What Are Policies for Women and Unborn Babies

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Women'southward empowerment related to pregnancy and childbirth: introduction to special issue

BMC Pregnancy and Childbirth volume 17, Commodity number:352 (2017) Cite this article

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Empowerment is widely acknowledged as a process by which those who take been disempowered are able to increase their cocky-efficacy, make life-enhancing decisions, and obtain control over resources [ane,ii,iii]. In addition, empowerment is multi-dimensional – a woman may be empowered in one dimension or sphere (such equally fiscal) but non in another (such as in sexual and reproductive decision-making). Most countries now recognize the importance for girls and women to go more empowered, both equally a goal in itself, too every bit to achieve a more gender equitable society [4]. More recently, researchers have been assessing the contexts and mechanisms past which empowerment straight or indirectly affects various aspects of women's health [five,6,seven]. A amend understanding of the situations where greater empowerment is associated with improved health outcomes can aid policymakers in planning and prioritizing their investments.

Although associations betwixt women's empowerment and some aspects of their health, such as fertility and contraception, have been studied fairly extensively and seem to exist mostly positive [half-dozen, 8, ix], the relationship between women'south empowerment and pregnancy or childbirth, including abortion, has non received sufficient attention. Moreover, empowerment measures all the same need to exist critically evaluated [10, 11] and to cover a range of potential empowerment domains – psychological, social, political, economic and legal [8, ix, 12, 13]. The purpose of this special issue in BMC Pregnancy and Childbirth is to bring a multidisciplinary lens and varied methodologies to the key question of how women's empowerment relates to pregnancy and childbirth. By highlighting women's health concerns, rights, and empowerment, this special upshot aims to catalyze societal-level changes that will yield sustainable improvements in health and well-being for women on a global calibration.

This special issue is sponsored by the Women'southward Health, Gender, and Empowerment Center of Expertise (COE), a office of the University of California Global Health Found. The COE is comprised of faculty, staff and students from across the campuses of the University of California, along with practitioners and international partners. The COE promotes inquiry, educational activity, and community appointment at the intersection of health and empowerment in the US and globally. Collectively, it represents a broad variety of disciplines and approaches to improving women's health and empowerment.

In the fall of 2015, the COE put out an open call for long abstracts from multiple disciplines on the part of women'south empowerment on pregnancy and childbirth. We received a total of 52 submissions, which were evaluated past all managing editors using several criteria, including strength of the empowerment construct, methodology, clarity, significance, innovation, and suitability for the supplement. The superlative 16 submissions were invited to submit total papers. All selected articles included a construct that is conceptualized equally women's empowerment, defined broadly. To further develop and share ideas concerning the articles for this issue, the COE conducted a one-day research workshop, which was partially funded by the National Institutes of Wellness, National Middle for Advancing Translational Sciences, University of California, Los Angeles, Clinical and Translational Science Found (NIH NCATS UCLA CTSI Grant Number UL1TR000124). Members of the COE submitting full papers had the opportunity to give an oral presentation presenting their report's aims and methods, receive feedback and guidance on how to improve their study'south conceptualization, hear about other scholars' work for this special issue, and network with others interested in these topics. A total of 12 papers successfully went through peer review and were accepted for this special issue [14].

The 12 studies included in this special issue apply methodologies from different disciplines – anthropology, sociology, constabulary, census, and public health – to provide empirical data on an aspect of women's empowerment during a critical period of the reproductive life-course. The authors were as well asked to discuss how their inquiry results could affect futurity policies and programs. We accept grouped the articles into three main subject field areas, namely (i) fertility, family planning, and ballgame; (ii) antenatal care, delivery, and the perinatal catamenia; and (3) maternal health and mortality.

Empowerment and fertility, family planning, and abortion

Gipson and Upchurch [15] tried to understand intergenerational transmission of women'south empowerment by examining the influence of maternal status on the reproductive health outcomes of their daughters in the Philippines. They institute that maternal empowerment was an important determinant of daughters' timing of sexual debut, where greater empowerment led to delayed sex, regardless of whether contraception was used. Yet, maternal empowerment was not predictive of daughters' reports of unintended pregnancy. The authors ended that more research is needed to ameliorate sympathise the intervening mechanisms between onset of sex activity and unintended pregnancy.

While most researchers examine the bear upon of women'south empowerment on reproductive outcomes, Samari [xvi] flipped the question and innovatively investigated the impact of childbearing on women's empowerment trajectories in Egypt. She discovered that, for a young woman, giving nascence is associated with increased empowerment; the kickoff birth and each subsequent birth predicted improvements in all measures of empowerment (individual household controlling, joint household decision-making, and mobility), except one (financial autonomy). She besides plant that empowerment earlier in a woman's life is a predictor of subsequent empowerment in life.

In her paper, McReynolds-Pérez [17] focused on Argentine republic, where abortion is legally restricted. Using ethnographic methods, she described the strategies used by activist healthcare providers to apply the health exception to extend the range of legal abortion. She showed how the providers conceptualized their work equally opening opportunities for women to practise their reproductive autonomy.

Mandal et al. [18] make a methodological contribution in their review of the measures of empowerment and gender-related constructs used to evaluate family planning and maternal health programs in low- and heart-income countries. Their review covered 16 plan evaluations, of which only a minority used a validated measure out of a gender construct. The authors recommended that future evaluations examination for a articulate causal pathway from programme participation to an intermediary mensurate of gender, to the ultimate family unit planning or maternal health result that the intervention intends to ameliorate.

Empowerment and antenatal intendance, delivery, and the perinatal menstruation

In many countries, during childbirth, women experience some form of mistreatment such every bit abuse, neglect, rudeness, or bigotry. Diamond-Smith et al. [19] were interested in assessing whether women in the slums of Lucknow, India, who held more gender equitable views were less likely to be mistreated. They hypothesized that empowerment could be a protective mechanism. Using the Gender Equitable Men (GEM) Scale to measure women'south views of gender equality, they found that women who had more than equitable views about the role of women were less probable to report experiencing mistreatment during childbirth. Interestingly, they also discovered that the wealthiest slum women reported more mistreatment and had lower GEM scores. It is non known whether wealthier women were more than likely to have higher expectations of quality, perceive slights, or experience more than mistreatment. Those with higher GEM scores may be more assertive in obtaining proper treatment during childbirth.

Hoffkling et al. [xx] present a rare look at the experience of transgender men in the United States who retained their uteruses, became pregnant, and gave birth. Based on in-depth interviews with x transgender men, the authors noted that becoming pregnant was at times an empowering act, only the experience was ofttimes difficult and alienating due to the lack of part models, transphobia and violence, insufficient preparation among providers, and lack of research on testosterone and pregnancy. The authors described how patient strategies and healthcare provider behaviors affected their sense of empowerment. In the cease, the authors provided specific recommendations for how providers and clinics can deliver advisable care to transgender men during the pre-transition, pre-conception, prenatal, and postpartum periods.

The objective of McGowan et al.'southward [21] paper was to exam the consequence of the Centering Pregnancy model of group antenatal care on women'due south empowerment, compared to standard individual antenatal care. The Centering Pregnancy model encompasses interactive learning and community-building, along with brusque individual consultations four times during a pregnancy. To assess the touch on empowerment in Malawi and Tanzania, the authors used the Pregnancy-Related Empowerment Calibration, which evaluates the connectedness women feel with their caregivers, their participation in decision-making, and whether they engage in pregnancy-related good for you behaviors. They found that Centering Pregnancy seems to be empowering in Republic of malaŵi, but not in neighboring Tanzania, suggesting that the model is context-dependent and may be empowering in situations where women take less access to other forms of advice, including cell phones.

Garcia and Yim [22] conducted a systematic review of studies on empowerment and interventions aimed at improving empowerment in the perinatal catamenia. They described findings from 27 articles focusing on perinatal depressive symptoms or premature birth. All of the observational studies found significant associations between empowerment and depressive symptoms. The interventions were predominantly based on introducing the Centering Pregnancy model and most were successful in reducing preterm birth or depression birthweight, but just interventions that provided women with coping skills for hereafter stressors reduced women's perinatal depressive symptoms.

In their literature review, Afulani et al. [23] examined the links between women's empowerment and prematurity. Although they did not find evidence supporting a directly link between women'southward empowerment and prematurity, they did place some studies that linked empowerment to factors known to exist associated with prematurity and outcomes for premature babies, namely (1) preventing early spousal relationship and promoting family planning, which will filibuster get-go pregnancy and increase inter-pregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other factors associated with stress; and (four) promoting use of recommended health services during pregnancy and delivery to help preclude prematurity and ameliorate survival of their babies. Thus, improving women's empowerment could potentially forbid prematurity, but definitive proof is however lacking.

Empowerment and maternal health and mortality

In their article, Shimamoto and Gipson [24] examined the mechanisms past which women'due south status and empowerment affect skilled nascency bellboy apply in W Africa. They institute the structural equation modeling approach to exist useful in examining the complex and multidimensional constructs of women's empowerment and their effects. Despite variations across measures, many of the women'south condition and empowerment variables were positively associated with skilled nascency attendance. In particular, women's didactics demonstrated a substantial indirect effect, and college education was related to older age at first spousal relationship, which in turn was associated with higher levels of empowerment and the use of skilled nascency attendants. Interestingly, the authors did not discover pregnant associations between household decision-making and the use of skilled nascency attendance.

It is normally believed that greater women's empowerment will pb to improvements in their health, specially in areas where disparities are highest such equally maternal bloodshed. To exam this assumption, Lan and Tavrow [25] sought to assess various gender composite measures to determine if they were associated with reduced mortality at the national level, after controlling for other macro-level and directly determinants. They used data from 44 low-income countries, half of which are in Africa. After decision-making for all measures, they establish that none of the composite measures of gender equality were significantly linked to maternal mortality in these countries. Rather, skilled birth attendance was the chief factor associated with maternal mortality in non-African countries, and perceptions of corruption were most linked to bloodshed in African countries, where bloodshed is highest. They ended that improving gender equality and even skilled birth attendance is unlikely to reduce maternal bloodshed in Africa unless corruption is addressed.

Laws and social norms tin can collaborate to disempower women, or they tin can be used to empower them. In addition, laws often take a norm-setting part. In their paper, Dunn et al. [26] analyzed the impact of international and domestic decisions on access to high quality reproductive healthcare, showing that homo rights litigation tin can support other efforts to attain ameliorate care for women. They discussed several case studies in which national courts in countries such as Uganda, equally well as international treaty bodies, have challenged traditional structures that discriminate against women. They argued that human rights litigation is a women'southward empowerment strategy that needs greater attention, because they found that cases like Alyne 5. Brazil brought public awareness about discrimination confronting poor or marginalized women in the health system and provided leverage to civil order to make changes. Indeed, human rights litigation oftentimes complements political and social movements and provides momentum to bring change.

Through an overview of the collection of manufactures every bit a whole, the primal findings were:

1. i.

   Fertility, pregnancy and ballgame

   • Fertility decline does seem to be linked to better well-being for women, but patriarchal gender norms can inhibit its impact. Just equally empowerment seems to affect health, women who start childbearing later are more than likely to show more gender equitable attitudes. When mothers are empowered, their daughters are less probable to have sexual practice at a young age, but they still have the aforementioned rates of unintended pregnancies. Among slum women, higher rates of expressed empowerment are correlated with lower levels of mistreatment by wellness providers during delivery. Providers who are themselves empowered can actively expand women'southward access to abortion, even in countries where information technology is legally restricted. Overall, gender-integrated interventions related to family planning and maternal wellness are not evaluated with sufficiently consistent and validated measures of women'south empowerment to know if they are having the intended impact.

2. 2.

   Antenatal care, delivery, and the perinatal period

   • In some contexts, group antenatal care can be more empowering to women than the standard of care, possibly because information technology increases communication and learning among a peer group. Significant women who feel empowered through amend coping skills prior to birth seem less probable to suffer from postpartum depression. For transgender men who give birth, culturally competent and caring providers can help to make the feel more empowering, although transphobia in society tin can make these men feel alienated and broken-hearted. While a direct link cannot be found between disempowerment and low birthweight or premature births, the same programs that empower women (such equally programs to reduce intimate partner violence) can too exist expected to reduce prematurity.

3. iii.

   Maternal health and mortality

   • Women who are more empowered are more than likely to use skilled nascence attendants, which could be expected to lower maternal mortality. Nonetheless, in Africa, women's empowerment may not lead to changes in maternal mortality rates if health systems remain corrupt. Litigation tin can be an empowering strategy globally if it reframes maternal mortality as discriminatory and changes public norms.

In summary, this special event provides a platform for examining the relevance of empowerment to diverse features of women's (and transgender men's) experiences of pregnancy and childbirth across the globe. While women's empowerment itself however needs further conceptualization, this special result broadens the range of health outcomes that are often associated with empowerment, provides insights into the current country of noesis and research, and points to the importance of considering and measuring empowerment when designing and implementing programs.

Nosotros limited our deepest gratitude to Chiao-Wen Lan for managing all steps of the editorial procedure and ensuring that the authors received constructive, impartial reviews. We are besides grateful for the time and invaluable comments provided by the peer reviewers of this special upshot (those reviewers with an asterisk are besides members of the COE):

• Onyema Afulukwe, Middle for Reproductive Rights

• Koki Agarwal, Jhpiego – an chapter of Johns Hopkins University

• Saifuddin Ahmed, Johns Hopkins Academy

• Million Autry,* University of California, San Francisco

• Sarah Baum, Ibis Reproductive Health

• Joelle Brown,* University of California, San Francisco

• Julianna Deardorff, University of California, Berkeley

• Teresa DePineres, Fundación Oriéntame/ESAR

• Shari Dworkin,* Academy of California, San Francisco

• Linda Franck,* Academy of California, San Francisco

• Caitlin Gerdts, Ibis Reproductive Wellness

• Sarah Jane Holcombe,* University of California, Berkeley

• Rana Marie Jaleel,* University of California, Davis

• Randall Kuhn, University of California, Los Angeles

• Andrzej Kulczycki, University of Alabama, Birmingham

• Susan Meffert,* University of California, San Francisco

• Deborah Mindry,* University of California, Los Angeles

• Corrina Moucheraud,* Academy of California, Los Angeles

• Kavita Singh Ongechi, University of North Carolina at Chapel Hill

• Bhavya Reddy, Public Health Foundation of India

• Lara Stemple,* University of California, Los Angeles

• Kirsten Stoebenau, American University

• Dallas Swendeman,* University of California, Los Angeles

• Charlotte Warren, Population Quango

• Sheri Weiser,* Academy of California, San Francisco

• Mellissa Withers,* Academy of Southern California

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Funding

This article is part of a special effect on women's health, gender and empowerment, led and sponsored by the University of California Global Wellness Institute, Centre of Expertise on Women'south Wellness, Gender, and Empowerment.

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About this supplement

This article has been published as function of BMC Pregnancy and Childbirth Volume 17 Supplement 2, 2017: Special event on women's wellness, gender and empowerment. The total contents of the supplement are available online at https://bmcpregnancychildbirth.biomedcentral.com/manufactures/supplements/volume-17-supplement-two.

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Affiliations

1. Academy of California Global Health Institute Women's Health, Gender, and Empowerment Center of Expertise, San Francisco, CA, U.s.

   Ndola Prata, Paula Tavrow & Ushma Upadhyay

2. Section of Maternal and Child Health, UC Berkeley Schoolhouse of Public Health, 50 Academy Hall, Berkeley, CA, Usa

   Ndola Prata

3. Department of Community Health Sciences, UCLA Fielding Schoolhouse of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, United states

   Paula Tavrow

4. Section of Obstetrics, Gynecology, & Reproductive Science, University of California, San Francisco School of Medicine, San Francisco, CA, United states of america

   Ushma Upadhyay

Contributions

NP, PT, and UU conceptualized the special issue. NP, PT, and UU drafted the paper and revised the final draft. All authors have read and approved the final draft of the manuscript.

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Correspondence to Ndola Prata.

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Prata, Due north., Tavrow, P. & Upadhyay, U. Women's empowerment related to pregnancy and childbirth: introduction to special result. BMC Pregnancy Childbirth 17, 352 (2017). https://doi.org/ten.1186/s12884-017-1490-half-dozen

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• Published: 08 November 2017

• DOI : https://doi.org/10.1186/s12884-017-1490-vi

Keywords

• Skilled Birth Attendance
• Group Antenatal Care
• Human Rights Litigation
• Maternal Empowerment
• Gender Equitable Attitudes

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