be informed, empowered, and autonomous concerning their reproductive and sexual health.

title: Autonomy and infant feeding decision making among teenage mothers in a rural and urban setting in KwaZulu Natal, South Africa
abstract: BackgroundThe nutritional status of infants born to teenage mothers can be sub optimal compared to those born to older mothers. One contributing factor is inappropriate feeding practices adopted by teenage mothers. Little is known about how infant feeding decisions are made among teenage mothers, particularly in under resourced settings. In this study we prospectively explored autonomy and infant feeding decision making among teenage mothers in a rural and urban setting in KwaZulu Natal, South Africa.MethodsThis study adopted a qualitative longitudinal design. Thirty pregnant participants were recruited to the study cohort, from the catchment area of two hospitals (one urban and one rural) Participants were purposively selected to include teenagers, HIV positive, and working pregnant women. We report findings from ten teenage mothers, aged between 15 and 19 years, who participated in the larger cohort (n 5 rural; n 5 urban) Monthly in depth interviews were conducted with participating mothers for 6 months starting 2 weeks after delivery. All interviews were conducted in the local language, transcribed verbatim and translated into English. Data was coded using NVivo v10 and framework analysis was used.ResultsFindings from this study showed that teenage mothers had knowledge about recommended feeding practices. However, our findings suggest that these mothers were not involved in infant feeding decisions once they were at home, because infant feeding decision making was a role largely assumed by older mothers in the family. Further, the age of the mother and financial dependency diminished her autonomy and ability to influence feeding practices or challenge incorrect advice given at home. Most feeding advice shared by family members was inappropriate, leading to poor infant feeding practices among teenage mothers. Returning to school and fear of breastfeeding in public were also barriers to exclusive breastfeeding.ConclusionTeenage mothers had a limited role in the infant feeding decision making process. Health workers have an important role to play in ensuring that knowledge about infant feeding is shared with the mother's family where infant feeding choices are made. This will improve support for teenage mothers, and may also positively impact on the nutritional status of children.

title: Women's autonomy and men's involvement in child care and feeding as predictors of infant and young child anthropometric indices in coffee farming households of Jimma Zone, South West of Ethiopia
abstract: Most of child mortality and under nutrition in developing world were attributed to suboptimal childcare and feeding, which needs detailed investigation beyond the proximal factors. This study was conducted with the aim of assessing associations of women's autonomy and men's involvement with child anthropometric indices in cash crop livelihood areas of South West Ethiopia.  Multi stage stratified sampling was used to select 749 farming households living in three coffee producing sub districts of Jimma zone, Ethiopia. Domains of women's Autonomy were measured by a tool adapted from demographic health survey. A model for determination of paternal involvement in childcare was employed. Caring practices were assessed through the WHO Infant and young child feeding practice core indicators. Length and weight measurements were taken in duplicate using standard techniques. Data were analyzed using SPSS for windows version 21. A multivariable linear regression was used to predict weight for height Z scores and length for age Z scores after adjusting for various factors.  The mean (sd) scores of weight for age (WAZ) height for age (HAZ) weight for height (WHZ) and BMI for age (BAZ) was 0.52(1.26) 0.73(1.43) 0.13(1.34) and 0.1(1.39) respectively. The results of multi variable linear regression analyses showed that WHZ scores of children of mothers who had autonomy of conducting big purchase were higher by 0.42 compared to children's whose mothers had not. In addition, a child whose father was involved in childcare and feeding had higher HAZ score by 0.1. Regarding age, as for every month increase in age of child, a 0.04 point decrease in HAZ score and a 0.01 point decrease in WHZ were noted. Similarly, a child living in food insecure households had lower HAZ score by 0.29 compared to child of food secured households. As family size increased by a person a WHZ score of a child is decreased by 0.08. WHZ and HAZ scores of male child was found lower by 0.25 and 0.38 respectively compared to a female child of same age.  Women's autonomy and men's involvement appeared in tandem with better child anthropometric outcomes. Nutrition interventions in such setting should integrate enhancing women's autonomy over resource and men's involvement in childcare and feeding, in addition to food security measures.

title: Health spending autonomy and infant mortality rates: A matter of local administrative capacity?
abstract: Brazil opted for decentralization in the provision of health services at the time of the 1988 Constitution's promulgation. The municipalities became entirely responsible for primary healthcare provision, sharing financing responsibilities with the central government. The aim of this paper is to evaluate the impact of health spending autonomy on infant mortality rates, using Brazilian local data from 2000 to 2007. As a measure of spending autonomy we used the share of overall health expenditures financed by municipalities' own resources. The larger the share of health expenditures which is not financed by the central government (grants) the greater the autonomy, because local governments can decide how and on what to spend these resources, and most of intergovernmental transfers to the health sector are allocated to predefined specific purposes. The fixed effects estimates, through the use of an instrumental variables approach, show that, on average, greater spending autonomy is not associated with lower infant mortality rates. However, given that local governments and populations are different in many aspects, it is reasonable to expect a heterogeneous response to decentralization. Galiani et al. (2008) for instance, assess the hypothesis that decentralization of high schools in Argentina may have increased the difference in educational outcomes. Could the same have happened to the quality of health in Brazilian municipalities? In well managed municipalities and in which individuals participate actively and can support their preferences, fiscal autonomy ought to improve the delivery of public services. Using a measure of efficiency in the delivery of health services to split the municipalities in two groups, we got significant results for the more efficient municipalities, implying an increase in inequality. This measure corresponds to efficiency scores estimated using data envelopment analysis (DEA) We also test for heterogeneous impacts of the Family Health Program (PSF) the most important Brazilian basic health care policy, which main expansion occurred until 2007. It is a federal Program that each municipality runs independently. Again, we find evidence of a heterogeneous response, since PSF only reduces infant mortality rates in efficient municipalities. We then confirm Galiani's (2008) hypothesis that decentralization may help only the best to do even better.

title: Women's autonomy and social support and their associations with infant and young child feeding and nutritional status: community based survey in rural Nicaragua
abstract: To evaluate the associations of women's autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar sweetened beverages) and nutritional status in rural Nicaragua.  Feeding practices and children's nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar sweetened beverages. Women's autonomy was assessed by a seventeen item questionnaire covering dimensions of financial independence, household child reproductive and health related decision making and freedom of movement. Women's social support was determined using the Duke UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles. Setting Los Cuatro Santos area, rural Nicaragua. Subjects A total of 1371 children 0 35 months of age.  Children of women with the lowest autonomy were more likely to be exclusively breast fed and continue to be breast fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar sweetened beverages but also be taller.  While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

title: Infant male circumcision and the autonomy of the child: two ethical questions
abstract: Routine neonatal circumcision the non therapeutic circumcision of infant males has generated considerable ethical controversy. In this article, I suggest that much of the disagreement results from conflicting ideas about the autonomy of the child. I examine two questions about autonomy. First, I ask whether we should be realists or idealists about the future autonomous choices of the child that is, whether we should account for the fact that the child may not make the best choices in future, or whether we should assume that his future choices will reflect his best interests. Second, I ask whether the child has a right to autonomy with respect to circumcision, an interest in autonomy or neither that is, whether respect for autonomy overrides considerations of interests, whether it counts as one interest among many or whether it counts for nothing. In response to the first question, I argue that we should be idealists when evaluating the child's own interests, but realists when evaluating public health justifications for circumcision. In response to the second question, I argue that the child has an interest in deciding whether or not to be circumcised, insofar as the decision is more likely to reflect his actual interests and his own values. Finally, I show how these findings may help to resolve some particular disputes over the ethics of infant male circumcision.

title: DOMESTIC VIOLENCE EXPOSURE, MATERNAL EDUCATION, AND MATERNAL AUTONOMY AS PREDICTORS OF INDIAN WOMEN'S USE OF MATERNAL HEALTH SERVICES AND INFANT LOW BIRTH WEIGHT

title: Effect of Women's Decision Making Autonomy on Infant's Birth Weight in Rural Bangladesh
abstract: Low birth weight (LBW) an outcome of maternal undernutrition, is a major public health concern in Bangladesh where the problem is most prominent. Women's decision making autonomy is likely an important factor influencing maternal and child health outcomes. The aim of the study was to assess the effect of women's decision making autonomy on infant's birth weight (BW) Methods. The study included data of 2175 enrolled women (14 45 years of age) from the Maternal and Infant Nutritional Intervention in Matlab (MINIMat study) in Bangladesh. Pearson's chi square test, analysis of covariance (ANCOVA) and logistic regression analysis were applied at the collected data.  Women with lowest decision making autonomy were significantly more likely to have a low birth weight (LBW) child, after controlling for maternal age, education (woman's and her husband's) socioeconomic status (SES) (odds ratio (OR) 1.4; 95% confidence interval (CI) 1.0, 1.8) BW was decreased significantly among women with lowest decision making autonomy after adjusting for all confounders.  Women's decision making autonomy has an independent effect on BW and LBW outcome. In addition, there is a need for further exploration to identify sociocultural attributes and gender related determinants of women decision making autonomy in this study setting.

title: Does maternal autonomy influence feeding practices and infant growth in rural India?
abstract: The high prevalence of child under nutrition remains a profound challenge in the developing world. Maternal autonomy was examined as a determinant of breast feeding and infant growth in children 3 5 months of age. Cross sectional baseline data on 600 mother infant pairs were collected in 60 villages in rural Andhra Pradesh, India. The mothers were enrolled in a longitudinal randomized behavioral intervention trial. In addition to anthropometric and demographic measures, an autonomy questionnaire was administered to measure different dimensions of autonomy (e.g. decision making, freedom of movement, financial autonomy, and acceptance of domestic violence) We conducted confirmatory factor analysis on maternal autonomy items and regression analyses on infant breast feeding and growth after adjusting for socioeconomic and demographic variables, and accounting for infant birth weight, infant morbidity, and maternal nutritional status. Results indicated that mothers with higher financial autonomy were more likely to breastfeed 3 5 month old infants. Mothers with higher participation in decision making in households had infants that were less underweight and less wasted. These results suggest that improving maternal financial and decision making autonomy could have a positive impact on infant feeding and growth outcomes.

title: Influence of women's autonomy on infant mortality in Nepal
abstract: BackgroundNepalese women lag behind men in many areas, such as educational attainment, participation in decision making and health service utilization, all of which have an impact on reproductive health outcomes. This paper aims to examine the factors influencing infant mortality, specifically, whether women's autonomy has an impact on infant mortality in the Nepali context.MethodsData were drawn from the Nepal Demographic and Health Survey, 2006. The analysis is confined to 5,545 children who were born within the five years preceding the survey. Association between infant mortality and the explanatory variables was assessed using bivariate analysis. Variables were then re examined in multivariate analysis to assess the net effect of women's autonomy on infant mortality after controlling for other variables.ResultsThe infant mortality rate (IMR) in the five years preceding the survey was 48 deaths per one thousand live births. Infant mortality rate was high among illiterate women (56 per 1000 live births) and among those not involved in decision making for health care (54 per 1000 live births) Furthermore, infant mortality was high among those women who had more children than their comparison group, who had birth intervals of less than two years, who had multiple births, who were from rural areas, who were poor, whose source of water was the river or unprotected sources, and who did not have a toilet facility in their household.Results from logistic regression show that women's autonomy plays a major role in infant mortality after controlling other variables, such as mother's sociodemographic characteristics, children's characteristics and other household characteristics. Children from literate women had a 32 percent lower chance (OR 0.68) of experiencing infant mortality than did children from illiterate women. Furthermore, infants of women who were involved in decision making regarding their own health care had a 25 percent lower (OR 0.75) chance of dying than did infants whose mothers who were not involved in healthcare decisions.ConclusionInfant mortality is high in Nepal. In this context, mother's literacy and involvement in healthcare decision making appear to be the most powerful predictors for reducing infant mortality. Hence, in order to reduce infant mortality further, ongoing female education should be sustained and expanded to include all women so that the millennium development goals for the year 2015 can be attained. In addition, programs should focus on increasing women's autonomy so that infant mortality will decrease and the overall well being of the family can be maintained and enhanced.