Women's Autonomy and Reproductive Health in Bangladesh

A high level of maternal, infant and neonatal mortality occurs in Bangladesh. Certain childbearing practices lead to a pattern of high-risk fertility as well as making Bangladeshi women more vulnerable to childbearing risks and adverse birth outcomes. Women in Bangladesh remain considerably subordinate to men in almost all aspects of their lives, from education and work opportunities to healthcare utilisation. The lack of opportunities contributes to the low status of women within their family and society, and generally poor health outcomes for both mother and children. This study aims to investigate the low status of women in relation to the significant amount of adverse reproductive health outcomes in Bangladesh, examining their autonomy and reproductive health in a single framework.

This thesis examines the nature of the associations between women’s autonomy and reproductive health as measured through high-risk fertility, high-risk pregnancy and adverse perinatal outcomes. In particular, the principal aim is to measure the influences of women’s autonomy in decision-making, physical mobility and economic matters on their reproductive health and outcomes. Furthermore, it also investigates whether the level of autonomy and reproductive health experiences differ across Bangladesh at local community and district levels.

The present study adopts a quantitative approach and uses data from the Bangladesh Demographic and Health Survey (BDHS 2011). A multilevel approach is applied to investigate the influences of autonomy on the reproductive health of women and their variations in different locations across Bangladesh. Multilevel logistic regression models (MLRM) of categorical response variables, and a causal mediation model (CMM) are used as statistical tools to analyse the relevant data for each outcome variable: high-risk fertility, high-risk pregnancy and perinatal mortality.

The analysis reveals that in Bangladesh, women have low levels of autonomy in economic matters. Nearly 90% of women do not have control of their own economic resources, either their husband or other family member decides how to spend their earnings. Among the three dimensions of autonomy, decision-making autonomy of women is found to be the strongest factor influencing high-risk fertility and maternal healthcare utilisation. Although, the level of autonomy is found to be significantly associated with high-risk childbearing practices, it does not have any significant effects on high-risk pregnancy and perinatal death. Rather, the influence of autonomy on birth outcomes was transmitted through the pathways of maternal age, parity, birth interval and use of antenatal care services. It was also found that maternal healthcare utilisation mediates the relationship between autonomy and high-risk fertility, high-risk pregnancy and perinatal outcomes. Women’s level of education and place of residence were found to be strong inhibiting factors influencing these relationships. Lastly, it is found that both the level of autonomy and reproductive health aspects vary significantly across Bangladesh.