Recently,women’s autonomy and its association with reproductive health and behavior haveemerged as a focal point of investigations and interventions around the world.Particularly, since the Cairo International Conference on Population andDevelopment in 1994, ICPD (United Nations 1994), and women’s role has been apriority area not only for sustainable development, but also in reproductivehealth. At the ICPD, a general consensus was reached to ameliorate women’sstatus, along with the related goals of improving women’s reproductive healthand securing their reproductive rights, which represents a paradigm shift thatemphasizes the reproductive autonomy of individuals. Followingthe ICPD, there have been a number of recent studies that examine women’sautonomy and its relationship with reproductive health and health outcomes(e.g.
, Kishor 2000, 2005; Bloom et al 2001; IUSSP 1997). Most of these studiesfound relationships between various aspects of autonomy and reproductive healthand behavior, but there are many complexities and contradictory findings amongthem, with different aspects of autonomy showing unexpected relationships withreproductive health and preferences in different settings and under differentresearch designs. For example, lower fertility and fertility desire wasobserved among women with higher levels of autonomy in Bangladesh (Balk 1994) and in many regions of India (Jejeebhoy 1991), and lower fertility wasfound to be associated with women’s greater autonomy in Malaysia, the Philippines,and Thailand(Tfaily 2004). These findings are attributed primarily to higher moderncontraceptive use among women with higher autonomy (Schuler and Hashemi 1994;Dharmalingam and Morgan 1996; Morgan and Niraula 1995).
On the other hand, intheir study of autonomy of women and trends in fertility and contraceptive usein Egypt and Bangladesh Amin and Lloyd (1997) found that a low level of femaleautonomy was not a barrier to fertility change and contraceptive use in Egypt. Althoughwomen’s autonomy is widely referred to in many studies, notably on reproductivestatus and health, the concept remains ill-defined and its relationship todemographic processes has not been well articulated, either theoretically orempirically (Presser and Sen 2000). There is no single accepted definition thatrepresents it or that captures the multiple dimensions of women’s position(Mason 1995).
Alternative terms such as women’s status, female position or role, closer ties to natal kin, control overresources, and prestige are all frequently used in the literatureinterchangeably to define women’s status (Mason 1986; Bloom et al. 2001). Balk(1994) argues that women’s status or autonomy can not be represented by onedirect measure nor by one indirect proxy alone, and that different aspects ofwomen’s autonomy influence fertility differently, in terms of magnitude anddirection. In most studies autonomy has been defined asthe capacity to manipulate one’s personal environment through control overresources and information in order to make decisions about one’s own concernsor about close family members (Basu 1992, Dyson and Moore 1983). This involvesan individual’s capacity and freedom to act independently of the authority ofothers, for instance the ability to leave the house without asking anyone’spermission, make personal decisions regarding contraceptive use or obtaininghealth care. Thus, women’s autonomy can be conceptualized as the ability to makeand execute independent decisions pertaining to personal matters of importanceto their lives or their family, even though men and other people may be opposedto their wishes (Mason 1995).
In Bangladesh,women’s autonomy variable has been included in the DHS surveys since 1993 whenthe number of female workers had just started increasing. Successive surveyshave documented this variable regarding women’s autonomy, recording her abilityto spend her own income on her own or by taking joint decisions with husband orother family members. Thispaper examines whether women’s decision-making autonomy affects fertilitypreferences and contraceptive use in Bangladesh. For the purpose of this study,the measures of women’s autonomy we consider here represent various domainsthat have been identified in the literature as important for women’sreproductive behavior. They include the extent to which women are autonomous indecision making regarding large and daily household purchases, the degree towhich they can go to visit families or relatives, and the extent of women’sinteractions/communications with their husbands regarding family planning. Westudy the relation of those indicators with reproductive behavior.
Inparticular, we hypothesize that women who are able to participate in householddecision-making, who have the ability to discuss family planning with theirpartner, who have freedom to visit families and friends, are more likely towish to limit childbearing and to use contraception than women who do notpossess these freedoms.