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Women’s autonomy is a potentially noteworthy but less studied indicator of women’s control to exercise reproductive rights in a patriarchal country such as Bangladesh. The study is a sociological investigation that examined whether women’s autonomy matters or not in determining their control to exercise reproductive rights in rural Bangladesh. A survey was conducted on 200 randomly selected married women from Hogladanga village in the Bagerhat district of Bangladesh. We administered an interview questionnaire containing 27 Likert-type questions under three mutually interlinked domains for autonomy measures and 12 Likert-type questions under two mutually interlinked domains for reproductive rights status measures. The findings revealed that women’s autonomy status is strongly associated with their control to exercise reproductive rights status (β = .862, p < .001) along with both of the proxy variables, that is, sexual behavior index (β = .915, p < .001) and reproductive behavior index (β = .62, p < .001). The study findings suggest that women’s autonomy must be considered an important sociocultural determinant of higher control to exercise reproductive rights for young mothers in Bangladesh. Keywords autonomy, reproductive rights, decision making, control over finance, freedom, sexual and reproductive behavior The norms and values of a patriarchal structure often cre- Introduction ate a barrier that prevents women from visiting health care Because of their relationship to an individual’s reproductive centers and withholds maternal health care without the con- functions, reproductive rights are considered legal rights sent of their husbands (O. M. R. Campbell & Graham, 2006; (Amnesty International [AI] USA, 2007; World Health Chowdhury, Islam, Gulshan, & Chakraborty, 2007; Mullany, Organization [WHO], 2014), which ensure women’s free- 2010; Rahman, Haque, & Sarwar Zahan, 2011). Accordingly, dom to decide when to have children as well as the spacing 85% of deliveries in rural Bangladesh still take place in and timing of their children’s births (WHO, 2006). To a great homes, whereas less than a quarter of births are attended by extent, a woman’s participation in fertility behavior is domi- skilled health care professionals (Bangladesh Bureau of nated by males, especially her husband and his family, due to Statistics [BBS], 2010). Moreover, only a small proportion the male supremacy in a patriarchal society (Jesmin & (25.5%) of women receive antenatal care (ANC), and only Salway, 2000; M. E. Khan, Townsend, & D’Costa, 2002; 27.1% of women seek postnatal care from qualified health Sebstad & Cohen, 2000). In rural Bangladesh, the reproduc- professionals within the first 2 days after delivery (National tive situation takes its worst form (Ahmed, 2005; Hussain & Institute of Population Research and Training [NIPORT], Khan, 2008; Rashid, 2006) with the common phenomena of 2011). Thus, the maternal mortality ratio (MMR) in physical and mental sexual harassment by husbands Bangladesh is 570 per 100,000 live births, one of the highest (Johnston & Naved, 2008; Wahed & Bhuiya, 2007). Women in the South Asian region (United Nations Children’s Fund deserve the right to participate in fertility decision making without facing any type of discrimination or violence (AI USA, 2007; WHO, 2014); however, a husband’s dominance Khulna University, Khulna, Bangladesh in fertility decisions often results in induced abortion, mis- North South University, Dhaka, Bangladesh carriage, and fetal death, and also leads to pregnancy-related Corresponding Author: complications (J. C. Campbell, 2002; Dunkle et al., 2004; Amit Kumar Biswas, Master of Social Science in Sociology, Rahman, Mostofa, & Hoque, 2014; Stephenson, Koenig, & Sociology Discipline, Khulna University, Khulna 9208, Bangladesh. Email: email@example.com Ahmed, 2006). Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open [UNICEF], 2009); at the same time, approximately 12,000 Method women die every year due to various pregnancy-related com- Study Setting plications (Planning Commission, Ministry of Planning, Bangladesh, 2008). The study was conducted in the Bagerhat district of The concept of “personal autonomy” plays an important Bangladesh. Due to our familiarity with the language and role in understanding the power dynamics between males and cultural practices of the local people, we purposely selected females in a male-dominated society such as Bangladesh the “Hogladanga village” of Ujalkur union in Bagerhat (Haque, Rahman, Mostofa, & Zahan, 2012; Rahman et al., district for the study. Under Khulna Division, Bagerhat 2014). In this regard, various literature suggests that the con- district is placed in Southwestern Bangladesh, formerly cept of “personal autonomy” denotes an individual’s control founded by Hazrat Khan Jahan Ali as a part of Khilafatabad over his or her own body and the resources he or she pos- Pargana. Bagerhat district has a total area of 3,959.11 km sesses (Haque et al., 2012; Kishor & Subaiya, 2008; Rahman, with the population of 1,476,090 people having a literacy 2012; Sen & Batliwala, 2000). According to this concept, rate of 44.3% (BBS, 2011; Wikipedia, 2015). Among 77 women’s autonomy generally emphasizes women’s ability to unions of Bagerhat district, Ujalkur union is considered as control their lives, easily access resources and information, one of the oldest union with an area of 31.35 km because and participate equally with their male counterparts in every of its hundred year’s legacy. Ujalkur union has 23 villages aspect of their lives (E. K. Brunson, Shell-Duncan, & Steele, and Moujas in total. About 6,615 families live in Ujalkur 2009; Kishor & Subaiya, 2008; Rahman, 2012; Sen & union with a population of 27,409 people (BBS, 2011). Batliwala, 2000). Along these lines, Rahman et al. (2014) Among 23 villages of Ujalkur union, Hogladanga village argued that women’s autonomy is closely associated with per- has its own uniqueness because of its traditional culture, sonal capacity rather than prestige or position within a social language pattern, and geographical setting. About 427 context (Haque et al., 2012; Rahman et al., 2014). Thus, families live in Hogladanga village with a population of women’s autonomy is explained through three different areas: 1,781 people (BBS, 2011). household decision-making power, control over financial resources, and the extent of freedom of movement (Bloom, Wypij, & Gupta, 2001; Nigatu, Gebremariam, Abera, Setegn, Research Design & Deribe, 2014; Tiwari & Kumar, 2006; Woldemicael, 2007). The nature of the study was explanatory, as we investi- Numerous studies have been conducted in South Asia and gated cause-and-effect relationships between women’s diverse international settings to examine the impact of wom- autonomy and their control to exercise reproductive rights. en’s autonomy on various women’s health issues, including We perceived women’s autonomy as an independent vari- fertility (Balk, 1994; Basu, 1992; Dyson & Moore, 1983; able and reproductive rights as a dependent variable. We Hindin, 2000; Jejeebhoy, 1991; Morgan & Niraula, 1995; conducted the study using survey research design to Singh, Singh, Singh, & Pathak, 2002; Vlassoff, 1991), birth explore the significance of women’s autonomy in deter- control (Dharmalingam & Morgan, 1996; Feldman, Zaslavsky, mining their control to exercise reproductive rights along Ezzati, Peterson, & Mitchell, 2009; A. H. T. Khan, 1997; with various sociodemographic variables. Particularly, in Schuler & Hashemi, 1994), reproductive behavior (Jejeebhoy, dealing with the attitude as well as the behavior of a sub- 1995), maternal and child health care (Nigatu et al., 2014; ject, survey research has a greater importance in collecting Woldemicael & Tenkorang, 2010), unintended pregnancies the greater body of data within a short time as well as its (Rahman, 2012), and health outcomes (Gupta, 1995). Despite wider applicability in various dimensions (Shaughnessy, the body of relevant knowledge, we currently lack understand- Zechmeister, & Jeanne, 2011). ing not only how exactly women’s autonomy status deter- mines their control to exercise reproductive rights but also what composes meaningful measures of women’s reproduc- Participant Inclusion Criteria tive rights status in Bangladeshi setting, and as a result, the present study explores women’s autonomy as a potential indi- To achieve the study objective, we defined participant cator of their reproductive rights. In this regard, the study pro- inclusion criteria of the study, that is (a) all the respondents ceeded on with the following research questions: should be women, (b) aged 15 to 49, (c) they all should be married and currently live with their husbands, (d) they Research Question 1: What is the autonomy status of should have at least one child, and last, (e) they should women in the study area? have lived in the selected study areas of Bagerhat district Research Question 2: What are the sociodemographic for minimum 2 years. Under these characteristics, we car- factors influencing women’s reproductive rights status? ried out a household census in the study area to identify the Research Question 3: Does women’s autonomy status exact population to draw a representative sample. In matter in ensuring their control to exercise reproductive “Hogladanga village,” we identified 230 married women rights? as the population of the study. Biswas et al. 3 friends and family members, taking walks, watching movies, Sampling participating in religious ceremonies, visiting community From the census, we selected a total of 200 married women, centers or clubs, going out alone to arbitrary distant places, having at least one child, using simple random sampling for and returning home from outings late at night. The response the conformity of greater validity of the present study as well options for the aforementioned three domains were (5) very as giving the equal chance and nonzero probability of being high, (4) high, (3) reasonable, (2) low, and (1) very low. selected to every respondent. We calculatedly selected the samples considering a confidence interval of 2.5 at 95% con- Measures of reproductive rights. We used two mutually inter- fidence level. linked indices, that is, the extent of power regarding sexual behavior and the reproductive index to measure women’s reproductive rights. We assessed the first indices through the Data Collection respondents’ observations and experiences by asking six spe- We collected data from both primary and secondary sources. cific questions with such issues as the frequency of enjoying We collected primary data through face-to-face interaction sexual intercourse, forced sex with husband, torture by the with the interviewees and secondary data from relevant jour- husband during forced sex and compelled intercourse during nals, periodicals, reports, and books. menstruation, or illness and health hazard due to forced inter- course. We measured the second indices by assessing answers Development of study instruments. The interview questionnaire to six precise inquiries on decisions about sexual union, con- contained both open-ended questions such as “Do you have traceptive use, the priority of conception, timing and spacing any notion about autonomy?”; if yes, “What do you understand of having children, maternal health care services, and post- from the term women’s autonomy?”; “How did you see your partum health care services. The response options for the household decision-making sphere in your family?”; and so on, sexual behavior index were (1) always, (2) sometimes, and to understand the respondent’s perceptions about the variables, (3) never, and the response options for the reproductive and closed-ended questions along with 27 Likert-type ques- behavior index were (1) decision of husband, (2) joint deci- tions with five possible responses. We incorporated these ques- sion of both husband and wife, and (3) decision of wife. tions in the survey tools to collect the desired three interlinked and mutually reinforcing indices on women’s autonomy, that Fieldwork. Before conducting the actual survey, we piloted is, power in household decision making, control over financial the interview schedule on 25 women to identify the shortfalls resources, and freedom of movement, suggested and performed within the tool. After piloting the questionnaire, we modified by Bloom et al. (2001), Nigatu et al. (2014), Tiwari and Kumar the interview schedule based on feedback from pretest. (2006), and Woldemicael (2007). Accordingly, to measure two Before going to the actual survey, we gave a 3-day intensive proxy variables of women’s reproductive rights, that is, power training to five female data collectors to clarify about the aim regarding sexual and reproductive behavior, we incorporated of the study, research procedure, data collection techniques, 12 Likert-type questions in accordance with AI USA (2007) content, and clarification of the questionnaire (by going and WHO (2006), under two indices into the survey tool. through each question of the questionnaire). Afterward, we used the revised interview schedule to administer the final Construction of women’s autonomy. Women’s autonomy is data collection from the respondents with trained female based on three interlinked factors, that is, participation in interviewers in face-to-face situation. household decision making, control over finances, and free- dom of movement. In the present study, we measured house- Data Processing hold decision-making autonomy by asking nine categorical After completion of data collection, we processed the raw questions based on the following variables: household pur- information by (a) removing illegal codes, (b) reducing logical chases (television, refrigerator, clothes/shoes/jewelry for self inconsistencies and errors, and (c) dropping improbabilities and children), purchases of real property, daily household and solving ambiguities. We coded data to classify them into expenditures, money spent on income-generating activities, meaningful codes in accordance with its quality, quantity, and selection of daily food menu, children’s education, children’s periodical basis to draw logical inferences. Later, we tabulated marital decisions, and control over finances. We measured data on the basis of similarities, attributes, and intervals. financial autonomy by asking six questions focusing on sub- sequent variables, such as spending money by herself, the household income, her own income, the selection of family Data Analysis expenditures, and control over credit and savings. Con- For the first index (household decision-making autonomy), versely, we explored freedom of movement by asking 12 we characterized respondents’ responses using a 1 to 5 range, questions that emphasized succeeding variables, such as trips with a maximum of 45 and minimum of 9 as the expected to the market, other shopping expeditions, visits to hospitals/ points/counts in the case of the first index for each person. We health centers, visits to children’s schools, interactions with 4 SAGE Open also followed this procedure sequentially for the second and respondents was 30.91 years. Most of the women (93%) in third indices. According to frequencies of points (highest/ rural areas were reportedly married before their legal age of lowest) in the statistical range, we used (highest value − low- marriage, whereas 88.5% of the respondents conceived est value + 1) formula with the number of classes as three to before age 18, and the average pregnancy ratio was 3.91. determine the class interval (range / number of classes) and to Among the respondents, 66% lived with extended family and categorize the decision-making power into higher, medium, more than half (60%) had six or more family members. A and lower types. Finally, taking into account all of the scores majority of the respondents (74%) were housewives who on the different indices, we used the sum of the total responses remained economically dependent (75%), and the average to construct the overall autonomy index (AI; Cronbach’s α = monthly income of the respondents was only BDT 1,894. .879) to facilitate and conduct multivariate analyses Accordingly, approximately half of the husbands’ (49%) (Cronbach’s α = .749, first index; Cronbach’s α = .872, sec- monthly incomes ranged from BDT 4,001 to BDT 7,000, ond index; and Cronbach’s α = .875, third index). Besides, with the average income BDT 5,549, and most of the hus- counting the sexual behavior index, we quantified each bands worked as day laborers (49%; Table 1). response using a 1 to 3 range with a maximum value of 18 and a minimum of 6, and also followed this method for the second Percentage Distribution of Respondents in index. Accordingly, we used (highest value − lowest value + Various Indices 1) formula with the number of classes as three to determine the class interval (range / number of classes) and to categorize Table 2 displays various indices related to women’s auton- the decision-making power into higher, medium, and lower omy and control to exercise reproductive rights through per- types (Cronbach’s α = .862, sexual behavior index; Cronbach’s centage distribution. As the table clearly shows, in every α = .877, reproductive behavior index; and Cronbach’s α = aspect of their lives, women’s participation is limited by their .892, reproductive rights status index [RRSI]). Finally, after male counterparts, especially in household decision making; calculating all the scores on the different indices cumula- more than half of the respondents (54.5%) stated that they tively, we used that sum of total indices of every individual to generally do not play a significant role in household deci- construct the RRSI to facilitate and to conduct multivariate sions, with a similar situation in financial matters (45%). analyses. We used bivariate linear regression technique to Regarding freedom of movement, although 37% of the show the associations between various sociodemographic respondents stated that they enjoy that right, this finding characteristics and indices of women’s autonomy with repro- does not prove that this freedom makes any crucial improve- ductive rights status along with two proxy variables, that is, ment to women’s control to exercise their reproductive sexual behavior index and reproductive behavior index. We rights, as they may think. For responses regarding the overall included all the significant predictor variables in multiple lin- AI, the highest percentage of the sample acknowledged ear regression models. We used SPSS (Version 21) to analyze medium (46%) and lower (40%) status, and this picture was the study data to measure the association between women’s diverse in the case of women’s control to exercise reproduc- autonomy and their reproductive rights. tive rights as highest percentage of the sample (51.5%) acknowledged low status in RRSI along with its two subindi- ces, extent of power in sexual behavior (46.5%) and repro- Ethical Considerations ductive behavior (47%). Ethical clearance was obtained from the Academic Committee of Sociology Discipline, Khulna University. Bivariate and Multivariate Analyses Furthermore, potential risks were minimized through strict In the first model, a series of bivariate regression analyses adherence to confidentiality and informed consent proce- revealed significant correlations between the sociodemo- dures. After explaining the purpose of the study, verbal and graphic characteristics and various indices of women’s auton- written consent was taken from all the participants prior to omy with the sexual behavior index of respondents, where their participation in the study. In addition, the respondents significant positive correlations were observed for age of were informed that their participation in the study is volun- respondent (β = .707, SE = .049, p < .001), educational status tary and that they would not be obligated to provide answers (β = .702, SE = .054, p < .001), power in household decision to any question(s) with which they are uncomfortable. making (β = .782, SE = .048, p < .001), control over financial activities (β = .812, SE = .046, p < .001), and the extent of Results freedom of movement (β = .683, SE = .048, p < .001). All the significant variables (p < .05) in the bivariate analyses were Sociodemographic Characteristics of the Study entered into the multiple linear regression model. All of the Subjects variables remained significantly correlated with the respon- The sociodemographic characteristics of the sample revealed dents’ sexual behavior index, that is, control over financial that a majority of the respondents belonged to the age group activities (β = .291, SE = .073, p < .001), followed by power of between 28 and 38 years, and the average age of the in household decision making (β = .256, SE = .063, p < .001), Biswas et al. 5 Table 1. Percentage Distribution of Respondents by Background Table 2. Percentage Distribution of Respondents in Various Characteristics (N = 200). Indices (N = 200). Variables n (f) % M (SD) Variables n (f) % Age composition of the respondent Household decision-making autonomy of index 17-27 67 33.5 30.91 (7.298) High 21 10.5 28-38 89 44.5 Medium 70 35.0 39-48 44 22 Total 200 100.0 Low 109 54.5 Educational status of the respondents Total 200 100.0 Primary level (1- to 5-year schooling) 187 93.5 2.05 (1.860) Control over finance index Junior secondary (6- to 8-year schooling) 11 5.5 High 22 11.0 Secondary and above (≥9-year schooling) 2 1 Medium 88 44.0 Total 200 100.0 Type of family Low 90 45.0 Nuclear family 68 34 Total 200 100.0 Extended family 132 66 Extent of freedom of movement index Total 200 100.0 High 53 26.5 Age at first marriage of respondent Medium 74 37.0 12-16 186 93 15.49 (1.859) 17-21 14 7 Low 73 36.5 Total 200 100.0 Total 200 100.0 Age at first pregnancy of respondent Autonomy index 14-17 177 88.5 13.94 (1.798) High 28 14.0 18-21 23 11.5 Total 200 100.0 Medium 88 46.0 Number of pregnancy of respondent Low 84 40.0 1-5 162 81 3.91 (1.990) Total 200 100.0 6-10 38 19 Extent of power regarding sexual behavior index Total 200 100.0 High 33 16.5 Number of children of respondent 1-3 134 67 3.15 (1.475) Medium 74 37.0 4-6 60 30 Low 93 46.5 7-9 6 3 Total 200 100.0 Total 200 100.0 Extent of power regarding reproductive behavior index Size of the family High 32 16.0 1-5 74 37 6.42 (2.082) 6-10 120 60 Medium 74 37.0 ≥12 6 3 Low 94 47.0 Total 200 100.0 Total 200 100.0 Occupation of respondent Reproductive rights status index Housewife 148 74 High 21 10.5 Housemaid 38 18 Employee 7 4 Medium 76 38.0 Business at home 7 4 Low 103 51.5 Total 200 100.0 Total 200 100.0 Monthly income of the respondent No income (0) 150 75 1,894 (973.194) Source. Field Survey, 2016. Low income (1,000-2,000) 40 20 Middle income (2,001-3,000) 6 3 High income (3,001-4,000) 4 2 women with more education, more control over finances, Total 200 100.0 household decision-making autonomy, and freedom of move- Occupation of respondent’s husband Day labor 98 49 ment had more control in reproductive decision making. The Rickshaw puller 62 31 adjusted-R value showed that approximately 77.7% of vari- Businessman 38 19 ance in the respondents’ sexual behavior index was explained Easy bike driver 2 1 by the predictor variables. Total 200 100.0 In the second model, bivariate regression analyses showed Income of the respondent’s husband a similar result, including the respondents’ age (β = .740, Low income (1,000-4,000) 70 34 5,549.75 (2,473.8) SE = .047, p < .001), educational status (β = .744, SE = .051, Middle income (4,001-7,000) 98 49 High income (7,001-10,000) 32 17 p < .001), power in household decision making (β = .777, SE Total 200 100.0 = .048, p < .001), control over financial activities (β = .810, SE = .046, p < .001), and the extent of freedom of movement Source. Field Survey, 2016. (β = .711, SE = .046, p < .001). These variables were also found to significantly correlate with the respondents’ repro- with the exception of extent of freedom of movement (β = ductive behavior index. In determining the respondents’ .116, SE = .049, p < .05). In particular, older women and reproductive behavior index, in the second multiple linear 6 SAGE Open Table 3. Bivariate and Multiple Linear Regression Analyses Examining Correlates of Reproductive Rights Along With Sexual and Reproductive Behavior Indices (N = 200). Bivariate Multivariate b SE-B β 95% CI p b SE-B β 95% CI p Dependent variable: Sexual behavior index of respondents (SBI) Age at first marriage .016 .029 .040 [−0.041, 0.074] .572 Size of the family member −.004 .025 −.010 [−0.053, 0.046] .889 Age of respondent .695 .049 .707 [0.598, 0.793] .000** .177 .047 .180 [0.084, 0.271] .000** Educational status .754 .054 .702 [0.647, 0.861] .000** .214 .055 .199 [0.106, 0.321] .000** Household decision making .850 .048 .782 [0.755, 0.945] .000** .278 .063 .256 [0.154, 0.402] .000** Control over financial activities .896 .046 .812 [0.806, 0.986] .000** .320 .073 .291 [0.177, 0.463] .000** Extent of freedom of movement .637 .048 .683 [0.542, 0.733] .000** .109 .049 .116 [0.012, 0.205] .027* 2 2 R = .782, adjusted R = .777; SE of the estimate = .348 Dependent variable: Reproductive behavior index of respondents (RBI) Age at first marriage .024 .029 .060 [−0.033, 0.081] .399 Size of the family member −.021 .025 −.059 [−0.070, 0.029] .408 Age of respondent .724 .047 .740 [0.632, 0.816] .000** .229 .043 .234 [0.144, 0.313] .000** Educational status .794 .051 .744 [0.694, 0.894] .000** .261 .049 .245 [0.164, 0.359] .000** Household decision making .840 .048 .777 [0.745, 0.936] .000** .239 .057 .221 [0.126, 0.351] .000** Control over financial activities .888 .046 .810 [0.798, 0.978] .000** .258 .066 .235 [0.128, 0.387] .000** Extent of freedom of movement .660 .046 .711 [0.568, 0.751] .000** .133 .044 .143 [0.046, 0.220] .003* 2 2 R = .819, adjusted R = .814, SE of the estimate = .316 Dependent variable: Reproductive rights status index of respondents (RRSI) Age at first marriage .022 .027 .058 [−0.031, 0.074] .417 Size of the family member −.007 .023 −.022 [−0.053, 0.038] .755 Age of respondent .645 .045 .717 [0.558, 0.733] .000** .202 .046 .225 [0.113, 0.292] .000** Educational status .676 .051 .688 [0.576, 0.776] .000** .198 .053 .202 [0.094, 0.302] .000** Household decision making .766 .045 .770 [0.677, 0.855] .000** .257 .061 .258 [0.137, 0.376] .000** Control over financial activities .800 .044 .794 [0.714, 0.886] .000** .268 .070 .265 [0.130, 0.406] .000** Extent of freedom of movement .555 .046 .650 [0.464, 0.646] .000** .064 .047 .075 [−0.029, 0.157] .175 2 2 R = .758, adjusted R = .752, SE of the estimate = .336. Note. CI = confidence interval. *p < .05. **p < .001 (two-tailed). model, all of the variables also remained significantly corre- household decision-making autonomy have higher control lated, such as age (β = .234, SE = .043, p < .001), education to exercise their reproductive rights. The adjusted-R value (β = .245, SE = .049, p < .001), power in household decision showed that approximately 75.2% of variance in the making (β = .221, SE = .057, p < .001), control over financial respondents’ RRSI was explained by the predictor vari- activities (β = .235, SE = .066, p < .001), and the extent of ables (Table 3). No problems were observed because all freedom of movement (β = .143, SE = .044, p < .05). More the variables had a variance inflation factor (VIF) score than 81% of variance in the respondents’ reproductive behav- below 4 (Rogerson, 2001). ior index was explained by the predictor variables. Bivariate regression analyses revealed significant cor- Finally, on the subject of the respondents’ control to relations between women’s autonomy and reproductive exercise reproductive rights (RRSI), all of the aforemen- rights status (β = .862, SE = .035, p < .001), along with tioned variables in the first two models were found to be both of the proxy variables, including the sexual behavior significantly correlated in bivariate regression and inte- index (β = .915, SE = .031, p < .001) and reproductive grated in the multiple linear model. Except for extent of behavior index (β = .915, SE = .031, p < .001). In particu- freedom of movement, all the variables found to correlate: lar, women with higher autonomy status had higher control control over financial activities (β = .265, SE = .070, p < to exercise their reproductive rights and greater control in .001) followed by power in household decision making (β both sexual and reproductive decision making. The = .258, SE = .061, p < .001), age (β = .225, SE = .046, p < adjusted-R values showed that 83.6%, 83.6%, and 74.2% .001), and educational status (β = .202, SE = .053, p < of variance in the respondents’ sexual behavior, reproduc- .001). More specifically, women who were older, had more tive behavior, and RRSI was explained by the women’s education, had more control over finances, and had more autonomy status (Table 4). Biswas et al. 7 Table 4. Bivariate Association Between Women’s Autonomy and Reproductive Rights Along With Two Proxy Indices (N = 200). Bivariate Independent Dependent b SE-B β 95% CI p Women’s autonomy index Sexual behavior index .978 .031 .915 0.917 1.039 .000** Reproductive behavior index .972 .031 .915 0.912 1.033 .000** Reproductive rights status index .843 .035 .862 0.774 0.913 .000** Note. CI = confidence interval. a 2 2 R = .837, adjusted R = .836. b 2 2 R = .837, adjusted R = .836. c 2 2 R = .744, adjusted R = .742. *p < .05. **p < .001 (two-tailed). as spending money for different purposes and control over Discussion their own income, credit, and savings, had more control The study findings suggest that women’s higher autonomy regarding their sexual and reproductive behavior. significantly influences their control to exercise their repro- In addition, the study showed that women’s freedom of ductive rights along with both of the proxy variables of repro- movement was also markedly linked with the proxy vari- ductive rights (extent of power regarding sexual and ables of reproductive rights, that is, the extent of the respon- reproductive behavior indices). These findings are also consis- dents’ power regarding the sexual and reproductive behavior tent with earlier studies such as Dharmalingam and Morgan indices (Bloom et al., 2001; Haque et al., 2012; Rahman (1996), Haque et al. (2012), Nigatu et al. (2014), Rahman et al., 2011; Rahman et al., 2014). (2012), and Rahman et al. (2014). From a critical point of Women’s autonomy status, in particular, was influenced view, the aforementioned studies focused only on one or two by their sociodemographic characteristics, such as age and issues related to reproductive health; for instance, Rahman educational status (Haque et al., 2012; Rahman et al., 2014), et al. (2014) indicated that in Bangladesh, married women’s and in the present study, autonomous status was common current as well as future intention to use contraception is sig- among women who possessed certain characteristics. The nificantly associated with their household decision-making study findings suggested that both women’s age and educa- autonomy. Similarly, Rahman (2012) suggested that greater tional status were associated with their reproductive rights household decision-making autonomy decreases the likeli- status and influenced women’s sexual and reproductive hood of experiencing an unintended pregnancy. Moreover, behavior (Al Riyami, Afifi, & Mabry, 2004; Haile & Haque et al.’s quantitative study in Bangladesh documented Enqueselassie, 2006; Haque et al., 2012; Rahman et al., the importance of maternal autonomy in greater utilization of 2014; Schuler & Hashemi, 1994). reproductive health care services among young mothers. However, the present study endeavored to focus on all of the From a research standpoint, some limitations should be indicators of reproductive rights, because in a patriarchal set- identified in addition to the present study’s findings. First, ting such as Bangladesh, all reproductive rights issues, such as the study focused only on rural women, and therefore a com- access to safe and affordable contraception, the right to safe parative study and discussion with urban counterparts would and healthy pregnancies, and access to reproductive health give a more comprehensive background. Second, the current care utilization, are mutually interlinked and to a great extent study integrated only three different dimensions in explain- influenced by autonomy paradigm of women as well as the ing women’s autonomy, that is, the extent of household deci- power structure of both males and females (Haque et al., 2012; sion-making power, control over financial resources, and the Rahman, 2012; Rahman et al., 2014; Story & Burgard, 2012). extent of freedom of movement. In addition, other dimen- Household decision-making autonomy was considered sions, such as the extent of participation in social and politi- the first female domain over all autonomy indices, and the cal activities and exposure to mass media, would afford the research found it was considerably connected with the repro- study a stronger basis for generalization because the concept ductive and sexual behavior indices of women. These find- of women’s autonomy is not homogeneous and varies ings are consistent with those in various earlier studies, according to cultural setting. Third, the study was conducted including Binyam, Mekitie, Tizta, and Eshetu (2011); Haque on a relatively small sample; a larger sample would enable et al. (2012); A. H. T. Khan (1997); and Rahman et al. (2014). the study to produce more generalizations. In accordance with previous studies by Engle, Menon, and Despite these drawbacks, this pioneering study sought to Haddad (1999); Haque et al. (2012); and Nigatu et al. (2014), examine the association between women’s autonomy and women’s financial autonomy was found to be significantly various indicators of reproductive rights together because concomitant with their sexual and reproductive behavior indi- they are mutually interlinked and strongly connected with the ces. Women who have control over financial resources, such power structure of both males and females in a patriarchal 8 SAGE Open society. Understanding the real situation regarding women’s Al Riyami, A., Afifi, M., & Mabry, R. M. (2004). Women’s auton- omy, education and employment in Oman and their influence reproductive health and rights through a single indicator is on contraceptive use. Reproductive Health Matters, 12(23), impractical; for instance, access to safe and affordable contra- 144-154. doi:10.1016/S0968-8080(04)23113-5 ception influences both fertility status and the likelihood of Amnesty International USA. (2007). Stop violence against women: experiencing unintended pregnancy among Bangladeshi Reproductive rights. Author. Retrieved from http://www. women (Rahman, 2012; Rahman et al., 2014). In addition, amnestyusa.org/our-work/campaigns/my-body-my-rights women’s access to reproductive health care utilization signifi- Balk, D. (1994). Individual and community aspects of women’s cantly influences the state of safe and healthy pregnancy in status and fertility in rural Bangladesh. Population Studies, 48, Bangladesh (Haque et al., 2012; Story & Burgard, 2012). 21-45. doi:10.1080/0032472031000147456 However, the present study uncovered significant informa- Bangladesh Bureau of Statistics. (2010). Multiple Indicator Cluster tion that could serve as a starting point to ensure women’s Survey (MICS) 2009. Bangladesh Bureau of Statistics, Ministry reproductive rights in Bangladesh. of Planning, Government of the People’s Republic of Bangladesh. Bangladesh Bureau of Statistics. (2011). District statistics 2011: Bagerhat. Bangladesh Bureau of Statistics, Ministry of Conclusion Planning, Government of the People’s Republic of Bangladesh. Retrieved from http://220.127.116.11/WebTestApplication/ Because women’s autonomy is closely linked with their con- userfiles/Image/District%20Statistics/Bagerhat.pdf trol to exercise reproductive rights, to improve women’s Basu, A. M. (1992). Culture, the status of women and demographic reproductive rights in a patriarchal setting, female autonomy behaviour. Oxford, UK: Clarendon. must be considered a sociocultural determinant for ensuring Binyam, B., Mekitie, W., Tizta, T., & Eshetu, G. (2011). Married their reproductive rights. In Bangladesh and the rest of the women’s decision making power on modern contraceptive use developing world, research on the women’s autonomy para- in urban and rural southern Ethiopia. BMC Public Health, 11, digm in connection with various reproductive issues is needed Article 342. doi:10.1186/1471-2458-11-342 to develop effective strategies and policies to ensure women’s Bloom, S. S., Wypij, D., & Gupta, M. D. (2001). Dimensions of women’s autonomy and the influence on maternal health reproductive rights because they are considered legal rights. care utilization in a North Indian city. Demography, 38, 67-78. Retrieved from http://siteresources.worldbank.org/ Declaration of Conflicting Interests INTPUBSERV/Resources/477250-1186007634742/das- The author(s) declared no potential conflicts of interest with respect gupta.india.2001.pdf to the research, authorship, and/or publication of this article. Brunson, E. K., Shell-Duncan, B., & Steele, M. (2009). Women’s autonomy and its relationship to children’s nutrition among the Rendille of Northern Kenya. 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Women’s work, autonomy, and birth control: Evidence from two where SS = sample size; SS = sample size, according to pop- South Indian villages. Population Studies, 50, 187-201. ulation; Z = confidence level (i.e., 1.96 for 95% confidence doi:10.1080/0032472031000149296 level); P = percentage selecting a choice (i.e., 0.5 used for Dunkle, K. L., Jewkes, R. K., Brown, H. C., Gray, G. E., McIntryre, sample size needed); C = confidence interval (i.e., 2.5); POP = J. A., & Harlow, S. D. (2004). Transactional sex among women population. in Soweto, South Africa: Prevalence, risk factors and associa- 2. The legal age at marriage for girl in Bangladesh is 18 years. tion with HIV infection. Social Science & Medicine, 59, 1581- 3. BDT stands for Bangladesh Taka (currency). 1592. doi:10.1016/j.socscimed.2004.02.003 Dyson, T., & Moore, M. (1983). On kinship structure, female References autonomy, and demographic behavior in India. Population and Ahmed, S. M. (2005). 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Progress and stagnation: Changes in fertility National Institute of Population Research and Training, and women’s position in an Indian village. Population Studies, 46(20), 195-212. doi:10.1080/0032472031000146196 Government of Bangladesh. 10 SAGE Open Wahed, T., & Bhuiya, A. (2007). Battered bodies & shattered minds: from the University of Khulna in Bangladesh. His research interests Violence against women in Bangladesh. The Indian Journal of include gender and reproduction, sociology of sex and gender, climate Medical Research, 126, 341-354. Retrieved from http://www. change adaptation, and public health and development. isca.in/IJSS/Archive/v2i1/7.ISCA-IRJSS-2012-077.pdf Taufiq-E-Ahmed Shovo is an assistant professor of sociology at Wikipedia. (2015). Bagerhat district. Retrieved from https:// Khulna University, Bangladesh. He received his Master’s of Social en.wikipedia.org/wiki/Bagerhat_District Science and Bachelor of Social Science (Hons.) in sociology from Woldemicael, G. (2007). Women’s autonomy and reproductive the University of Khulna in Bangladesh. He teaches courses on preferences in Eritrea. Journal of Biosocial Science, 41, 161- social problems and issues, introduction to anthropology, human 181. doi:10.1017/S0021932008003040 ecology and environment, and industrial sociology at undergradu- Woldemicael, G., & Tenkorang, E. Y. (2010). Women’s autonomy and ate-level classes. His teaching and research interests include migra- maternal health-seeking behavior in Ethiopia. Maternal & Child tion, family, youth studies, sociology of sex and gender, develop- Health Journal, 14, 988-998. doi:10.1007/s10995-009-0535-5 ment policy, and child rights. World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health. Retrieved from Moutithi Aich is currently working as a health officer in the project http://apps.who.int/iris/bitstream/10665/70501/1/WHO_ titled Bangladesh Rajshahi Division Maternal and Child Nutrition RHR_HRP_10.22_eng.pdf Project by World Vision, Bangladesh. She received her BSc (Hons.) World Health Organization. (2014). Sexual and reproductive health in food and nutrition from the University of Khulna in Bangladesh and rights: A global development, health, and human rights and currently a postgraduate student of Master of Public Health in priority. Retrieved from http://who.int/reproductivehealth/pub- North South University of Bangladesh. Her research interests lications/gender_rights/srh-rights-comment/en/ include gender and reproduction, health, nutrition, and food security. Author Biographies Sykat Mondal completed Bachelor of Social Science (Hons.) in Amit Kumar Biswas is a sociologist seeking to better understand sociology from the University of Khulna in Bangladesh and cur- human behavior, interaction, and organization within the context of rently enrolled as a postgraduate student of Master of Social Science larger social, political, and economic forces. He received his Master’s in sociology. His research interests include sociology of sex and of Social Science and Bachelor of Social Science (Hons.) in sociology gender, and public health and development.
SAGE Open – SAGE
Published: Jun 7, 2017
Keywords: autonomy; reproductive rights; decision making; control over finance; freedom; sexual and reproductive behavior
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