Built, Economic, and Natural Capitals’ Influence in Health Decision-Making and Gender-Based Outcomes for Women in Nepal

Background and Purpose: Gender-based violence (GBV) is strongly associated with global public-health outcomes and human rights concern (Ellsberg et al., 2008). GBV is deeply rooted in gender inequalities and power imbalances. The cultural gendered norms shape how women should behave in a relationship, particularly in South Asia. This often acts as barriers for women to have financial freedom, obtain education, make better decisions about their health, and hold land ownerships, which have been shown to decrease the risk of violence and improve physical and mental health (Clark et al., 2019). While owning mobile phones have helped remove gender-based barriers in health care access and decision making for Nepalese women and girls (Parajuli et al., 2017). Research has shown that economically empowered women and those who have land and assets are less likely to experience GBV (Mejia et. al., 2014). GBV is a growing problem in Nepal (UNFPA, 2012). This research aims to assess the role of capital and rights-based perspective in understanding the role of economic, built and natural capital in health-decision making and GBV.

Methods: The study used data from the 2016 Nepal Demographic and Health Survey [NDHS]. The sample included married or cohabiting women (n=2422) aged 15-49. Hierarchical regression was used to assess education, having a mobile phone, having a bank account, owning land, and occupation are related to health decision-making and subsequently to GBV. These constructs are relevant in specifying economic, built, and natural capital contribution to GBV in Nepal.

Results: Most women in our study had secondary (30.1%) or no education (40.7%) and reported being economically disadvantaged (49.5%). About 70% owned telephones but only 5% reported using mobile phones for financial transactions. More than half of the women (55%) did not have a bank account nor had the authority to make independent decisions about their health (87%), earnings (89%), and use of contraception (87%). A majority did not own land or a house (88%) and were mainly self-employed (49%) or unemployed (30%). About 17% reported being victims of some form of GBV. The hierarchical regression models revealed that at stage one, owning land contributed significantly to the model (β=-.287, p=.001) indicating that ownership of land can improve health-decision making. Similarly, having a bank account (20.5% variance) (β=.-414, p=.001), F(1,90)=35.2, p<.001; owning a mobile phone (5.9% variance) F(1,86)=26.7, p<.001; education (β=.-057, p<.001); occupation (β=.011, p=.012), F(1,84)=17.21, p<.001, and GBV, F(1,83)=12.48, p<.001, explained 36.2% of the variance in health-decision making. Results suggest that an increase in land ownership, holding a bank account, owning a mobile phone, and education decreases GBV and improves health decision-making. Taking part in labor force may not necessarily decrease GBV.

Conclusions and Implications: GBV and lack of health decision-making debilitate women’s agency and power within a relationship. More needs to be understood in ways inequities in various capital ownerships impact them. Social workers in policy, practice, and research must continue to understand the role of these factors in promoting sustainable development and human rights for women in Nepal and globally.