Association between women’s autonomy and reproductive health outcomes in India

Background

In India, limited autonomy in maternal reproductive healthcare decision-making remains a persistent issue. This study investigates the impact of women’s autonomy in managing their healthcare on abortion history, knowledge of contraceptive methods, wanted pregnancy, and delivery via caesarean section in India.

Data and methods

The data for this study were extracted from two rounds of the Indian Demographic and Health Survey [DHS (2015–16) and DHS (2019–21)]. Descriptive statistics, logistic regression and time interaction regression model were employed to investigate the association between women’s autonomy in managing their healthcare and access to reproductive healthcare services.

Results

Women whose healthcare decisions were jointly managed with their husband/partner had higher odds of having a wanted pregnancy [OR = 1.64; p<0.01] in 2015–16 and [OR = 1.29; p<0.10] in 2019–21 compared to women who managed healthcare decisions alone. However, the significance of shared healthcare decision-making in predicting a wanted pregnancy diminished between 2015–16 and 2019–21. In 2015–16, the odds of delivery via caesarean section were lower for women who managed their healthcare jointly with their husband/partner [OR = 0.79; p<0.05] and for those whose healthcare decisions were made by someone else [OR = 0.57; p<0.01] compared to women who managed healthcare decisions alone. Additionally, in 2015–16 when healthcare decisions were made by the husband/partner alone, women had significantly lower odds of knowing contraceptive methods [OR = 0.48; p<0.05] compared to when women managed healthcare decisions alone. Furthermore, in each round, women with higher levels of education, health insurance coverage, from wealthier households, and those whose husbands were educated and older at the time of childbirth, had higher odds of having contraceptive knowledge and a wanted pregnancy in India.

Conclusion

In summary, we found that when healthcare decisions were made solely by the husband or partner, women had significantly lower odds of being knowledgeable about contraceptive methods. Furthermore, we found that the odds of delivery via caesarean section were lower when women jointly managed their healthcare with their partner. To achieve Sustainable Development Goal 3.7, which calls for universal access to sexual and reproductive healthcare services, it is crucial to promote informed reproductive choices, enhance contraceptive knowledge, and increase access to reproductive healthcare services in India.