Over half a million women die annually due to maternity complications. Studies support that utilization of health services reduces maternal mortality. Using a nationally representative sample of 7878 previously pregnant women from Nepal we examined if gender empowerment is associated with health service use. Findings showed that three of the five indicators of empowerment – women’s age at birth of their first child, their education and knowledge about sexually transmitted diseases – significantly increased utilization of health services, especially antenatal and delivery services. Women’s opinion about wife beating and their participation in intra-household financial decisions were insignificant. Implications for social work practice are discussed.
AcharyaL.B.ClelandJ. (2000) ‘Maternal and Child Health Services in Rural Nepal: Does Access or Quality Matter More?’, Health Policy and Planning15(2): 223–9.
2.
AdayL.A.AndersenR.M. (1974) ‘A Framework for the Study of Access to Medical Care’, Health Services Research9(3): 208–20.
3.
AndersenR.M. (1995) ‘Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?’, Journal of Health and Social Behavior36: 1–10.
4.
AndersenR.M.NewmanJ. (1973) ‘Societal and Individual Determinants of Medical Care Utilization in the United States’, Milbank Memorial Fund Quarterly51: 95–124.
5.
AnwarI.SamiM.AkhtarN.ChowdhuryM.E.SalmaU.RahmanM.KoblinskyM. (2008) ‘Inequity in Maternal Health-care Services: Evidence from Home-based Skilled-birth-attendant Programmes in Bangladesh’, Bulletin of the World Health Organization86(4): 252–9.
6.
BloomS.S.WypijD.GuptaM.D. (2001) ‘Dimensions of Women’s Autonomy and the Influence on Maternal Health Care Utilization in a North Indian City’, Demography38(1): 67–78.
7.
ChakrabortyN.IslamM.A.ChowdhuryR.I.BariW.AkhterH.H. (2003) ‘Determinants of the Use of Maternal Health Services in Rural Bangladesh’, Health Promotion International18(4): 327–37.
8.
ChowdhuryR.IslamM.A.GulshanJ.ChakrabortyN. (2007) ‘Delivery Complications and Healthcare-seeking Behavior: The Bangladesh Demographic Health Survey, 1999–2000’, Health and Social Care in the Community15(3): 254–64.
9.
DavidsonP.L.AndersenR.M.WynR.BrownE.R. (2004) ‘A Framework for Evaluating Safety-net and Other Community-level Factors on Access for Low-income Populations’, Inquiry41(1): 21–38.
10.
EhrhardtA.A.SawiresS.McGovernT.PeacockD.WestenM. (2009) ‘Gender, Empowerment, and Health: What is it? How Does it Work?’, Journal of Acquired Immune Deficiency Syndromes51: S96–S105.
11.
FurutaM.SalwayS. (2006) ‘Women’s Position Within the Household as a Determinant of Maternal Health Care Use in Nepal’, International Family Planning Perspectives32(1): 17–27.
12.
GelbergL.AndersenR.M.LeakeB.D. (2000) ‘The Behavioral Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People,’ Health Services Research34(6): 1273–302.
13.
HortonR. (2009) ‘What Will it Take to Stop Maternal Deaths?’, The Lancet374(9699): 1400–2.
14.
HotchkissD.R. (2001) ‘Expansion of Rural Health Care and the Use of Maternal Services in Nepal’, Health & Place7: 39–45.
15.
JahanR. (2007) ‘Securing Maternal Health Through Comprehensive Reproductive Health Services: Lessons from Bangladesh’, American Journal of Public Health97(7): 1186–190.
16.
KabeerN. (1994) Reversed Realities: Gender Hierarchies in Development Thought. London: Verso.
17.
KabeerN. (1997) ‘Women, Wages and Intra-household Power Relations in Urban Bangladesh’, Development and Change28: 261–302.
18.
KabeerN. (1999) ‘Resources, Agency, Achievements: Reflections on the Measurement of Women’s Empowerment’, Development and Change30: 435–64.
19.
KabeerN. (2005) ‘Gender Equality and Women’s Empowerment: A Critical Analysis of the Third Millennium Development Goal 1’, Gender & Development13(1): 13–24.
20.
KhanK.S.WojdylaD.SayL.GülmezogluA.M.Van LookP.F.A. (2006) ‘WHO Analysis of Causes of Maternal Death: A Systematic Review’, The Lancet367: 1066–74.
21.
KoblinskyM.AnwarI.MridhaM.K.ChowdhuryM.E.BotleroR. (2008) ‘Reducing Maternal Mortality and Improving Maternal Health: Bangladesh and MDG 5’, Journal of Health, Population, & Nutrition26(3): 280–94.
22.
KoenigM.A.JamilK.StreatfieldP.K.SahaA.Al-SabirA.ArifeenS.E.HillK.HaqueY. (2007) ‘Maternal Health and Care-seeking Behavior in Bangladesh: Findings from a National Survey’, International Family Planning Perspective33(2): 75–82.
MamunA.A.PadmadasS.S.KhatunM. (2006) ‘Maternal Health During Pregnancy and Perinatal Mortality in Bangladesh: Evidence from a Large-scale Community-based Clinical Trial’, Pediatric and Perinatal Epidemiology20: 482–90.
25.
Ministry of Health and Population, New ERA and Macro International (2007) Nepal Demographic and Health Survey 2006. Kathmandu, Nepal: Ministry of Health and Population, New ERA and Macro International.
26.
NussbaumM.C. (2000). Women and Human Development: The Capabilities Approach. Cambridge, UK: Cambridge University Press.
27.
PagelC.LewyckaS.ColbournT.MwansamboC.MeguidT.ChiudzuG.UtleyM.CostelloA.M. (2009) ‘Estimation of Potential Effects of Improved Community-based Drug Provision, to Augment Health-facility Strengthening, on Maternal Mortality due to Postpartum Hemorrhage and Sepsis in Sub-Saharan Africa: An Equity-effectiveness Model’, The Lancet374(9699): 1441–8.
28.
PandeyS.LinY. (2011) Predictors of Antenatal Care Use and Institutional Delivery in India. Working Paper. George Warren Brown School of Social Work, Washington University: St. Louis, MO.
29.
PhillipsK.A.MorrisonK.R.AndersenR.AdayL.A. (1998) ‘Understanding the Context of Healthcare Utilization: Assessing Environmental and Provider-related Variables in the Behavioral Model of Utilization’, Health Services Research33(3): 571–96.
30.
PradhanB. (2003) ‘Measuring Empowerment: A Methodological Approach’, Development46(2): 51–7.
31.
SeipelM.M.O. (1992) ‘Promoting Maternal Health in Developing Countries’, Health & Social Work17(3): 200–6.
32.
SenA. (1999) Development as Freedom. Oxford: Oxford University Press.
33.
SimkhadaB.TeijlingenE.R.PorterM.SimkhadaP. (2006) ‘Major Problems and Key Issues in Maternal Health in Nepal’, Kathmandu University Medical Journal4(14): 258–63.
34.
United Nations Development Programme (UNDP) (1995) Human Development Report. New York: Oxford University Press.
35.
United Nations (2000a) World’s Women: Trends and Statistics. New York: United Nations.
WilliamsJ. (2005) Measuring Gender and Women’s Empowerment Using Confirmatory Factor Analysis. Boulder, CO:Population Program, Institute of Behavioral Science, University of Colorado.
