Reproductive Health of Women in Developing Countries: Application of Sen's Perspectives

Purpose: Health problems related to reproduction of women in developing countries are a major social problem that warrants social work attention. Each year more than 500,000 women die of pregnancy related complications (Pillai & Johnson, 2007; World Bank, 1993). HIV/AIDS infection alone causes increasingly high number of infants' and children's deaths (Goldenberg & Jobe, 2001). Despite these staggering statistics, attempts to understand the variations in reproductive health in developing countries are few and far between. Currently available models of reproductive health at the cross national level in developing countries lack strong theoretical foundation and are based on theories chosen eclectically and use only a limited number of structural constructs (Clark, 2006; Pillai & Gupta, 2006; Pillai & Wang, 2001)). In addition, concepts such as the roles of social development and capability on reproductive health remains unexplored and poorly specified. In order to address some of these shortcomings in the existing literature on reproductive health in developing countries, we have used now well known development theories proposed by Nobel Laureate Amartya Sen. The proposed model hypotheses that, social development and reproductive capabilities positively influence reproductive health of women in developing countries controlling for economic growth and political development.

Methods: The units of analysis in this study are nations identified by World Bank (2004) as developing. Data necessary for testing the proposed model of reproductive health are obtained from 142 developing countries. The data were obtained from a number of international organizations such as the United Nations and World Bank. The theoretical model is composed of four latent dimensions indicated by 20 observed variables. The four latent factors are social development, political development, reproductive health capabilities and reproductive health levels. Economic growth is tested directly using GDP per Capita. Factor based scales are developed to measure the four latent factors. The proposed model is evaluated using structural equation methods for path analysis.

Results: The proposed model suggested that economic growth (beta=0.126, p<.05), and political development (beta=.378 (p<.05) are essential for enhancing social development in developing countries. Further more, social development was found to have a direct effect (beta=.742, p<.05) and an indirect effect on reproductive health levels through reproductive capabilities (beta= .450, p<.05). Reproductive capability was found to have direct effect on reproductive health (beta=.829, p<.05). Both hypotheses of the model were empirically supported. The path model provided excellent fit the observed variance-covariance matrix as indicated by high scores above .90 on GFI and CFI and a score below point 0.05 on RMSEA.

Social Work Implications: These findings highlight the significance of social development and capability based approaches to promote reproductive health in developing countries. We argue that capability and social development based approaches are more congruent with social work values than those based on economic development models alone. It is well known that social development is contingent on programs and policies that support social justice and human rights. These two values are core social work values and suggest that social work skills and methodologies are essential for social development program.