Effect of clinical engagement on value, standardisation, decision-making and savings in NHS product procurement.

BACKGROUND: UK healthcare expenditure is now £193.8 billion a year. The procurement function is seen as central to driving efficiencies within the NHS. This comes with an increasing onus on clinicians, including nurses and allied health professionals, to accept procurement outcomes to realise efficiency savings, with or without prior engagement. AIMS: This empirical study seeks to examine whether clinical engagement in the procurement of healthcare products in the NHS is necessary to achieve value, savings and standardisation; it will thereby address a gap in the research. METHODS: A multi-method qualitative case study design was used, which included a survey and eight semi-structured interviews. FINDINGS: Results identified three factors that influence the achievement of value, savings and standardisation around clinical engagement: micro-level processes for clinical engagement; clinical stakeholders and clinical procurement professionals as experts at the centre of procurement activity; and clinical value in standardisation. A shift away from standardisation to resilience was identified, resulting from current market supply pressures. CONCLUSION: This research brings empirically derived findings to address gaps in research, supports the benefit of clinical engagement through specific forums for collaboration at a trust level and provides a clinical/expert impact/preference matrix as a resource for procurement professionals to facilitate clinical engagement.

How does women's empowerment relate to antenatal care attendance? A cross-sectional analysis among rural women in Bangladesh.

BACKGROUND: In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status. METHODS: We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects. RESULTS: Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status. CONCLUSIONS: Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019.

Factors associated with decision-making power of married women to use family planning in sub-Saharan Africa: a multilevel analysis of demographic health surveys.

BACKGROUND: In sub-Saharan Africa, there are several socio-economic and cultural factors which affect women's ability to make decision regarding their own health including the use of contraceptives. Therefore, the main aim of this study was to determine factors associated with decision-making power of married women to use family planning service (contraceptives) in sub-Saharan Africa. METHODS: The appended, most recent demographic and health survey datasets of 35 sub-Saharan countries were used. A total weighted sample of 83,882 women were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of decision-making power of married women to use family planning service in sub-Saharan countries. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential variables included in the final model. RESULTS: Married women with primary education (AOR = 1.24; CI:1.16,1.32), secondary education (AOR = 1.31; CI:1.22,1.41), higher education (AOR = 1.36; CI:1.20,1.53), media exposure (AOR = 1.08; CI: 1.03, 1.13), currently working (AOR = 1.27; CI: 1.20, 1.33), 1-3 antenatal care visits (AOR = 1.12; CI:1.05,1.20), ≥ 4 ANC visits (AOR = 1.14;CI:1.07,1.21), informed about family planning (AOR = 1.09; CI: 1.04, 1.15), having less than 3 children (AOR = 1.12; CI: 1.02, 1.23) and 3-5 children (AOR = 1.08; CI: 1.01, 1.16) had higher odds of decision-making power to use family planning. Mothers who are 15-19 (AOR = 0.61; CI: 0.52, 0.72), 20-24 (AOR = 0.69; CI: 0.60, 0.79), 25-29 (AOR = 0.74; CI: 0.66, 0.84), and 30-34 years of age (AOR = 0.82; CI: 0.73, 0.92) had reduced odds off decision-making power to use family planning as compared to their counterparts. CONCLUSION: Age, women's level of education, occupation of women and their husbands, wealth index, media exposure, ANC visit, fertility preference, husband's desire in terms of number of children, region and information about family planning were factors associated with decision-making power to use family planning among married women.

Utilization of Postnatal Care Service in Indonesia and its Association with Women's Empowerment: An Analysis of 2017 Indonesian Demographic Health Survey Data.

OBJECTIVE: The coverage of postnatal care (PNC) is among the lowest globally when compared with other maternal and child interventions. This study aims to assess PNC utilisation in Indonesia and its association with women's empowerment indicators to provide evidence for the need for policy change. METHODS: Data from the 2017 Indonesian Demographic Health Surveys was analyzed for any use of PNC, early first PNC (within 2 days of birth) and PNC after discharge for newborns. Women's empowerment factors were calculated using a principal component analysis of 17 indicators. The association between women's empowerment factors and PNC was assessed using logistic regression adjusted for covariates and complex survey design. RESULTS: The prevalence of any PNC by skilled professionals in Indonesia was high but PNC after discharge was very low. Labor-force participation and women's knowledge level were associated with any PNC, but the association between women's knowledge level and any PNC was modified by place of birth. Disagreement towards justification of wife beating and women's knowledge level were associated with early PNC but the association was modified by place of birth. Decision-making power was also associated with early PNC but modified by infant's gender. Disagreement towards justification of wife beating was negatively associated with PNC after discharge, but the association between decision-making power and PNC after discharge was modified by the infant's size at birth. CONCLUSIONS FOR PRACTICE: PNC coverage after discharge in Indonesia needs improvement. Women's empowerment indicators need to be addressed in improving PNC coverage.

Women's household decision-making power and contraceptive use in Mali.

BACKGROUND: Utilization of contraceptives remains low in several countries in sub-Saharan Africa despite evidence of its benefits. Several factors are associated with contraceptive use. However, little is known about the association between women's decision-making capacity and the utilization of contraceptives in Mali. This study sought to determine the effect of women's household decision-making power on contraceptive use in Mali. METHODS: This study involved a cross-sectional analysis of data from the 2018 Mali Demographic and Health Survey. A total of 7893 married women were included in the final analysis. A binary logistic regression analysis was conducted with statistical significance set at p < 0.05. RESULTS: Contraceptive use among married women in Mali was 17.1%. The odds of using contraceptives were higher among women with joint decision-making with their husbands on how to spend respondent's earnings [aOR = 1.79; 95% CI = 1.12, 2.85], joint decision-making with their husbands on what to do with their husband's earnings [aOR = 1.43; 95% CI = 1.12, 1.83], and joint decision-making with husband on large household purchases [aOR = 1.32; 95% CI = 1.10, 1.59]. Deciding alone on a visit to family or relatives was associated with lower odds of contraceptive use [AOR = 0.72; 95% CI = 0.58, 0.89]. CONCLUSION: The study has revealed that joint household decision-making is positively associated with contraceptive use. Therefore, to achieve Sustainable Development Goal 3, the ministry for the advancement of women, children and families and related stakeholders must unearth strategies to empower women in joint decision-making and encourage men's involvement in contraceptive decision-making.

Twelve-month organizational study examining the associations among behavioral healthcare worker's perceptions of autonomy, decision-making power, organizational commitment, and burnout: Reconceptualizing the role of commitment in shaping staff member experiences of the work environment.

Previous research has demonstrated that behavioral healthcare workers' experiences of autonomy and decision-making power in the workplace are positively associated with their commitment to the organization and negatively associated with occupational burnout. Models examining the relationships between workplace climate and staff member well-being generally conceptualize workplace climates as predictors of individual commitment and burnout. However, the relationships among these constructs have primarily been explored in cross-sectional study designs. The current study adds to the existing literature by examining the relationships among perceived autonomy and decision-making power in the organizational climate, and individual levels of organizational commitment and burnout over a 12-month period (N = 43). The study was done in a public hospital's behavioral healthcare department in the Western New York region. Cross-lagged panel analyses were conducted to assess if time-one scores on perceived autonomy and decision-making power predicted time-two scores of organizational commitment and burnout. Findings indicate that, contrary to popular conceptualization, individual staff member's commitment to the organization predicted future states of perceived autonomy and decision-making power. Individual commitment to the organization may be a driving factor in how staff members experience and perceive the service environment.

Women's decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso.

BACKGROUND: In 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women's lack of decision-making power. The objective of the study is to investigate women's decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso. METHODS: A descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis. RESULTS: A conceptual framework describing women's participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women's decision-making power. CONCLUSION: In light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women's decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women's health and empowerment.

Exclusive breastfeeding in rural Western China: does father's co-residence matter?

BACKGROUND: China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father's co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father's co-residence and breastfeeding family support as well as maternal decision-making power. METHODS: A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding. RESULTS: The exclusive breastfeeding (0-6 months) rate was 16% in rural western China. Fathers' co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227-0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (ß =0.109, P = 0.105; ß =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (ß = - 0.196, P = 0.007). CONCLUSIONS: Fathers' co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father's education to help them better involvement and show more respect to mothers' decisions.

Low acceptance of intimate partner violence by pregnant women in Uganda predicts higher uptake of HIV self-testing among their male partners.

Introduction: Heterosexual couples are at high risk for HIV acquisition in sub-Saharan Africa, and HIV self-testing (HST) is an additional approach to expand access to HIV testing services. However, it is not well known how gender equality is associated with HST.Methods: We used intervention-arm data from a cluster-randomised controlled HST intervention trial (N = 1 618) conducted in Uganda to determine the association between attitudes towards intimate partner violence (IPV), decision-making power and male partner's uptake of HST among heterosexual couples expecting a child in south-central Uganda. The original study question was to assess the impact of providing pregnant women with HST kits to improve male partner's HIV testing rates. For this analysis, the primary exposures were gender equality (measured by male partner's and female partner's attitudes towards IPV and the female partner's household decision-making power), and the primary outcome was the male partner's uptake of HST. Multivariate logistic regression was used for analysis.Results: We found that male partner HST uptake did not vary depending on male partner's attitudes towards IPV or decision-making power; however, male partner HST uptake did depend on the female partner's attitude towards IPV, with 1.76 times more testing (95% CI 1.06-2.92) in couples where the woman had "medium" versus "high" acceptance of IPV, and 1.82 times more testing (95% CI 1.08-3.08) in couples where the woman had "low" versus "high" acceptance of IPV.Conclusions: This study shows the importance of appropriate negative attitudes by women to IPV in increasing male partner's HST uptake to integrate HST into national health care policies.

Contraceptive use in Cambodia: does household decision-making power matter?

In Cambodia, the growth of family planning services and socio-economic development have resulted in a spectacular rise in contraceptive prevalence rate and an equally remarkable reduction in contraceptive use differentials. With rising educational levels and increased participation in the modern labour market, Cambodian women are playing an increasingly pivotal role in household decision-making. This study used data from three rounds of Cambodia Demographic and Health Surveys to elucidate trends and patterns of contraceptive use. It then examined the determinants of contraceptive use through the use of logistic regression. The central hypothesis to be tested was whether or not women's involvement in household decision-making affected contraceptive use. Multivariate analysis showed that apart from the number of living children, women's work status and education of both men and women had a more significant impact on contraceptive use, as compared to women's power in household decision-making. More effort is needed to empower women in all aspects in order to reduce the socio-economic differentials in contraceptive use and improve their reproductive health, in line with the goal of the global agenda of the sustainable development goals (SDGs) to leave no one behind.

Women's empowerment and the use of antenatal care services: analysis of demographic health surveys in five Southeast Asian countries.

Women's empowerment and use of antenatal care (ANC) services remain important in the Association of Southeast Asian Nations (ASEAN). This assessed the association between women's empowerment and ANC use in five ASEAN countries. ANC information for the most recent births of 29,444 currently married women in the last 5 years preceding the Demographic Health Survey was analyzed (Cambodia [DHS2014], Indonesia [DHS2012], Myanmar [DHS2015-2016], Philippines [DHS2013], and Timor-Leste [DHS2009]). Analyses used multiple logistic regression adjusting for complex sampling designs. The number of ANC visits was positively associated with labor-force participation in Cambodia, the Philippines, and Timor-Leste; with disagreement with justification for wife beating and women's knowledge level in Cambodia, Indonesia, Myanmar; and with women's decision-making power in Cambodia and Indonesia. The association of women's empowerment variables with timing of the first ANC visit was not as evident as that for number of ANC visits. Compared to adult mothers, adolescent mothers with medium knowledge level had less odds of attending ≥4 ANC in Cambodia, and adolescent mothers with the poorest labor-force participation had lower odds of attending the first ANC early in Myanmar. Tailored policy on women's improved access to labor force and health information in each country may be needed to improve ANC use.

Household decision-making power and the mental health and well-being of women initiating antiretroviral treatment in Oromia, Ethiopia.

Low decision-making power (DMP) has been associated with HIV seropositivity among women in sub-Saharan Africa. As treatment accessibility and life expectancy for HIV-positive individuals increase, greater attention to the mental health and well-being of HIV-positive women is needed. This study examined whether low DMP was associated with psychological distress, social support or health-related quality of life (HRQoL) among women initiating ART. The sample included 722 women aged 18 or older initiating ART during 2012-2013 at six HIV clinics in Oromia, Ethiopia. DMP was assessed with five questions about household resource control and decision-making. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10). HRQoL was assessed with the overall subscale of the HIV/AIDS-Targeted Quality of Life instrument. Multivariable logistic regression analyses controlled for age, education, and location (urban/rural). Most respondents (63%) reported high DMP, followed by medium (27%) and low (10%) DMP. More than half (57%) reported psychological distress. Compared to medium DMP, low DMP among married or cohabitating women was associated with greater odds of low social support (aOR: 1.9 [1.3, 2.9]; high DMP among women not in a relationship was associated with greater odds of low social support (aOR: 4.4 [2.4, 8.1]) and psychological distress (aOR: 1.7 [1.1, 2.6]). Interventions to reduce psychological distress among women initiating ART should consider the familial context, as high DMP among women not in a relationship was associated with psychological distress. High DMP may indicate weak social ties and fewer material resources, particularly among women not in a relationship.

Factors affecting modern contraceptive use among fecund young women in Bangladesh: does couples' joint participation in household decision making matter?

OBJECTIVES: The purpose of the study was to explore the association between couples' joint participation in household decision making and modern contraceptive use (MCU) among fecund (physically able to bear child) young women in Bangladesh. METHODS: This study utilized a cross-sectional data (n = 3507) extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. Differences in the utilization of modern contraceptives (MC) by socio-demographic characteristics were assessed by χ2 analyses. Binary logistic regression was used to identify the associated factors of usingMC, and the odds ratio with a 95% CI was computed to assess the strength of association. Multicollinearity was also checked by examining the standard errors in the fitted model. RESULTS: Desire for a child after two years go by and no child at all contributed the most to increasing MCU followed by receiving family planning (FP) methods from FP workers. Couples' joint decision making power on women's health care, child's health care and visiting family members or relatives emerged as the third most influential factor that might be associated with MCU. CONCLUSIONS: Since spousal joint decision making increases the likelihood of using MC, government should include strategic interventions in FP programs to elevate women's status through creating educational and employment opportunities and encouraging more visible involvement in household decision making.

Household-level data on well-being, inequalities, and social capital in Western Province, Zambia.

This article presents survey data from households from the Muoyo-Mukukutu area in Western Province, Zambia based on stratified sampling. Data from 411 households were collected using a questionnaire survey from 2022. Understanding the complexities of well-being is crucial for informing policies to enhance the quality of life and reduce multidimensional poverty in developing countries. Hence, the survey focuses on subjective and objective well-being and their determinants. Survey data contains details on various dimensions of objective well-being, such as living standards, health, and nutrition. It also covers the issue of subjective well-being (life satisfaction), including the related concept of freedom of choice. Moreover, we collected detailed information about diverse forms of inequalities and deprivations at the societal and intra-household level, paying particular attention to the areas of social capital and decision-making power. Additionally, the data contain details about the relationships with and attitudes to traditional leaders and statutory government representatives, respondents' economic activities and aspirations (with a special focus on agriculture), and their various socio-demographic characteristics. Individual survey results can be compared with a robust set of data as we intentionally used questions applied in other international surveys when possible.

Prevalence of Contraceptive Non-use Due to Husbands/Partners Influence Among Married Women in Ethiopia: A Multilevel Analysis Using Demographic and Health Survey 2016 Data.

Background: In Ethiopia women with their husbands/partners are the decision-makers for contraceptives non-use suffered either due to the consequence of unintended pregnancy or due to the indirect impact of the secret use of contraceptives from their husbands/partners. Despite this challenge, there is a dearth of evidence about the magnitude of husbands/partners' decision-makers on contraceptives n non-used in Ethiopia. Objective: This study was aimed to assess the magnitude of husbands'/partners decisions on contraceptive non-use and associated factors among married and non-contraceptive user reproductive-age women in Ethiopia. Methods: The study was conducted based on Ethiopian demographic and health survey 2016 data which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 5,458 married and non-contraceptive user reproductive-age women were taken. A multilevel logistic regression model was used because of the data nature hierarchical, and variables with p ≤ 2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. Adjusted odds ratio with 95% CI was used to declare both the direction and strength of association and variables with p < 0.05 were considered statistically significant with the outcome variable. Results: Husband decision-making power on contraceptive non-use was 10.44% [9.65-11.28%]. Husband's educational level higher (adjusted odds ratio (AOR = 2.6; CI 1.4-4.7), being Muslim, protestant, and others in religion (AOR = 2.4; CI 1.7-3.5), (AOR = 2.1; CI 1.4-3.1), (AOR = 4.5; CI 2.3-8.5), respectively, media exposure (AOR = 1.4; CI 1.0-1.8), husband wants more children (AOR = 3.7; CI 2.8-4.8), husband desire did not know (AOR = 1.4; CI 1.1-1.9), information about family planning (AOR = 0.6; CI 0.4-0.8), visited by field worker (AOR = 0.7; CI 0.5-0.9), visited health facility (AOR = 0.6; CI 0.4-0.7), and community husband education high (AOR = 1.6; CI 1.1-2.4) were statistically significant with husband decision making power on contraceptive non-use. Conclusion: In Ethiopia 1 out of 10 married and non-pregnant women is influenced by their husband/partner's decision-making power of non-use contraceptives. Husband's educational level high, religion (Muslim, protestant, and others), media exposure, husband's desire for children (husband wants more and does not know), and community husband education were variables positively associated with the outcome variable; whereas having information about family planning, visited by field worker, and visited health facility were negatively associated husband decision making power for non-use contraceptive in Ethiopia.

Factors associated with decision-making power on family planning utilization among HIV-positive women attending public health facilities in Eastern Ethiopia.

BACKGROUND: Family planning for HIV-positive women has numerous advantages. However, the need of family planning utilization is challenged by women's nonautonomous decision-making power. Therefore, this study aimed to examine the level and associated factors of decision-making power to utilize family planning among HIV-positive married women. METHODS: A facility-based cross-sectional study was conducted from March to June 2020 among 363 HIV-positive married women on ART, using systematic random sampling technique. Logistic regression analysis was used to identify variables that affect women's decision-making power on family planning utilization. Statistical significance was declared at p-value < 0.05 with 95% confidence interval and strength of association was reported by adjusted odds ratio. RESULTS: Overall 55.2% (95% CI: 49.9-60.5) of the women had decision-making power on family planning utilization. Women's having good knowledge (AOR: 2.87, 95% CI: 1.52-5.40), favorable attitude (AOR: 1.96, 95% CI: 1.13-3.38), women's getting family planning counseling in ART clinics (AOR: 2.04, 95% CI: 1.16-3.59), women who get integration service of FP and ART (AOR: 1.83, 95% CI:1.07-3.12) were factors independently associated with women decision-making power on family planning utilization. CONCLUSION: Decision-making power to utilize family planning among married HIV-positive women was low. Factors like poor knowledge about family planning, dissatisfaction with family planning service, not getting counseling about family planning in ART clinics, and not receiving family planning service in ART clinics were independently associated with women's decision-making power on family planning. Infrastructure linked with the health facility, knowledge, and attitudinal factors should all be combined in future family planning programs.

What Type of Housework Happiness Do You Prefer? Does Gender and Health Matter? A Taiwanese Study.

The purposes of this study was to discover the circumstances in which people gain happiness from performing housework and to understand gender differences in housework-related happiness. We used national data from the Taiwan Social Change Survey conducted in 2011. Only married and cohabiting respondents were included in this study (N = 1250). Two types of housework happiness were developed: the goal satisfaction type (GST) and the activity enjoyment type (AET), based on interview results in pilot studies and the concept of positive psychology. We found that the significant variables on the two types of housework-related happiness for the total sample were gender, socioeconomic status, gender role attitude, decision-making power, relative feminine housework, and respondent's health. In addition, the effects on the two types of housework-related happiness for males and females are different. Most people derive happiness from housework if their preferences for type of housework and their personal characteristics are matched. It is possible to transform an otherwise monotonous daily activity into a source of happiness through the process of understanding your housework preference type, learning to enjoy the beauty of housework, and creating fun with chores for families. However, the survey (TSCS) used in this study was carried out over 10 years ago (2011) and the results may be somewhat different in Taiwan today.

Perinatal Mental Health Problems in Rural China: The Role of Social Factors.

Background: Perinatal mental health is important for the well-being of the mother and child, so the relatively high prevalence of perinatal mental health problems in developing settings poses a pressing concern. However, most studies in these settings focus on the demographic factors associated with mental health problems, with very few examing social factors. Hence, this study examines the prevalence of the depressive, anxiety and stress symptoms among pregnant women and new mothers in rural China, and the associations between these mental health problems and social factors, including decision-making power, family conflicts, and social support. Methods: Cross-sectional data were collected from 1,027 women in their second trimester of pregnancy to 6 months postpartum in four low-income rural counties in Sichuan Province, China. Women were surveyed on symptoms of mental health problems using the Depression, Anxiety, and Stress Scale (DASS-21) and social risk factors. Multivariate logistic regression analyses were conducted to examine social risk factors associated with maternal mental health problems, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results: Among all respondents, 13% showed symptoms of depression, 18% showed symptoms of anxiety, 9% showed symptoms of stress, and 23% showed symptoms of any mental health problem. Decision-making power was negatively associated with showing symptoms of depression (OR = 0.71, CI: 0.60-0.83, p < 0.001) and stress (OR = 0.76, CI: 0.63-0.90, p = 0.002). Family conflict was positively associated with depression (OR = 1.53, CI: 1.30-1.81, p < 0.001), anxiety (OR = 1.34, CI: 1.15-1.56, p < 0.001), and stress (OR = 1.68, CI: 1.41-2.00, p < 0.001). In addition, social support was negatively associated with depression (OR = 0.56, CI: 0.46-0.69, p < 0.001), anxiety (OR = 0.76, CI: 0.63-0.91, p = 0.002), and stress (OR = 0.66, CI: 0.53-0.84, p < 0.001). Subgroup analyses revealed that more social risk factors were associated with symptoms of anxiety and stress among new mothers compared to pregnant women. Conclusion: Perinatal mental health problems are relatively prevalent among rural women in China and are strongly associated with social risk factors. Policies and programs should therefore promote individual coping methods, as well as target family and community members to improve the social conditions contributing to mental health problems among rural women.

Empowerment and Intimate Partner Violence in Pakistan: Results From a Nationally Representative Survey.

Using empowerment theory, the current study examines antecedents of lifetime experience of intimate partner violence, intimate partner violence experienced in the last 12 months, emotional violence, and husbands' controlling behaviors toward their wives in Pakistan. Using data from a subsample of 658 women from the nationally representative Pakistan Demographic and Health Survey 2012-2013, this study examined whether empowerment variables, such as household decision-making power, economic decision-making power, and adherence to patriarchy, operationalized as justification of wife beating, contribute to intimate partner violence using logistic regression analyses. Results indicate that adherence to patriarchal norms, household decision-making power, and higher education was found to be associated with lifetime prevalence of intimate partner violence. Adherence to patriarchal norms, economic decision-making power, and higher education was found significantly associated with intimate partner violence in the past 12 months. Adherence to patriarchal norms was significantly associated with experiencing emotional violence as well as controlling behaviors by husbands. In conclusion, women's adherence to patriarchal norms is a reflection of the patriarchal society in which they live; indeed, this was found to be the most important predictor of women's experience of intimate partner violence, when different types of violence were assessed. Implications for social work practice are discussed.

Household Decision-Making and HIV Care Continuum Outcomes Among Women Living with HIV in Mozambique.

Gender inequality has been associated with HIV infection among women. Less is known about the relationship between gender inequality and HIV care continuum outcomes. This study assessed whether household decision-making power (DMP), one component of gender inequality, was associated with linkage to HIV care, antiretroviral therapy (ART) initiation, or retention in care among women living with HIV in Mozambique. The sample included 600 women ≥18 years of age newly diagnosed with HIV in Mozambique. Data were collected between April 2013 and June 2016. DMP was assessed with three questions about participation in decisions regarding: major household decisions, routine household decisions, and visits to family. Women who did not contribute to decision making in any domain were categorized as having low DMP. HIV care information was obtained from electronic medical records. Multivariable log-Poisson regression analyses were conducted to assess the relationship between DMP and HIV care continuum outcomes. Almost half (49%) of participants reported medium DMP, followed by high (39%) and low DMP (12%). In multivariable regression analyses, when compared with respondents with medium DMP, those with low DMP had a lower likelihood of retention in care 12 months after diagnosis [adjusted risk ratio (aRR) 0.69 (95% CI 0.49-0.98)]. There was no significant relationship between low DMP and linkage to HIV care or ART initiation. High DMP was not significantly associated with HIV outcomes assessed. Women who report low DMP may face barriers to long-term engagement in HIV care. Interventions to improve retention in care among women should consider the role of household decision making and gender inequality.