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Women’s Empowerment and Women’s Health Outcomes

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (15 February 2021) | Viewed by 39462

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Special Issue Editors

Dr. Sarah Blackstone

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Guest Editor

Department of Family Medicine, University of Virginia, Charlottesville, VA 22904, USA
Interests: women’s health; maternal health; reproductive health; antenatal care; HIV

Dr. Laura Merrell

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Guest Editor

Department of Health Sciences, James Madison University, Harrisonburg, VA 22807, USA
Interests: health literacy; health behavior; sexual and reproductive health; maternal and child health; oral health; global health

Special Issue Information

Dear Colleagues,

Women’s health disparities exist worldwide due to biological and gender-related differences in, as well as sociocultural barriers limiting access to, the use of quality health care. Health outcomes in women are related to the infrastructure of communities and societies, and are often a reflection of women’s place in society. Women’s positions in society are influenced by their educational, cultural, economic, legal, and political position. These are closely linked with women’s empowerment—a process by which women have the ability and agency to make strategic decisions about many aspects of life, including health, economics, familial, and interpersonal decisions. In attempts to address disparities in women’s health, there is a need for more research exploring the mechanisms by which women’s empowerment and status in home or society influence health, and how to work within and across cultural differences to improve the health of women.

This Issue will have a broad focus on the impact of women’s empowerment on several dimensions of women’s health, including reproductive health, pregnancy, childbirth, postnatal outcomes, quality of care, abuse and violence, and mental health. We welcome original research papers using different study designs as well as systematic reviews and meta-analyses.

Dr. Sarah Blackstone
Dr. Laura Merrell
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

women’s empowerment
socioeconomic position
women’s health
reproductive health
maternal health
women’s mental health
violence toward women

Published Papers (10 papers)

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Research

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17 pages, 758 KiB

Open AccessFeature PaperArticle

Mujeres Unidas: Addressing Substance Use, Violence, and HIV Risk through Asset-Based Community Development for Women in the Sex Trade

by Lianne A. Urada, Andrés Gaeta-Rivera, Jessica Kim, Patricia E. Gonzalez-Zuniga and Kimberly C. Brouwer

Int. J. Environ. Res. Public Health 2021, 18(8), 3884; https://doi.org/10.3390/ijerph18083884 - 07 Apr 2021

Cited by 4 | Viewed by 2822

Abstract

This paper examines the prevalence of and potential for community mobilization (CM) and its association with HIV/STI risk, substance use, and violence victimization among women, particularly those using substances, in the sex trade in Tijuana, Mexico. Methods: 195 women participated in Mujeres Unidas (K01DA036439 Urada) under a longitudinal survey study, “Proyecto Mapa de Salud” (R01DA028692, PI: Brouwer). Local health/social service providers (N = 16) were also interviewed. Results: 39% of women who participated in community mobilization activities used substances. In adjusted analyses (n = 135), participation in CM activities (n = 26) was more likely among women who did not report substance use (AOR: 4.36, CI: 1.11–17.16), perceived a right to a life free from violence (AOR: 9.28, CI: 2.03–59.26), talked/worked with peers in the sex trade to change a situation (AOR: 7.87, CI: 2.03–30.57), witnessed violence where they worked (AOR: 4.45, CI: 1.24–15.96), and accessed free condoms (AOR: 1.54, CI: 1.01–2.35). Forty-five of the women using substances demonstrated their potential for engaging in asset-based community development (ABCD) with service providers in Mujeres Unidas meetings. Conclusion: Women using substances, vs. those who did not, demonstrated their potential to engage in ABCD strategies. Women’s empowerment, safety, and health could be enhanced by communities engaging in ABCD strategies that build and bridge social capital for marginalized women who otherwise have few exit and recovery options. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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17 pages, 996 KiB

Open AccessArticle

The Association between Assisted Reproduction Technology (ART) and Social Perception of Childbearing Deadline Ages: A Cross-Country Examination of Selected EU Countries

by Eun Jung Kim and Min Jung Cho

Int. J. Environ. Res. Public Health 2021, 18(4), 2111; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042111 - 22 Feb 2021

Cited by 4 | Viewed by 2048

Abstract

The advancement of assisted reproductive technologies (ART) has gained much attention in relation to childbearing postponement. Our study’s purpose was to empirically examine how perceptions of childbearing deadline age vary in association with availability and prevalence of ART across different countries. The present study used data from the 2006 European Social Survey and the 2006 European Society of Human Reproduction and Embryology to examine selected EU countries. A total sample of 17,487 respondents was examined. Multilevel regression modeling was used. Results showed that first, younger generations were more generous with maternal childbearing ages but stricter with paternal deadline ages. Second, respondents residing in countries with higher percentage of reproductive clinics per population were more generous with maternal ages, however no significant association was observed with regard to paternal childbearing ages. Third, on the contrary, respondents residing in countries with higher utilization of ART treatments were stricter with maternal ages, which may be because they are more likely to be aware of the physiological and financial difficulties associated with ART treatments. The present study is meaningful in that it is the first study to empirically examine social perceptions of childbearing ages in relation with ART. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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8 pages, 344 KiB

Open AccessArticle

Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study

by Pedro Hidalgo-Lopezosa, Ana María Cubero-Luna, Andrea Jiménez-Ruz, María Hidalgo-Maestre, María Aurora Rodríguez-Borrego and Pablo Jesús López-Soto

Int. J. Environ. Res. Public Health 2021, 18(2), 456; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020456 - 08 Jan 2021

Cited by 12 | Viewed by 3246

Abstract

Background: Birth plans are used for pregnant women to express their wishes and expectations about childbirth. The aim of this study was to compare obstetric and neonatal outcomes between women with and without birth plans. Methods: A multicentre, retrospective case–control study at tertiary hospitals in southern Spain between 2009 and 2013 was conducted. A total of 457 pregnant women were included, 178 with and 279 without birth plans. Women with low-risk gestation, at full-term and having been in labour were included. Sociodemographic, obstetric and neonatal variables were analysed and comparisons were established. Results: Women with birth plans were older, more educated and more commonly primiparous. Caesarean sections were less common in primiparous women with birth plans (18% vs. 29%, p = 0.027); however, no significant differences were found in instrumented births, 3rd–4th-degree tears or episiotomy rates. Newborns of primiparous women with birth plans obtained better results on 1 min Apgar scores, umbilical cord pH and advanced neonatal resuscitation. No significant differences were found on 5 min Apgar scores or other variables for multiparous women. Conclusions: Birth plans were related to less intervention, a more natural process of birth and better outcomes for mothers and newborns. Birth plans can improve the welfare of the mother and newborn, leading to birth in a more natural way. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

11 pages, 531 KiB

Open AccessArticle

Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba’ah Study

by Rami H. Al-Rifai, Iffat Elbarazi, Nasloon Ali, Tom Loney, Abderrahim Oulhaj and Luai A. Ahmed

Int. J. Environ. Res. Public Health 2021, 18(1), 36; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010036 - 23 Dec 2020

Cited by 6 | Viewed by 3305

Abstract

Background: The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women’s knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. Methods: Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba’ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into “adequate (total score 6–10)” or “lack of adequate (total score 0–5)” knowledge. Crude and multivariable models were used to identify factors associated with “lack of adequate” knowledge on the mode of delivery and factors associated with CS preference. Results: A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18–24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07–8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06–3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02–1.14), employment (aOR, 1.96, 95% CI, 1.13–3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71–55.73) were associated with a preference towards CS delivery. Conclusion: This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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13 pages, 693 KiB

Open AccessArticle

Use of a Health Advocacy Model for Survivors of Interpersonal Violence

by Jessica Grace, Scott T. Walters, Irene Gallegos, Erika L. Thompson and Emily E. Spence

Int. J. Environ. Res. Public Health 2020, 17(23), 8966; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17238966 - 02 Dec 2020

Cited by 1 | Viewed by 1887

Abstract

This article examines the implementation of a health advocacy model designed for survivors of interpersonal violence (IPV) in a metropolitan area of North Texas. Using a framework influenced by motivational interviewing, solution-focused therapy, and trauma-informed care, this program engaged IPV survivors in creating health and safety goals. Goal attainment scaling was used to track progress after each health advocacy encounter. Clients could set their own goals for healthcare, self-care, and safety. The program served 419 clients and 648 goals were set by clients at the first visit. Among all goals, 89% selected goals focused on healthcare, with 47% of those selecting obtaining health insurance or coverage as a need. These results demonstrate the need for an enhanced healthcare response for this population. The remaining goals selected were self-care (7%) and safety (3%). The design of the health advocacy intervention shows promise towards filling the gaps between IPV and healthcare service delivery systems. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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18 pages, 344 KiB

Open AccessArticle

Women’s Empowerment as a Mitigating Factor for Improved Antenatal Care Quality despite Impact of 2014 Ebola Outbreak in Guinea

by Laura K. Merrell and Sarah R. Blackstone

Int. J. Environ. Res. Public Health 2020, 17(21), 8172; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218172 - 05 Nov 2020

Cited by 12 | Viewed by 2466

Abstract

Improving maternal outcomes and reducing pregnancy morbidity and mortality are critical public health goals. The provision of quality antenatal care (ANC) is one method of doing so. Increasing women’s empowerment is associated with positive women’s health outcomes, including the adequate timing and amount of ANC use. However, little is known about the relationship between women’s empowerment and quality ANC care. Despite a history of political instability, low women’s equality and poor maternal health, the Republic of Guinea has committed to improving the status of women and access to health. However, the 2014 Ebola outbreak may have had a negative impact on achieving these goals. This study sought to examine factors in the relationship between women’s empowerment and the receipt of quality ANC (indicated by the number of health components) within the context of the Ebola outbreak. This study conducted multiple logistic regressions examining associations between covariates and the number of ANC components received using data from the 2012 and 2018 Guinea Demographic Health Surveys. Several aspects of women’s empowerment (healthcare decision-making, literacy/access to magazines, monogamous relationship status, contraceptive use, socio-economic status/employment) were significantly linked with the receipt of a greater number of ANC components, highlighting the importance of women’s empowerment in accessing quality maternity care. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

19 pages, 1114 KiB

Open AccessArticle

“A Woman Is a Puppet.” Women’s Disempowerment and Prenatal Anxiety in Pakistan: A Qualitative Study of Sources, Mitigators, and Coping Strategies for Anxiety in Pregnancy

by Armaan A Rowther, Asiya K Kazi, Huma Nazir, Maria Atiq, Najia Atif, Nida Rauf, Abid Malik and Pamela J Surkan

Int. J. Environ. Res. Public Health 2020, 17(14), 4926; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17144926 - 08 Jul 2020

Cited by 18 | Viewed by 4399

Abstract

Common mental disorders are highly prevalent among pregnant women in low- and middle-income countries, yet prenatal anxiety remains poorly understood, particularly in the sociocultural context of South Asia. Our study explored sources, mitigators, and coping strategies for anxiety among symptomatic pregnant women in Pakistan, particularly in relation to autonomy in decision-making and social support. We interviewed 19 pregnant married women aged 18–37 years recruited from 2017–2018 at a public hospital in Rawalpindi who screened positive for anxiety. Thematic analysis was based on both inductive emergent codes and deductive a priori constructs of pregnancy-related empowerment. Gender norms emerged as an important dimension of Pakistani women’s social environment in both constraining pregnancy-related agency and contributing to prenatal anxiety. Women’s avenues of self-advocacy were largely limited to indirect means such as appeals to the husband for intercession or return to her natal home. The levels of autonomy during pregnancy depended on the area of decision-making, and peer/family support was a critical protective factor and enabling resource for maternal mental health. Women’s disempowerment is a key contextual factor in the sociocultural experience of prenatal maternal anxiety in South Asia, and further examination of the intersections between empowerment and perinatal mental illness might help inform the development of more context-specific preventive approaches. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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14 pages, 691 KiB

Open AccessArticle

Understanding the Meaning of Conformity to Feminine Norms in Lifestyle Habits and Health: A Cluster Analysis

by Sara Esteban-Gonzalo, Petula Sik Ying Ho, Marta Evelia Aparicio-García and Laura Esteban-Gonzalo

Int. J. Environ. Res. Public Health 2020, 17(4), 1370; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17041370 - 20 Feb 2020

Cited by 6 | Viewed by 4491

Abstract

Background: Gender roles impact different spheres of life and lead women to behavioral patterns and lifestyle habits associated with femininity, generating important differences between men and women in health. The present study analyzed relationships between conformity to the feminine norms and different lifestyle indicators: Educational level, marital status, alcohol consumption, tobacco consumption, sleeping hours, social support, and physical activity. Additionally, cluster analysis was developed in order to identify different patterns of gender role conformity. Methods: The sample was made up of 347 women age 18–70 from Spain. Data collection was conducted during 2014. Results: Multiple logistic regression analyses produced odds ratios showing that women with lower feminine role conformity were more likely to use tobacco and alcohol, but less likely to share their lives with someone. Cluster analysis found four different profiles of gender role conformity related to different patterns of alcohol consumption and marital status. Conclusions: Conformity to feminine norms was associated with basic affective conditions such as sharing life with others and with alcohol and tobacco consumption, but not with physical activity, social support, and sleep duration. Whereas tobacco and alcohol use have important health implications, public health systems should pay attention to gender-related variables in order to design and implement specific prevention programs. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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Review

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24 pages, 1096 KiB

Open AccessReview

“The Problem Is that We Hear a Bit of Everything…”: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy

by Vivian Lyall, Lindsay Wolfson, Natasha Reid, Nancy Poole, Karen M. Moritz, Sonya Egert, Annette J. Browne and Deborah A. Askew

Int. J. Environ. Res. Public Health 2021, 18(7), 3445; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073445 - 26 Mar 2021

Cited by 30 | Viewed by 5896

Abstract

Understanding the factors that contribute to women’s alcohol use in pregnancy is critical to supporting women’s health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada’s Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women’s alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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21 pages, 623 KiB

Open AccessReview

A Scoping Review of the Health of Conflict-Induced Internally Displaced Women in Africa

by Oluwakemi C. Amodu, Magdalena S. Richter and Bukola O. Salami

Int. J. Environ. Res. Public Health 2020, 17(4), 1280; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17041280 - 17 Feb 2020

Cited by 28 | Viewed by 6672

Abstract

Armed conflict and internal displacement of persons create new health challenges for women in Africa. To outline the research literature on this population, we conducted a review of studies exploring the health of internally displaced persons (IDP) women in Africa. In collaboration with a health research librarian and a review team, a search strategy was designed that identified 31 primary research studies with relevant evidence. Studies on the health of displaced women have been conducted in South- Central Africa, including Democratic Republic of Congo (DRC); and in Eastern, East central Africa, and Western Africa, including Eritrea, Uganda, and Sudan, Côte d’Ivoire, and Nigeria. We identified violence, mental health, sexual and reproductive health, and malaria and as key health areas to explore, and observed that socioeconomic power shifts play a crucial role in predisposing women to challenges in all four categories. Access to reproductive health services was influenced by knowledge, geographical proximity to health services, spousal consent, and affordability of care. As well, numerous factors affect the mental health of internally displaced women in Africa: excessive care-giving responsibilities, lack of financial and family support to help them cope, sustained experiences of violence, psychological distress, family dysfunction, and men’s chronic alcoholism. National and regional governments must recommit to institutional restructuring and improved funding allocation to culturally appropriate health interventions for displaced women. Full article

(This article belongs to the Special Issue Women’s Empowerment and Women’s Health Outcomes)

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