Improving Data Concerning Women’s Empowerment in Sub-Saharan Africa

Jessica Heckertand Madeleine Short Fabic

Published in Studies in Family Planning 44(3): 319-344

Summary• Motivated by concerns about the adequacy of DHS women’s empowerment

data in SSA (Schatz and Williams 2012; Upadhyay and Karasek 2012).

• Assess the utility of the women’s empowerment questions in the current (Phase 6) DHS in the context of SSA

• How might the women’s empowerment questions differ if designed specifically for SSA?

• Identify data needs in five areas: • Economic empowerment• Knowledge of legal rights and recourse• Participation in decision making• Attitudes and social norms• Adolescent girls

• Recommend specific items for future DHS• Suggest other surveys fill known data gaps

Outline

• Background: DHS and women’s empowerment questions• Background: Women’s empowerment and sexual and

reproductive health • Methods

– Interviews with 36 gender and health experts– Review of qualitative literature

• Results & Discussion – Integrated to allow for discussion

Demographic and Health Surveys• Household survey

• Household questionnaire • Women of reproductive age; 15-49 years• Men of reproductive age, in most countries; typically 15-59 years

• Purpose• Data for in-country use• Data that can be compared across countries and across time• Contribute to aggregate data at the global level

• Myriad health topics• Standardized core questionnaire with optional modules and

country-specific additions• Revised every five years; Key issues are comparability, length

Sexual and Reproductive Health and Women’s Empowerment

• SRH is health domain where women may be least likely to be able to act in favor of their own health

• Desire fewer children and plan their births (Kim & Watts 2005)

• Avoid risky partners and use condoms (Blanc & Wolff 2001; Achan et al. 2009)

• Contraceptive use and delay of pregnancy may empower women (Barnett et al. 1999; Okal et al. 2008; Hindin 2012)

• Fertility and successful motherhood may empower women (Sudarkasa 1986; Harrison & Montgomery 2001)

Relationship between WE and SRH• Empirical evidence on the relationship between WE and SRH in

SSA are mixed• Why?

– Rigidity and pervasiveness of gender norms as related to spouses and kin (DeRose, Dodoo, & Patil 2002; DeRose & Ezeh 2005; Dodoo & Frost 2008)

– Effects of WE may vary according to fertility transition stage and contraceptive prevalence (Martin 1995; Barbieri & Hertrich 2005; Bongaarts 2006)

– Statistical relationship would be attenuated if WE measures are weakly correlated with what they aim to measure

Methods• Ghana, Mozambique, Senegal, and Uganda

– Priority countries for USAID Office of Population and Reproductive Health – Availability of contacts– Diversity of HIV and fertility patterns

• Interviews with 36 gender and health experts– Snowball sample– Tailored interview guides provided to respondents in advance– Topics included i) Current use of DHS, ii) Contextual relevance of survey items,

iii) Gaps in women’s empowerment and gender data, iv) Other survey items to measure women’s empowerment

• Open coding to identify common themes in the data—ATLAS.ti• Qualitative literature to explain or provide alternative explanations

Five Common Themes

• Economic Empowerment• Legal Right and Recourse• Decision Making• Social Norms and Attitudes• Data Regarding Adolescent Girls

(Limit discussion on this point because of IFPRI’s primary activities)

Economic Empowerment • Key domain (n = 22) • DHS lacks questions on income generation resources

such as access to land and capital• Land ownership

They [women] can work on the land but they don’t own it. They do not have the power to own their land. [Senegal]

• Ownership vs. Access: Communal/clan land ownership & allocation of state-owned land

Land is owned by the community, by the clan. So the issue of women’s ownership of land is that most of the land is owned by the clan system, and the clan will allocate land to a man. The man won’t own that land, so the issue is not ownership; it might be access…The customary clan system, they have their own rules for how they allocate land. Women are worse off than men. [Uganda]

• Loss of access upon divorce or widowhood, b/c access exists via the husband

Economic Empowerment cont.

• Women’s land access secondary to men’s in economic crisisWith the economic crisis over the last two years, we have found that food crops that used to be

for women have become cash crops… Food crops are now being sold by men. [Uganda]

• Animal ownership– Again access vs. ownership

• Access to credit– Investment capital may be accessible only through relationships with men– Men’s provision of start-up capital is often an expectation of sexual

relationships (urban Ghana, Ankomah 1996)

– Credit access may allow women to circumnavigate these relationships

Survey Questions for Economic Empowerment

• Land access may be more important than ownership– If land is owned, who makes decision about income/crops– Additional land (not owned) for income generation– Who makes decisions about income/crops from this other land

• Questions about access to credit– Desire to take out a loan– Whether she took out a loan– Whether she thought this was a good decision

Legal Rights and Recourse• Substantial changes in legal rights afforded to women during

the past several decades• 12 experts wanted indicators of how well knowledge of

women’s legal rights had been popularized • Laws ≠ Enforcement: Do women feel they can seek recourse?

A major programmatic component of popularizing these laws has been educating those who respond when the legal rights of women are violated, such as police officers. [Uganda]

Survey Items to Examine Rights and Recourse

• Ethiopia 2011 DHS asked if women knew of the 2005 national law prohibiting wife beating

• Knowledge was positively associated with educational attainment, household wealth, and urban residence (CSA and ICFI 2012)

• No analyses correlate it with other WE indicators• Easily be incorporated into a survey for which stakeholders aim to

empower women by rule of law• No specific recommendations for the DHS core questionnaire,

because links between knowledge of legal rights, women’s empowerment and health are unclear

Decisionmaking

• Need for decisionmaking data that pertains to fertility, family planning, and women’s reproductive health

• Choosing number of children• Do you talk to your husband about family planning?• When a daughter should marry• Permission-seeking for HIV testing

• Women’s public participationCulturally, in many parts of Uganda, women are not allowed to speak in public.… In some other cultures, Western ones, it can be seen as assertive. In Uganda it can be seen to be undisciplined. [Uganda] Expanding the public sphere to include women’s voices makes a huge difference for both women’s sense of efficacy and eventually in community outcomes. [Senegal]

Relevance and Interpretation of Decisionmaking Qs

• Food choice– Reinforces women’s prescribed roles (thus not empowerment)– Husbands may limit family member’s food access

• Freedom of movement (visits to her relatives)– Gh, Sen, Ug, respondents said this topic was not relevant– Moz respondents said it was relevant

• In surveys limited to urban Kampala, there was difficult conceptualizing a “major purchase”

• Exclusive decision making may indicate absent husband

Recommended Decisionmaking Items

• Discussions with spouse about how to delay or avoid pregnancy

• Whether contraceptive use is his/hers/joint decision• Other community members who have input into decisions to

delay or avoid childbearing

– All are modifications of current and previous DHS items

Social Norms and Attitudes

• 22 respondents discussed family, community and social norms that restrict women from acting in favor of their health

• Value of the collective goodThe group is the most desirable thing—being part of a group and conforming to the group and being respected by the group.… For example, if your mother-in-law comes and says that she wants to marry your 12-year-old daughter, you won’t be able to refuse…The woman might say, “I am against female genital cutting,” but that doesn’t mean a thing as long as the whole community isn’t against abandonment. [Senegal]

• Women often cannot refuse sex with their husbandsWomen are brought up that once you are married, it is like you cannot say no. If a man demands sex, his request should be fulfilled.…You find that if the practice continues, he even has power to report you to the paternal aunties or even the clan leaders and bring it as a family thing. [Uganda]

Social Norms and Attitudes Cont.• Role of the extended family

Some of the questions, the way they ask the sexual and reproductive health questions…, it is like they—the husband and wife—take the decisions alone. There is the extended family, which has a lot of influence on couples. I think if possible we could have questions that could explore the influence of the extended family on reproductive outcomes of couples. [Uganda]

• Bridewealth (brideprice)They cannot negotiate safer sex because of brideprice. They cannot limit the number of children that they have because of brideprice. They cannot go to school and do their own thing because they were bought. The issue of brideprice and all of that is a controversial issue, because it has been on the floor of parliament over three or four years. [Uganda]

Recommendations—Social Norms and Attitudes

• These findings also informed the decisionmaking questions• Recommend optional bridewealth module

– Whether bridewealth was promised– Whether promised amount was paid (in full, partially, or not at all)

• Many social norms are specific to countries or regions – Excellent for national or regional surveys– Own behavior, what she believes others do, what she believes that

others believe she does, what she believes she should do, what she believes other should do

Adolescent Girls• Need for sexual and reproductive health indicators from those

younger than 15 (n = 13)• Adolescent relevant topics: early marriage, initiation rites,

social norms around adolescent sexuality • Substantial deviation from current sampling frame and unique

ethical considerations• Suggest that adolescent-specific surveys fulfill this role

Limitations

• Response bias because of our affiliation with USAID• Limited attention to within-country variability• Do not compare data needs across regions

Conclusions

• No single item or combination of items will indicate women’s empowerment across a diversity of contexts

• Women’s empowerment data users should carefully consider cultural context

• Adding survey items should be weighed against financial and technical costs