Female empowerment and community-based productive associations: A systematic literature review / Empoderamiento femenino y asociaciones productivas comunitarias: Una revisión sistemática de literatura

Abstract Albeit its long trajectory on social sciences and gender studies, female empowerment promotion has gained a renewed protagonism because of its inclusion on the Millenium Development Goals and the Sustainable Development Goals. Among prioritized strategies to achieve this empowerment, international agencies and national governments have focused on gene-rating associative processes around productive activities. This study presents a systematic literature review to analyze the impact of community-based productive rural association's membership over different dimensions of female empowerment: resources, agency, and results. Then, a systematic literature review of five quantitative studies and eight qualitative studies is carried on. The analysis is organized according to each dimension of the empowerment process. In quantitative papers, the standardized size effects are estimated; a content analysis is made for qualitative papers. Results show that impacts of belonging to productive associations have been studied mostly from the empowerment approach as agency -decision-making process-, and for this specific dimension, size effects are statistically significant but small (8=0,05; 0,22).

Resumen Pese a estar presente en diversas discusiones de las ciencias sociales y los estudios de género la promoción del empoderamiento femenino ha alcanzado un renovado protagonismo a partir de su inclusión en los Objetivos de Desarrollo del Milenio y de Desarrollo Sostenible. Dentro de las estrategias priorizadas para lograr este empoderamiento las agencias internacionales y gobierno nacionales han apostado por la generación de procesos asociativos en torno a actividades productivas. En este documento se presenta una revisión sistemática de literatura que tiene por objetivo analizar el impacto de pertenecer a asociaciones productivas rurales en las diferentes dimensiones del proceso de empoderamiento, a saber: recursos, agencia y resultados. Con este fin, se utiliza una metodología de revisión sistemática de literatura de cinco artículos cuantitativos y ocho artículos cualitativos. Para el caso de los cuantitativos, se presenta una organización basada en el componente del proceso de empoderamiento evaluado y se estima el tamaño del efecto estandarizado; para el caso de los cualitativos, se realiza un análisis de contenido de los hallazgos siguiendo la misma organización por dimensiones del proceso. Los resultados muestran que el impacto de la pertenencia a cooperativas ha sido estudiado de forma mayoritaria desde el enfoque de empoderamiento como agencia, entendida como toma de decisiones; y que, para este componente en particular, los tamaños de los efectos (d de Cohen) son significativos, aunque pequeños (8=0,05; 0,22).

The Effects of Husbands' Alcohol Consumption and Women's Empowerment on Intimate Partner Violence in India.

The influence of husband's alcohol consumption and that of women's empowerment has been largely studied separately in relation to the intimate partner violence (IPV) faced by women, which has hindered a nuanced understanding of gender-based violence in India. This study aimed to understand how husbands' alcohol consumption shapes the relationship between women's empowerment and violence among Indian couples. Data from the 2015-16 National Family Health Survey (NFHS) were used in this study. A composite women's empowerment index was constructed and its association with husbands' drunkenness and odds of facing emotional, physical, severe, and sexual violence was examined. This study found that compared to women whose husbands were never drunk, those whose husbands were sometimes or often drunk had significantly higher odds of experiencing physical, emotional, and sexual violence. For all the types of IPV, an increase in the empowerment index was associated with a significant reduction in the odds of experiencing violence. However, increasing frequency of husband's drunkenness in combination with increasing scores on the empowerment index was associated with a significant increase in the odds of IPV, except sexual violence. Our findings highlight the nuances of IPV, situating the experiences of women in the social, cultural, and economic realities of Indian society.

Prevalence of Sexually Transmitted Infections and Factors Associated with HIV Status Among Vulnerable Women in Northern Uganda: Baseline Results from Pe Atye Kena Cohort Study.

BACKGROUND AND OBJECTIVES: HIV infection among vulnerable women (VW) has been attributed to unfavourable power relations and limited access to sexual and reproductive health information and services. This work aims to report sexually-transmitted infections (STI) prevalence and assess the impact of HIV awareness, demographic and socio-behavioural factors on HIV status in a rural area of northern Uganda. METHODS: Pe Atye Kena is a longitudinal cohort intervention study enrolling young women aged 18-49 years old living in the municipality of Gulu, Uganda. HIV, HBV, syphilis serologic tests, and a comprehensive electronic questionnaire on sexual high-risk behaviours were administered before intervention. In this work, we report baseline characteristics of the population along with factors associated with HIV status. Statistical analysis was performed by uni- and multivariable regression models. RESULTS: 461 VW were enrolled (mean age: 29 (SD7.7)). 40 (8.7%) were found to be positive for HIV, 42 (9.1%) for syphilis and 29 (6.3%) for HBV. Older age (> 34 years vs. < 24 years; OR 4.95, 95% CI: 1.7 to 14); having done the last HIV test > 12m before the interview (OR 5.21, 95% CI: 2.3 to 11); suspecting the male sexual partner to be HIV+ (OR 2.2; 95% CI: 1.1 to 4.3); not having used condom at first sexual intercourse (OR 2.6; 95% CI 1.3 to 5.15) were all factors associated with an incident HIV diagnosis. CONCLUSIONS: In this cohort, HIV prevalence is high, and sexual high-risk behaviours are multifaced; future interventions will be aimed to reduce HIV/STIs misconceptions and to promote a sense of community, self-determination and female empowerment.

Is Empowerment of Female Radiologists Still Needed? Findings of a Systematic Review.

Considering that radiology is still a male-dominated specialty in which men make up more than two thirds of the workforce, this systematic review aimed to provide a comprehensive overview of the current role of women in radiological imaging, focusing on the main aspects such as career progression, leadership, academic practice, and perceived discrimination. Three electronic databases were searched up to 21 October 2020. To identify additional records, weekly automatic email alerts were set up on PubMed until December 2020 and reference lists of key studies and included papers were screened. Two reviewers independently performed the search, study selection, quality appraisal, data extraction, and formal narrative synthesis. In case of disagreement, a third reviewer was involved. Across the 61 included articles, women worked more often part-time and held fewer positions of power in hospitals, on editorial boards, and at the academic level (associate and full professors). Women were less often in relevant positions in scientific articles, had fewer publications, and had a lower H-index. Discrimination and sexual harassment were experienced by up to 40% and 47% of female radiologists, respectively. Our study highlights that women in radiology are still underrepresented and play a marginal role in the field, struggling to reach top and leading positions.

The weight of patriarchy? Gender obesity gaps in the Middle East and North Africa (MENA).

The worldwide obesity epidemic has impacted women more heavily than men. These gender-based differences are particularly pronounced in the Middle East and North Africa (MENA) region where gender obesity gaps on average exceed 10 percentage points. This paper examines one of the explanations, namely the role of female empowerment on gender gaps in obesity. We study the effect of several measures of female empowerment including female labor market participation on gender obesity gaps over a time span of 41 years (1975-2016) in a sample of 190 countries. We document that after controlling for a number relevant controls, gender obesity gaps are only associated to measures of female empowerment in the MENA region but that this is not true worldwide. We then use an instrumental variable approach in order to illustrate that the causality runs indeed from empowerment, proxy it by both labor market and political participation to gender obesity gaps and not vice versa. Our results reveal that a one percentage point increase in female labor market participation (female MPs in national parliament) predicts a 0.2 (0.09) percentage point decrease in gender gaps in obesity in the MENA region.

Multidimensional Benefits of Improved Sanitation: Evaluating 'PEE POWER®' in Kisoro, Uganda.

With 2.3 billion people around the world lacking adequate sanitation services, attention has turned to alternative service provision models. This study suggests an approach for meeting the sanitation challenge, especially as expressed in Sustainable Development Goal 6.2, using a toilet technology system, such as Pee Power® that generates electricity using diverted urine as a fuel. A field trial was carried out in a girls' school in Kisoro, Uganda, where the generated electricity was used to light the existing toilet block. The trial was evaluated in terms of social acceptability and user experience using a multidimensional assessment protocol. The results of our assessment show that users felt safer when visiting the toilets at night. Lights provided from the technology also helped with the perceived cleanliness of the toilets. The technology was well accepted, with 97% of the respondents saying that they liked the idea of the Pee Power® technology and 94% preferring it over other facilities on site. This shows how the technology helps meet SDG target 6.2, with its particular focus on vulnerable populations.

Gestalt-terapia e Empoderamento Feminino na Relação Terapêutica: Reverberações a partir do Atendimento Psicoterápico entre Mulheres / Gestalt Therapy and Female Empowerment in the Therapeutic Relationship: Reverberations from Psychotherapy among Women / Terapia Gestalt y Empoderamiento Femenino en la Relación Terapéutica: Reverberaciones de la Atención Psicoterapéutica entre Mujeres

Este artigo tem por objetivo compartilhar possíveis reverberações da relação terapêutica, dentro da abordagem gestáltica, no processo de empoderamento feminino em psicoterapia. Partindo da ênfase relacional dada pela proposta teórica da Gestalt-terapia, este texto surge das vivências das autoras em seus consultórios de psicologia, refletindo sobre os desdobramentos dos encontros. Neste contexto, uma escuta atenta revela que os reflexos da cultura patriarcal são notórios nas demandas trazidas pelas mulheres que chegam ao setting terapêutico. Desde as insatisfações com o próprio corpo às dúvidas sobre escolha profissional; das relações conjugais às experiências (ou não) de maternidade, entre outras questões, observamos as exigências de uma sociedade machista ecoando sobre corpos femininos que, muitas vezes, incapazes de dar conta do "você deveria/não deveria", adoecem. Na contramão dos "deverias", a Gestalt-terapia nos instrumentaliza, através da relação terapêutica, a buscar, com cada mulher, seu modo próprio de existir-no-mundo, reconhecendo suas necessidades e construindo formas de atendê-las. Com isso, testemunhamos movimentos singulares de empoderamento feminino, os quais podem reverberar coletivamente nos contextos em que essas mulheres se posicionam e tecem novos encontros. (AU)

This article aims to share possible reflections about the therapeutic relationship, within the gestalt approach, in the process of female empowerment in psychotherapy. Considering the relational emphasis given by the theoretical proposal of Gestalt-therapy, this text emerges from the authors' experiences in their psychology offices, reflecting about the impact of the encounters. In this context, a careful listening reveals that the reflexes of patriarchal culture are notorious in the demands brought by women who reach the therapeutic setting. From dissatisfaction with one's body to doubts about professional choice; from marital relationships to (or not) experiences of motherhood, among other issues, we observe the demands of a chauvinistic society echoing over female bodies that, frequently, are unable to cope with the "you should / shouldn't" and get sick. Contrary to the "shoulds", Gestalt-therapy instructs us, through the therapeutic relationship, to seek with each woman their own way of existing, recognizing their needs and constructing ways to take care of them. Thus, we witness unique movements of female empowerment that can collectively reverberate in the contexts in which these women stand for themselves and meet other people. (AU)

Este artículo tiene como objetivo compartir las posibles reverberaciones de la relación terapéutica, dentro del enfoque gestáltico, en el proceso de empoderamiento femenino en psicoterapia. Partiendo del énfasis relacional dado por la propuesta teórica de la terapia Gestalt, este trabajo emerge de las experiencias de las autoras en sus consultorios de psicología, reflexionando sobre el desarrollo de los atendimientos. En este contexto, una escucha cuidadosa revela que los reflejos de la cultura patriarcal son notorios en las demandas presentadas por las mujeres que llegan al entorno terapéutico. Desde la insatisfacción con el cuerpo hasta las dudas sobre la elección profesional; desde relaciones matrimoniales hasta (o no) experiencias de maternidad, entre otros problemas, observamos las demandas de una sociedad chovinista que resuena sobre los cuerpos femeninos que, a menudo incapaces de hacer frente al "deberías / no deberías" se enferman. Contrariamente a los "deberes", la terapia Gestalt nos instruye, através de la relación terapéutica, para buscar, con cada mujer, su propia manera de existir en el mundo, reconociendo sus necesidades y construyendo formas de satisfacerlas. Por lo tanto, fuimos testigos de movimientos singulares de empoderamiento femenino, que pueden reverberar colectivamente en los contextos en los que estas mujeres se posicionan y tejen nuevos encuentros. (AU)

A conditional cash transfer and Women's empowerment: Does Bolsa Familia Influence intimate partner violence?

We apply mixed methods to explore how a conditional cash transfer (CCT) may influence intimate partner violence (IPV). Qualitative interviews with female beneficiaries of Bolsa Familia, Brazil's CCT program, and service providers suggest positive, negative, and null associations between CCTs and IPV are all plausible. These associations result from a combination of economic and psychological motivations. We also use quantitative methods to examine if the expansion of Bolsa Familia between 2004 and 2009 affects the female homicide rate and marital separations. Using municipal level data in a difference-in-differences analysis, we find null associations between Bolsa Familia and female homicides. When we examine the impact on marriages and separations, indicative of a change in the reservation utility of women within the household, we find no impact on marriages but Bolsa Familia is associated with an increase in separations, and, to a greater extent, separations of couples with children. These results suggest Bolsa Familia impacts women's agency within the family, but not to the extent that it reduces the most extreme form of IPV.

Is microfinance associated with changes in women's well-being and children's nutrition? A systematic review and meta-analysis.

BACKGROUND: Microfinance is the provision of savings and small loans services, with no physical collateral. Most recipients are disadvantaged women. The social and health impacts of microfinance have not been comprehensively evaluated. OBJECTIVE: To explore the impact of microfinance on contraceptive use, female empowerment and children's nutrition in South Asia, Sub-Saharan Africa and Latin America and the Caribbean. DESIGN: We conducted a systematic search of published and grey literature (1990-2018), with no language restrictions. We conducted meta-analysis, where possible, to calculate pooled ORs. Where studies could not be combined, we described these qualitatively. DATA SOURCES: EMBASE, MEDLINE, LILACS, CENTRAL and ECONLIT were searched (1990-June 2018). ELIGIBILITY CRITERIA: We included controlled trials, observational studies and panel data analyses investigating microfinance involving women and children. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. The methodological quality of included studies was assessed using the Cochrane risk-of-bias tool for controlled trials and quasi-experimental studies and a modified Newcastle Ottawa Scale for cross-sectional surveys and analyses of panel data. Meta-analyses were conducted using STATA V.15 (StataCorp). RESULTS: We included 27 studies. Microfinance was associated with a 64% increase in the number of women using contraceptives (OR 1.64, 95% CI 1.45 to 1.86). We found mixed results for the association between microfinance and intimate partner violence. Some positive changes were noted in female empowerment. Improvements in children's nutrition were noted in three studies. CONCLUSION: Microfinance has the potential to generate changes in contraceptive use, female empowerment and children's nutrition. It was not possible to compare microfinance models due to the small numbers of studies. More rigorous evidence is needed to evaluate the association between microfinance and social and health outcomes. PROSPERO REGISTRATION NUMBER: CRD42015026018.

Intervención educativa en salud comunitaria para el empoderamiento de jefas de hogar en un sector económicamente vulnerable de la ciudad de Santiago de Chile / Health community educational intervention to empowerment female heads of households in an economic disadvantage community in Santiago Chile

OBJETIVO: contribuir al empoderamiento de las mujeres jefas de hogar pertenecientes a una comunidad de un sector económicamente vulnerable de la ciudad de Santiago, por medio de la entrega de herramientas y habilidades en salud. Muestra: 13 mujeres, entre 22 y 55 años. METODOLOGÍA: Intervención educativa basada en el Modelo 'Comunidad como Socio' de Anderson y McFarlane de Enfermería y el Modelo de Educación para Adultos de Jane Vella. Se respondió una encuesta anónima para recopilar información. El diagnóstico participativo permitió identificar temas a tratar: control de signos vitales y su aplicabilidad, y atención de primeros auxilios. RESULTADOS: Se aportó al conocimiento del manejo de cuidados básicos en salud (Signos Vitales, Primeros Auxilios y Hábitos de Vida Saludable) aplicados a su autocuidado y al de sus familias. Se practicó lo aprendido en un escenario simulado. CONCLUSIÓN: Se identificaron fortalezas, como motivación por el aprendizaje y buena recepción de las metodologías participativas. La intervención contribuyó al empoderamiento de las participantes mediante el aprendizaje de contenidos, otorgando seguridad para enfrentar situaciones de emergencia en su vida cotidiana.

OBJECTIVE: Contribute the empowerment of female heads of household belonging to a community of an economically vulnerable sector of the city of Santiago, through the delivery of tools and skills in health. Sample: 13 women, between 22 and 55 years old. METHODOLOGY: Educational intervention based on the "Community as a Partner" Model of Anderson and McFarlane of Nursing and the Adult Education Model of Jane Vella. A survey was answered anonymously to collect information. The participatory diagnosis allowed identifications of thetopics concerned including: control of vital signs and its applications and first aid attention demonstrated practically in the sessions. RESULTS: Contributions were made to the knowledge regarding the management of basic care in health (Vital Signs, First Aid and Habits of Healthy Living) applied to self-care of patients and their respective families. In a simulated scenario, participants in the survey demonstrated that they practiced what they had learned. CONCLUSION: Strengths such as motivation for learning and positive response to participative methodologies were identified. Additionally, the intervention contributed to the empowerment of the participants through the learning of contents and development of confidence to confront emergency situations in every day life.

Stakeholders' perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study.

BACKGROUND: Wars affect maternal health services by destroying health systems. Eritrea experienced two wars with neighbouring Ethiopia. Despite this, the maternal mortality ratio (MMR) in Eritrea fell by 69% from 1590 per 100,000 live births in 1990 to 501 in 2015. This study aimed to examine facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea. METHODS: Using in-depth interviews and field observations for data collection, this qualitative study was conducted in five healthcare facilities in Asmara, the capital of Eritrea, in February and March 2016. The participants were: women (n = 40), husbands (n = 5), healthcare providers (n = 10), and decision makers (n = 5). RESULTS: There were two perceived facilitators of utilisation of and access to maternal health services: health education (related to the WHO health service delivery building blocks) and improvement in gender equality driven by the role played by Eritrean women as combatants during the War of Independence (1961-1991). The only perceived barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and shortage of healthcare workers (related to the WHO health workforce building block). CONCLUSION: This study assessed women and their husbands/partners' perceptions and the possible effects of contemporary Eritrean culture and the history of war on the utilisation of and access to maternal health services in the country. As well, we examined healthcare providers' and decision makers' perspectives. The two key facilitators of women's utilisation of and access to maternal health services were health education and women's empowerment driven by their role as combatants during the War of Independence. One main barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and a shortage of healthcare workers. As only a limited number of qualitative studies have been published about maternal health services in war-affected sub-Saharan African countries, our findings regarding health education and women's empowerment could be considered in other war-affected countries similar to Eritrea. Nevertheless, further research is needed to investigate our findings - particularly regarding female empowerment driven by women's role in combat in relation to their maternal health.

Female-Headed Households Associated with Lower Childhood Stunting Across Culturally Diverse Regions of Pakistan: Results from a Cross-Sectional Household Survey.

Objectives Early childhood stunting adversely influences long-term cognitive and health outcomes. There is limited evidence on whether female empowerment within households could reduce its prevalence. We investigated this relationship in Punjab, Pakistan, which has high stunting rates and a sizeable proportion of female-headed households, and whether this relationship differed across three provincial regions with diverse cultural attitudes towards the role of women in society. Methods Using cross-sectional data from the 2011 Multiple Indicator Cluster Survey, we identified 13,412 children aged 1-4 from 8985 two-parent households in three culturally distinct regions in Punjab, Pakistan. Logistic regression models assessed whether the likelihood of stunting was associated with female-headed households, a proxy for female empowerment, and whether this relationship differed by region. Regressions controlled for child- and household-level covariates. Results Children had 26% lower odds of stunting among female-headed households (OR 0.74, CI 0.60, 0.90). The interaction term for female-headed households and child stunting by provincial region was not statistically significant, suggesting that the relationship holds across the three culturally distinct regions. Conclusions for Practice Female empowerment was associated with lower rates of stunting among young children, and the results did not vary by provincial region. This suggests that women can play important roles as agents of change, even in areas where females have limited freedoms. Greater investments in public education and awareness campaigns to improve health literacy might have important spillover effects for child health and improve the success of existing public health interventions targeting childhood stunting.

Associations between women's autonomy and child nutritional status: a review of the literature.

Around the world, many women continue to experience low levels of autonomy. Recent literature has reported that the health consequences of low maternal autonomy extend beyond mothers and translate into health consequences for their children, and may be an important causal factor in child malnutrition. This review summarises the current knowledge of the relationship between maternal autonomy and children's nutritional status (defined as any measure that reflects the nutritional state of the body, such as birthweight or anthropometric scores) and child-feeding practices. The review also includes both discussion of the limitations found in the literature and directions for future research. A systematic review of the literature was conducted. Results of the studies included in the review strongly suggest that raising maternal autonomy is an important goal for improving children's nutritional status, yet gaps in the current knowledge exist, further confounded by issues with how autonomy is measured and limitations of cross-cultural comparability. A thorough understanding of the consequences of restricting women's autonomy will inform programmes and policy worldwide, and speed progress towards both empowering women and alleviating the global burden of child malnutrition.