Women’s Autonomy and Health OutcomesDistrict-level Data AnalysisPankaj GautamMalavika Subramanyam

IIT Gandhinagar | Fall 2014

What is Autonomy? Why Autonomy?• Self-government or self-direction: acting on motives, reasons, or values that

are one's own.• Women’s autonomy can be measured in a variety of ways[1], but women’s

access to and control over resources is a fundamental aspect of autonomy.[2]

• How does women’s autonomy operate and lead to improvements in health?• Policy decisions: Does autonomy have an interactive relationship with

health service availability in influencing health behaviour or outcomes?• Hypothesis: Women’s autonomy is associated with better health seeking

behaviour, which in turn, is expected to lead to improved health outcomes provided community factors such as characteristics of health systems are taken into account.[3] [4] [5]

Methodology• Quantitative research using

• India Human Development Survey [6]

• National Family Health Survey [7]

• Relevant question/variable identification from IHDS questionnaire to calculate autonomy score.

• District-level women empowerment measures’ reconstruction (Desai, 2010).

• Data modelling and estimation using Empirical Bayes method

Relevant Questions/Variables for Autonomy Score Calculation• Who is the primary decision maker about farm matters in your house?• Who is the primary person responsible for taking care of the animals in your household?

• Besides work on the household farm or in any of the household's businesses, what work for pay or goods did [NAME] do last year?

• Who in the household worked in household nonfarm business last year? Please include women and children.

• Education of each member of the family.• Exposure to Mass Media: How often do people in the household listen to the radio, read newspapers and watch TV.

Relevant Questions/Variables for Autonomy Score Calculation• How much did you pay as school fees for NAME in last year? [in addition to govt. support]

• How much did you spend on [NAME]'s books, uniform transportation, and other materials last year?

• How much did you pay for private tuition last year?• Has [NAME] ever been enrolled in school?• At what age did [NAME] start school?• Please tell me who in your family decides the following things?• Who chose your husband?• Did you have any say in choosing him?

Control Over FamilyResourcesNumber of districts: 357

Acknowledgement: Haider Ali, PhD Scholar, Department of Civil Engineering, IIT Gandhinagar

Access to Resources

Acknowledgement: Haider Ali, PhD Scholar, Department of Civil Engineering, IIT Gandhinagar

Number of districts: 357

Participation inHousehold DecisionsNumber of districts: 357

Average score of women who have any say in household decisions about• what to cook,• whether to buy an expensive consumer

durable item,• how many children the respondent and her

husband should have,• when to take a sick child to the doctor, and• marriage arrangements for the children. [8]

Acknowledgement: Haider Ali, PhD Scholar, Department of Civil Engineering, IIT Gandhinagar

Multilevel Model

Observations within districts will vary about the district

mean

District means will vary about the grand mean

𝑌 𝑖𝑗=𝛽 0+𝑢0 𝑗+𝑒0 𝑖𝑗

= ith observation of jth district = Model estimated crude mean = Predicted random effect of jth district = Residual term from ith observation of jth district

Excluded the question on cooking and created a dummy variable that reflects whether women have a final say in any of the other four decisions.

Representation:• Control over family resources• Access to resources• Participation in household decisions

Women’s AutonomyEmpirical Bayes estimates, derived from 2-level hierarchical linear model, which are equal to the fixed-portion linear predictor plus contributions based on predicted random effects.The empirical Bayes estimate is a weighted average of the crude mean for each district k and the crude mean across all districts in the data. The weights are proportional to the reliability of the neighborhood measure, estimated by

Legend𝛾 00𝑘=

𝜏𝜂

𝜏𝜂+{∑1𝑗 [𝜏𝑏+

𝜎 2

𝑛 𝑗𝑘 ]− 1}

− 1

= Variance of random effect = Sample size

Future Work• Identification of association between women’s autonomy and

health indicators obtained from NFHS.

References/Citations1. Narayan, D., ed. 2006. Measuring Empowerment: Cross-Disciplinary Perspectives. New Delhi: Oxford University Press.

2. Andrist, L. (2008). Social Capital’s Dark Side and Patriarchy in India. India Human Development Survey, Working Paper No. 7. NCAER, University of Maryland College Park.

3. Caldwell, J. C. (1986). Routes to Low Mortality in Poor Countries. Population and Development Review, 12, 171-220.

4. Basu, A. M. (1992). Culture, the Status of Women and Demographic Behavior. Oxford: Clarendon.

5. Desai, S. (1998). Maternal Education and Child Health: Is There a Strong Causal Relationship? Demography, 35, 71-81.

6. Desai, S., Dubey, A., Joshi, B.L., Sen, M., Abusaleh, S., and Vanneman, S. India Human Development Survey (IHDS) [Computer file]. ICPSR22626-v1. University of Maryland and National Council of Applied Economic Research, New Delhi [producers], 2007. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-07-30.

7. International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS), Mumbai: IIPS

8. Desai, S. (2010). Gender scripts and age at marriage in India. Demography, Volume 47, Issue 3, pp 667-687, 2010-08-01. Springer-Verlag.