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Her Health Behavior, Her Choice? Decision-Making Power Over Key Health and Nutrition Behaviors Among Pregnant and
Laurie C Miller1,2, Regina Brown2, Reema Safadi3
1Tufts University School of Medicine, Friedman School of Nutrition Science & Policy, and Eliot-Pearson Department of Child Study & Human Development, Tufts University, Boston, Massachusetts, USA.
Women's participation in family diet and health decisions is strongly associated with better family outcomes. We examined decision-making power among participants in a Community Health and Nutrition Program in Jordan, which sought to improve maternal, infant, and young child nutrition (MIYCN) and modern contraception through service-provider training and media campaigns. Cross-sectional surveys in Amman, Karak, and Zarqa governates enrolled 3518 pregnant/lactating women (PLW) in the program (2021-23). PLW respondents indicated whether receiving messages about MIYCN and contraceptive use changed their practices, and whether their decision-making was total, shared with other family members (husbands, mothers, mothers-in-law), or not possible for these choices. Results were analyzed using chi-square tests and multiple linear regressions. After receiving program messages, 78% of PLW changed ≥ 1 practice. Between 52.8% and 90.3% of PLW had decision-making power to accept or reject recommendations for the six targeted behaviors. Compared to Amman, Zarqa residence was negatively associated with decision-making power over women's dietary diversity (OR = 0.418, p < 0.05) and early initiation of breastfeeding (OR = 0.493, p < 0.05), while Karak residence was negatively associated with decision-making power over modern contraceptive use (OR = 0.419, SE = 0.116, p < 0.01). Number of children was positively associated with decision-making power over exclusive breastfeeding (OR = 1.18, p < 0.01). Nationality, age, and wealth were not associated with decision-making power over these practices. Decision-making power varied among PLW in the program: PLW living outside Amman and those with fewer children had less autonomy to change practices. Further research is needed to understand how to best support decision-making power among these populations. Trial Registration: Registered at clinicaltrials.gov (NCT05365698).
Women's participation in family diet and health decisions is strongly associated with better family outcomes. We examined decision-making power among participants in a Community Health and Nutrition Program in Jordan, which sought to improve maternal, infant, and young child nutrition (MIYCN) and modern contraception through service-provider training and media campaigns. Cross-sectional surveys in Amman, Karak, and Zarqa governates enrolled 3518 pregnant/lactating women (PLW) in the program (2021-23). PLW respondents indicated whether receiving messages about MIYCN and contraceptive use changed their practices, and whether their decision-making was total, shared with other family members (husbands, mothers, mothers-in-law), or not possible for these choices. Results were analyzed using chi-square tests and multiple linear regressions. After receiving program messages, 78% of PLW changed ≥ 1 practice. Between 52.8% and 90.3% of PLW had decision-making power to accept or reject recommendations for the six targeted behaviors. Compared to Amman, Zarqa residence was negatively associated with decision-making power over women's dietary diversity (OR = 0.418, p < 0.05) and early initiation of breastfeeding (OR = 0.493, p < 0.05), while Karak residence was negatively associated with decision-making power over modern contraceptive use (OR = 0.419, SE = 0.116, p < 0.01). Number of children was positively associated with decision-making power over exclusive breastfeeding (OR = 1.18, p < 0.01). Nationality, age, and wealth were not associated with decision-making power over these practices. Decision-making power varied among PLW in the program: PLW living outside Amman and those with fewer children had less autonomy to change practices. Further research is needed to understand how to best support decision-making power among these populations. Trial Registration: Registered at clinicaltrials.gov (NCT05365698).
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