Abstract: Optimal Birth Interval and Attitude Towards Intimate Partner Violence: A Closer Look at Kenya through a Nationally Representative Survey (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Saturday, January 13, 2018: 8:00 AM

Liberty BR Salon I (ML 4) (Marriott Marquis Washington DC)

* noted as presenting author

Rumyana Kudeva, DSW, Assistant Professor, Eastern Washington University, Cheney, WA

Beth Halaas, EdD, Assistant Professor, Eastern Washington University, Cheney, WA

Njeri Kagotho, PhD, Assistant Professor, Ohio State University, Columbus, OH

Bipasha Biswas, PhD, Associate Professor, Eastern Washington University, Cheney, WA

Background and Purpose: Despite increased government support to improve women’s health, maternal death remains alarmingly high in Kenya at 488 deaths/100,000 live-births (Kenya National Bureau of Statistics and ICF Macro, 2014). The United Nations’ Sustainable Development Goals (SDG) envision a reduction in global maternal mortality ratio to less than 70 per 100,000 live-births (SDG #3). Optimal birth-intervals (OBI) can decrease the rates of maternal mortality, effectively prevent negative perinatal outcomes, and improve maternal and child health (MCH). However, the role of OBI in influencing MCH is underexplored in literature, especially in Kenya. This study explores how the juxtaposition of women’s agency and intimate partner violence (IPV) impact OBI in the context of Kenya and situate women’s reproductive behaviors and agency within this region.

Methods:Using the latest Kenya Demographic Health Survey data 2014 (KDHS) (Kenya National Bureau of Statistics and ICF Macro, 2014), this study analyzed household responses from married/partnered couples with at least two children (n = 4178). Birth interval was a continuous outcome variable denoting the number of months between current and previous birth, ranging from 9-271 months. The predictor variables, ‘IPV attitudes’ and women’s autonomy were both latent constructs. Data cleaning and bivariate analyses were conducted in STATA14 (StataCorp, 2015), while structural equation models (SEM) were estimated in Mplus7 (Muthén & Muthén, 2015). Model fit was assessed using the chi-square test. Root mean square error of approximation (RMSEA), comparative fit index (CFI), and Tucker Lewis index (TLI) were also considered.

Results: Sixty-eight percent of women reported non-optimal BI, with the mean BI at 46 months for women. Women's mean age is 32 years, majority are from rural Kenya (66%), use modern contraception (60%), and 73.5% are employed. Regarding IPV, 25% of women are agreeable to wife-beating if woman argues with husband or goes out without permission, and 37.8% if woman neglects children. Women’s agency (examined by autonomy) in decision making revealed joint decision making by 40% or more in most categories. About 22% of women reported their husband/partner to be the decision maker regarding healthcare. Optimal BI was associated with partner making decisions for visits from friends/relatives (OR= 0.70, 95% CI [0.55-0.89]) and attitudes towards IPV (OR=0.06, 95% CI [0.01- 0.33]). After controlling for individual, household, and community level factors, SEM results [X²(151) = 767.92, p £ 0.001, RMSEA = 0.031 (90% CI [0.029, 0.033]), CFI = 0.95, TLI = 0.95] supported the study hypothesis that women with permissive IPV attitudes report shorter BI [β = -1.2, p=0.03]. However, women’s autonomy was not significantly associated with BI.

Conclusions and Implications: Safe BI is not the norm for women in this analysis; more than two out of three report non-optimal BI time-frame. Given the likelihood of IPV contributing to safer birth outcomes, it will be important to develop programs and policies that challenge existing community IPV norms, support women’s independence, and influence reproductive and child health outcomes.