Journal of Womens Health, Issues and Care ISSN: 2325-9795

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.

Research Article, J Womens Health Issues Care Vol: 3 Issue: 2

Cross Sectional Study on Decision-making Power of Working and Non-working Women in Family Planning and Reproductive Health and Rights in Gombak, Malaysia

Sultana AM*
Department of Social and Citizenship Studies, Faculty of Human Sciences, Universiti Pendidikan Sultan Idris (UPSI), Perak, Malaysia
Corresponding author : Sultana AM
Department of Social and Citizenship Studies, Faculty of Human Sciences, Universiti Pendidikan Sultan Idris (UPSI), 35900 Tanjong Malim, Perak, Malaysia
E-mail: [email protected]
Received: September 06, 2013 Accepted: April 03, 2014 Published: April 07, 2014
Citation: Sultana AM (2014) Cross Sectional Study on Decision-making Power of Working and Non-working Women in Family Planning and Reproductive Health and Rights in Gombak, Malaysia. J Womens Health Issues Care 3:2. doi:10.4172/2325-9795.1000140

Abstract

Cross Sectional Study on Decision-making Power of Working and Non-working Women in Family Planning and Reproductive Health and Rights in Gombak, Malaysia

The study focuses on a woman's decision making position regarding family planning and reproductive matters from Malaysian perspective. The main aim of this study is to measure working and non-women decision-making power of family planning and reproductive matters in Malaysia. The study employed cross sectional survey research deign. A total of 132 women were selected as the respondents from three academic institutions and three residential areas in Malaysia by using purposive sampling methods.

Keywords: Working women; Non-working women; Family decision-making; Family planning; Reproductive health and rights

Keywords

Working women; Non-working women; Family decision-making; Family planning; Reproductive health and rights

Introduction

The study starts with the discussion of the basic concept of reproductive health and rights in order to understand the importance of women’s decision making position regarding reproductive and contraceptive matters. According to ICPD national definition “reproductive health is a state of complete physical, mental and social wellbeing, in all matters relating to the reproductive system and its functions and processes. It implies that people have the capability to reproduce and the freedom to decide if, when and how often to do so” [1]. This definition clearly implies that the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law. Furthermore, an extensive literature focused on women’s reproductive rights and children’s health from the human right perspective. A recent document published by the World Health Organization [2] found that participation is associated with positive changes in health and health-related outcomes.
In accordance with this definition, mutual understanding of family planning and reproductive matters is one of the important issues in the harmony of the family. The study examines women’s decisionmaking positions regarding family planning and reproductive matters in the process of family decision-making. The study also attempts to investigate the factors that might influence on both working and nonworking women’s decision making position regarding reproductive and contraceptive matters. There are many factors influencing on couples reproductive and family planning matters such as perceptions, evaluations, norms and attitudes, [3-4]. Most of these studies focus on gender attitudes and norms that influence on women reproductive and family planning matters. Most gender ideological constructs from traditional (conservative), or anti-feminist to non-traditional (egalitarian), liberal, or feminist. Traditional gender ideologies emphasize the value of the distinctive roles for women and men. According to a traditional gender ideology men are considered as breadwinner whereas women fulfill their roles through nurturing and homemaking activities. In addition, according to the traditional point of view, men are more assertive, competitive, decisive, confident, ambitious, and instrumentally oriented, whereas women are more nurturing, empathetic, helpful, sympathetic, gentle, affectionate, and expressively oriented [5]. From these belief systems in traditional societies, men often play the dominant roles in family planning decisions. Women, on the other hand, usually expect that their husbands should be the decision-maker of important decisions such as family planning matters. In the patriarchal societies, male superiority is accepted as part of the natural order of things [6]. For example, in many parts of the world, domination of unprotected sex is considered as an acceptable a way of asserting male power and demonstrating manhood and male rights over women [7]. These attitudes may affect on women reproductive health and rights as well as the overall family planning system.
However, these traditional attitudes and norms are common in the most of the developing countries that may influence on women’s reproductive health and rights. For example, in Bangladesh, husbands are often involved in decisions about their wives’ health care [8-10]. Women’s independence and autonomy, with respect to health-related decision-making, may be restricted in a society where women are embedded in social relationships and have strong cultural and structural ties to men [11]. Similarly, in Malaysia, patriarchal society exits where men hold traditional belief system. Although this belief is gradually breaking down with increased education and cultural globalization, husbands are still viewed as the main decision-maker in the family in some parts of this country. However, unequal power relations in the family may have an influence on women reproductive health and rights. In some cases, it is noted that women are unable to discuss, negotiate or decide on sexual and reproductive issues. Man being the leader of the family and more often the decision maker in many parts of the society certainly has a significant influence on the practice of family planning and contraception. Family planning has suffered an extreme stereotyping which associate the service to women [12].
For example, lack of practicing family planning is clearly demonstrated by the Report on the Confidential Inquiries into Maternal Death (CEMD) Malaysia 2001 – 2005 [13]. It shows that about 70% of the maternal death cases did not practice any kind of family planning method [14]. According to the report made by the Federation of Reproductive Health Association of Malaysia (FRHAM) — Reproductive Rights Advocacy Alliance Malaysia (RRAAM) [15] only 48% of married women are using contraception. However, in Malaysia, using of modern method among couples has also not been increased. It was reported that only 32 % of women used a modern method in 2004 compared to 30 % in 1994 and 34% in 1998. Among the states, use of modern methods in 2004 was lowest in Kelantan at only 16%, followed by Terengganu at 19% and the highest was Negri Sembilan at 63 % [16]. According to Tay NP [16] husband’s objection is one of the important reasons for not using contraception, which is an indicator of gender power relations [16].
The study also attempts to identify the factors that influence on a woman's decision making position related to family planning matters. Extensive literature supported [17-21] that there is a relation between women's education and their reproductive behaviors. There is also a positive relationship between education, occupation and income, because higher levels of education provide better employment opportunities and enhances income [22]. Conversely, employment has an impact on contraception and fertility as it provides women's contribution to their families [23,24]. However, a number of studies [25,26] supported that there are other factors such as spouses’ level of education, individual preferences, social status, economic input, and personal values influence in a woman's decision making position in theses aspects. The study attempted to examine both working and non-working women's decision-making power of the particular aspects of family planning and reproductive matters. From these circumstances, the study attempts to determine a better understanding of decision making position of women in family planning and reproductive matters that would facilitate interventions in improving women’s right on these aspects.

Objectives and Methods

The objectives of this article are (1) to examine working and nonworking women decision making position about family planning matters (2) to identify the difference between working and nonworking women’s decision-making position on family planning matters and reproductive matters (3) to measure women perception on their right about family planning and reproductive matters and (4) to determine the influence of socioeconomic factors that might have an influence on women’s decision making position on family planning and reproductive matters. The study was basically quantitative in nature as it compared decision-making powers between two groups and measured the relationship between the variables and decision power of the respondents. A cross sectional survey was carried out on the basis of two selection criteria. First, the respondent must be a married woman. Secondly, the age range of respondent must be between 20 to-69 years old. A total of 132 women were selected as the respondents from three academic institutions and three residential areas in Malaysia. Semi-structured questionnaires were prepared in obtaining data. Questionnaires were handed to each respondent and the information was collected directly by the researchers. Questionnaires were completed in a supervised setting by the research protocol. The research assistant and principle researcher herself carried out data collection. The study questionnaire technique used in order to examine both working and non-working women’s decision making power and gender attitude concerning family planning and reproductive matters. The variables related to decision making on reproductive health and rights were measured using 5 statements using Anchored scale ranging from 1=strongly Agree 5=Strongly Disagree.
Family planning variables are related to using the family contraceptive method, number of children should have freedom of visiting health center and freedom to receive the treatments from the health center for reproductive health related matters. Data were analyzed using the Statistical Package for the Social Science (SPSS) program. The questions were coded before being entered into the computer to be analyzed. For measuring women’s rights and decision making power of family planning matters frequency, standard deviation, mean and percentages were largely used in this study. The correlation coefficient was also conducted to examine the relationship between respondent’s decision making power and the socioeconomic variables.

Results and Discussions

Demographic Information of the Respondents
Table 1 summarized demographic background of respondents for a better understanding of determining the relationship between socioeconomic variables and women's decision-making Respondents from the working group had a mean age of 2.03 (SD=0. 80) while respondents from the non-working group had a mean age of 2.65 (SD= 1.13).
Table 1: Demographic Information of the Respondents between Working and Non-Working Women.
The data show that the majority of respondents (42.4 percent) involved in this research were aged between 30-39 years old while only 21.2 of percent of respondents belonged to the age range between 40-49 years. In terms of religious status, the majority of the respondents from both groups were Muslim. There were the highest numbers of respondents were Malay from the working and nonworking group (refer to Table 2). The data on occupational status of the respondents revealed that the highest numbers of respondents were found in full-time employed groups. A small number of respondents (5.5 percents) belonged to self-employed group. Selfemployed referred to those respondents who involved in small business. Different educational levels of respondents were selected in this study. The respondents’ educational level was also important for measuring women’s decision-making in their families. Results revealed that the highest number of respondents (28.8 percent) from the working group belonged to degree level of education. On the other hand, the majority of respondents (4.5 and 43.9 percent respectively) from the non-working group hold PMR (Lower Secondary Assessment) and MCE (Malaysian Certificate of Education). From these data, it can be noted that working women tended to have higher education than the non-working group.
Table 2: Measuring Decision Making Power of the Working and Non-Working Women in Their Families about Family Planning Matters.
Working and Non-working women decision making position about reproductive and family planning matters
Table 2 summarized the decision making power of the working and non-working women in their families about family planning and reproductive matters.
Family planning questions are related to using the family contraceptive method, number of children should have freedom of visiting health center and freedom to receive the treatments from the health center for reproductive health related matters. The results (Table 1) revealed that majority of (87.9 percent) of respondents from working group agreed that they have decision making on family planning methods followed by only 6.06 percent of them disagree and 4.5 percent were not sure respectively. On the other hand, 69.7 percent of respondents from non-working group agreed that they have decision-making power on family planning matters which is slightly less than working women. Mean and standard deviation for non working women were 1.5 and 0.7 respectively. Similarly, in the second statement it can be seen that the majority of respondents (78.8 percent) from working group agreed that they can make a choice how many children they should have. Mean and standard deviation for this statement were recorded 1.4 and 0.8 respectively. Whilst 57.6 percent of respondents from non-working group was agreed that they have freedom of selecting number of children they should have.
From this statement, it can be noted that working women tend to have more decision-making power than non-working women about the number of children they should have. With respect to use modern contraceptive methods, 72.7 percent of respondents from working women were joint decision maker on using modern contraceptive methods. The mean and standard deviation were 1.5 and 0.9 respectively. On the other hand, 47.0 percent of respondents from non-working group were joint decision maker whereas 53.0 percent of them were husband decision maker and 1.5 percent of them were not applicable category as these respondents were older who were not required to use any contraceptive method respectively. These results revealed that working women are more capable in making joint decisions about contraceptive method than non-working women.
With respect to freedom of visiting a health center to know more about family planning matters, 87.9 percent of respondents from working group were agreed, followed by 6.1 percent were disagreed and 3.0 percent were not sure whether they enjoy the freedom in this matter respectively. Mean and standard deviation for working women were recorded 1.2 and 0.6 respectively. On the other hand, only a few respondents (39.4 percent agree) from non-working group enjoyed the similar freedom. Mean and standard deviation for non-working women were 1.7 and 0.7 respectively. Similar results can be noted in the last statement. Working women (77.3 percent) enjoyed greater freedom with respect to receive the treatments from the health center for reproductive health related problems than the non-working women (40.9 percent).
From these results, it can be noted that women decision-making power and freedom in family planning matters depends on women's occupational status. With respect to reproductive and family planning matters, most of working women enjoy greater freedom and exercise greater power compared to non-working women. As mentioned elsewhere generally in Malaysia women’s family planning and reproductive matters decisions are controlled by men. For instance, even using a modern method among couples has also not been increased. It was reported that only 32% of women used a modern method in 2004 compared to 30% in 1994 and 34% in 1998. Among the states, use of modern methods in 2004 was lowest in Kelantan at only 16%, followed by Terengganu at 19% and the highest was Negri Sembilan at 63% [16].
Women’s gender ideology towards their decision making right to family planning and reproductive matters
This section will measure women’s gender ideology that might effect on family planning decision and reproductive matters. Gender roles and ideologies are those behaviors and attitudes prescribed and assigned to males and females by the broader culture solely on the basis of gender [27]. Gender ideology also can be seen as a force in the dynamics of gender relation which organize social thought and action and works to fix the individual within a certain mental horizon [28]. The main point of this discussion is on how gender ideology may influence on a woman's decision making position on reproductive and family planning matters. According to Batliwala [29] in male dominated societies, men’s superior status leading to power over women and dominant status is supported by religious, traditional and ideologies beliefs. Similarly, women gender ideology also can be pointed out here from the traditional and cultural perspective.
In traditional society, generally, women accept male authority. Women are often required to put men first. They are often expected to defer to male authority [7]. Similarly, women may accept husband’s authority especially on family planning decision. The study, therefore, examined working and non-working women gender ideology and the results are presented in Figure 1. The results revealed that with respect to depending on husband’s decision on family planning matters, 46.96 percent of working group and 63.63 percent respondents from nonworking group answered “Yes” respectively. From these findings it is noted that non-working respondent’s positive responses to the matter is higher than working group. Therefore, it can be said that nonworking women tended to have a more traditional ideology than working women. However, 48.48 percent of respondents from the working group and only 27.27 percent of respondents from nonworking were disagreeing with the statement respectively.
Figure 1: Respondent’s Gender Ideology about Family Planning and Reproductive Matters.
These results clearly indicated that most of the working women depended on husband’s decision on family planning and reproductive matters. Furthermore, respondents were asked to provide the reasons behind their acceptance of husband’s decisions on family planning matters. Results are presented in Figure 2 revealed that19.69 percent of respondents from non-working group and 16.69 percent of respondents from working group stated religious belief as the reason respectively.
Figure 2: Factors Influence on Accepting Husband’s Decision [blue color bar presents ‘non-working’ and green color presents’ working’ women.
Mean while 13.63 percent of respondents from non-working group and 19.09 percent of respondents from working group considered husband as the head of the family for depending on husband’s decision in this matter respectively. However, some respondents from both groups stated other reasons include husband is the right person, mutual understanding with husband, husbands is responsible, compromise with husband and happy with husband’s decision respectively. From these findings, it can be summarized that women’s gender ideology has not much influence on their decisions about family planning and reproductive matters since the majority of respondents tended to have non-traditional ideology who do not believe in husband’s decision in these aspects.
Relationship between socioeconomic variables and Working and Non-working women in family planning and reproductive matters
The study attempts to determine the relationship between socioeconomic variables and decision-making power of working women on family planning and reproductive matters. Results of the Correlation Coefficient of decision-making powers of working women on family planning matters are presented in Table 3 revealed that religion (r = 0.13), ethnic (r = 0.01), occupation (r = 0.12) education (r =0. 05), respondent’s monthly income (r = 0.06), type of family (r = 0.03) and number of children (r = 0.15) have a weak relationship with the respondent’s decision-making power of family planning and reproductive matters. Whilst duration of marriage (r = 0.34; p<0.01) was found significantly related to decision making power among working women on family planning matters.
Table 3: Correlation Coefficient of Decision-Making Powers of Working Women on Family Planning Matters. Significant levels: *p<0.05, **p<0.01.
Moreover, the study examined the relationship between socioeconomic variables and women decision making of non-working women on family planning and reproductive matters. The results are also presented in Table 4 revealed that all the selected variables such as ethnic, educational level , religion, family size, type of family, number of children and duration of marriage were not significantly related to their decision making power on family planning matters.
Table 4: Correlation Coefficient of Decision-making Power between Non-working Women Related to Family Planning matters. Significant levels: *p<0.05, **p<0.01.
Therefore, it can be said that the respondent’s socioeconomic variables have a weak relationship with their decision making of nonworking women on the similar aspects.

Conclusion

The study examined the decision making power of working and non-working women on the particular aspects of family planning and reproductive health related matters. Although the literature support that some parts of Malaysia, husband’s gender ideology and objection are the important reasons for not using contraception which is an indicator of unequal power relations, the present study found that the majority of the working women had positive responses towards their participation in decision making on family planning and reproductive matters. However, when comparing decision-making power between two groups, there are significant differences emerge. The results revealed that working women are more capable in making joint decisions about contraceptive method than non-working women. Similarly, with respect to reproductive and family planning matters, most of working women enjoy greater freedom and exercise greater power compared to non-working women. However, as there are considerable numbers of working women enjoy greater freedom; interventions are needed for the disadvantage group to improve their condition and understanding their own rights about their family planning and reproductive matters to move towards achieving equal opportunity and overall harmony of the family. Overall, the study suggests that improvement in women’s access to education particularly the higher level of education opportunities would increase women’s employment and income. This could expand their ability to make decisions in the family with the particular aspects of family planning and reproductive matters.

References






























Track Your Manuscript

Media Partners

Associations