Eliminate The Gender Inequality Health And Social Care Essay
To eliminate poverty, increase human right and eliminate gender inequality, the empowerment of women plays a major role for a country like: Bangladesh (DFID, 2000). Particularly women empowerment in individual level can help as a basis for social change (Parveen and LeonhÈuser, 2004). For Bangladesh, women are half of the total population of more than 148 million people (WHO, 2012) and it has got achievements in promoting gender equity since 1990 (Hossain, 2011). By promoting gender equity and empowering women, women can make their own decision regarding their health and they can have increase access to health care services if they need. An understanding of women status and empowerment regarding their health within their households and communities can improve not only the health status of women but also the community and whole country by improving necessary health care interventions.
In Bangladesh, women empowerment plays top priority in national curriculum for improvements of social and economic conditions of people (Bangladesh Demographic Health Survey (BDHS), 2007). In the past 20 years, various economic and social development indicators indicate that Bangladesh has made substantial progress in increasing women's access to education, health care and participation in labor markets (Nazneen, Hossain and Sultan, 2011). In United Nations Development Program (UNDP) (2007) report, Bangladesh achieves 81 out of 93 countries on Gender Empowerment Measure and 140 among 177 countries on Human Development Index. Fertility rate in Bangladesh was reduced to half between 1971 and 2004. Girl's school attendance rate is increased. Infant mortality associated with gender discrimination has been closed. Vast number of village young women start to work in garment factories, who were rarely seen outside of their homes in earlier generations (World Bank 2008).
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In 2005 World Summit, all nations' governments agreed that "progress for women is progress for all" (Haque, Tareque, Islam and Mostofa, 2011). Women's empowerment is described in relation with political, social, health and economic empowerment (West, 2006).Participation in income-generating activities leads to women's empowerment because access to resources can improve women's bargaining position, so that they can have greater
control over decisions and life choices. If woman has income, she doesn't need to depend on her husband or others for survival and she can take care of herself. Greater bargaining power in household is assumed as empowerment because woman can have greater control over her and her family's life. Working makes women empower because women can participate in public network and it can increase self-esteem or self-worth (West, 2006).
Many studies have shown that there is a positive relationship between women employment and women's empowerment, and women employment also increases women autonomy. There is a very limited research paper established on assessment of women empowerment regarding health among female factory workers in Bangladesh, whether they are empowered or not. This study will try to assess the empowerment of female factory workers regarding their health in detail and also looking deeper into the factors that have the connection with empowerment indicators.
Background and Literature Review
Women empowerment and autonomy are critical elements for achieving sustainable development (BDHS, 2007). Bangladesh was ranked as 116th country in the Gender Inequality Index of the UNDP Human Development Index in 2010 (UNDP, 2010). Naved mentioned that in Bangladesh, women are marginalized in men-dominated society (Hasib, 2011) and gender discrimination makes women more vulnerable to disease and death (United Nations Children's FundÂ (Unicef), n.d.). Women cannot receive health care because social norms in community limit women go to clinic/hospital alone. Afrin mentioned that women in Bangladesh cannot make critical decision on seeking health care in their lives and they need permission from their husbands, who always make final decision and husbands don't know what their wives suffering (as cited by Hasib, 2011).
In Bangladesh, pregnant women often suffer pregnancy-related complications because they are late in seeking health care due to they need to wait permission and decision from their husbands or in-laws (Hasib, 2011). Although there is an increasing trend in health facilities in Bangladesh, 85% of deliveries take place at home (Unicef, 2009) and only less than 25% of births are delivered by skilled health personnel (Unicef and BBS, 2010). Only 21% of pregnant women take four antenatal care visits, which is recommended by World Health Organization (WHO) and coverage of antenatal care is very low (NIPORT, 2009). Mothers are the last priority for seeking health care in family while sons and husbands are the first priority (Hasib, 2011).
According to Bangladesh Demographic and Health Survey, women have less access to mass media than men. This leads to women receive less knowledge on serious illness like: tuberculosis, HIV, family planning and cancer. Limited access to health care services, lack of information on health and inequality in decision making are most common factors which cause women suffering most (Hasib, 2011). Another factor that limits women access to health care is poverty. So, if women can get empowerment through paid work, women can purchase better health services and get better health outcome by increasing income (Amin, Shah and Becker,2010).
Regarding the health seeking behavior of the female garment workers, 45% of the female respondents did not go to any doctor when they feel ill and in most cases, they tried to solve with their own treatment by buying over the counter drugs. The main reason for not going to health facility are cost of treatment, time constraints and most important thing is there is no onsite health facility in garment factory (Paul-Majumder, 2003).
Domestic violence in married women is also a major problem in Bangladesh. According to 2007 research, more than 50% of ever married women aged between 15 and 49 had suffered some form of physical and/or sexual violence from their husbands and 25% also suffered in last year (NIPORT, 2009). Another important point regarding perception of violence against women is more than one third of both men and women perceived that men are justified in hitting or beating their partners in some conditions like: arguing with them (Unicef, 2009).
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As mentioned by the Bangladesh Garment Manufacturers and Exporters Association (BGMEA), women workers play a major role in factories and it accounts for about 85% of total employment in ready-made-garment industry (as cited by Business for social responsibility (BSR), 2010). Employment in garment factories makes an increase in age of marriage and women's income, but many significant challenges like: women health still remain (BSR, 2010). According to Sheva and Huq, female workers are facing major health problems such as: anemia, post-birth complications like: fistula and prolepses (as cited by BSR, 2010), cough, cold, eye-pain, headache, chest-pain, breathing problems (Jahan, 2012). But totally, workers don't receive health care from any kind of facility (Jahan, 2012). As mentioned by Sheva and Huq, female workers often feel helpless against being transmitted to them by their husbands if they have AIDS or any other STI (as cited by BSR, 2010).
Women are employed in garment sectors with disadvantages out weight the advantages like: low salary for the labor, lower bargaining power and docility (Paul- Majumder and Begum, 2000). Garment factories' women have to work in poor infrastructure and work environment. Many studies mention that working hours per day is 12 hours and also workers have to work overnight work and it is almost 24 hours in work place for 1-5 days per month (Jahan, 2012). According to Majumder and Begum (2000) and Battacharya and Rahman (1998), female workers have to work lower status than male workers in terms of job distribution, wage rates, leave granting, and etc (as cited by Jahan, 2012). There is also verbal, non verbal and physical abuses occurring among female garment workers by supervisors and co-workers (Jahan, 2012).
On the other hand, some people say that working alone can't empower women because there are other factors that limit women to empower like: poverty and limited job opportunities for women. Socio-demographic factors can also influence the women empowerment directly and also indirectly like: social status, job opportunities and gender role expectations. Combination of social norms and women's lower educational level leads to the jobs that women can work with less skill, poor payment, no security and poor working conditions. These reasons give the idea that participation in income generation activities does not lead to women empowerment (West, 2006).
So, assessment of empowerment level of female garment factory workers regarding health is necessary for better understanding of their health care together with their position in household and community.
In Bangladesh, although there is a rapid achievement in gender equity in social and economic domains, current condition and status of women and girls within society is still low (Hossain, 2011). Women's access to positions of influence and power is limited. Bangladesh Demographic Health Survey (2007) describes that women lag behind men in areas of literacy, educational attainment, employment and media exposure, which can make women empower and develop women's personality and upgrading their position in household and society. For working outside of their homes, they have to struggle to against with their cultural roles (Islam, 2005). Percent of unemployed women between age of 15 and 49 years is 65% and it is still high (Unicef and BBS, 2007).
Son preference in Bangladesh still exists due to economic value of sons, continuity of family line, family strength and socio-cultural norms. This leads to gender inequality and low quality of life for women. Due to gender discrimination in socio-cultural environment, girls and women face many obstacles to their development. Girls are considered as financial burdens to their family and they have less access to health, care and education (Unicef, 2010). When interviewed women aged between 20 and 49, three-quarters of them were married before the age of 18 (Unicef and BBS, 2007). It happens especially in rural areas and urban slums in Bangladesh. Families want to relieve from caring of their daughters and they arrange early marriage because after marriage, girls have to live with their husband's family. This leads to girls drop out of school and have to work full time for their husbands family, where they usually lack bargaining power in household and also lack of empowerment regarding their health care (Unicef, 2010).
Bangladesh's child marriage and adolescent motherhood rates are highest in world (Unicef, 2010). Adolescent fertility rate is 133 per 1000 girls aged 15-19years (WHO, 2012). Maternal mortality in Bangladesh is very high and it is 570 maternal deaths per 100,000 live births (Unicef, 2009). Life time risk of dying during pregnancy for pregnant women in
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Bangladesh is one in 51, which is very high in comparison with Ireland where one in 47,600, which is best performer (Unicef, 2009). Every year due to pregnancy or delivery complications, about 12,000 women die (Government of Bangladesh (GoB), 2008). It is due to early marriage, malnutrition, less access to medical services and lack of knowledge (Unicef, 2010).
Women's mobility is very limited and decision making power is restricted. Forty eight percent of women say that husbands make decisions for their health and 35% say that husbands alone make decision for visit to relatives and friends (Unicef, 2007). Education is necessary to reduce discrimination and violence against women. Bangladesh has achievement in this area because girls to boys ratio in primary and secondary school is same (Unicef, 2010).
Zohir and Paul-Majumder (1996), Compbell (1997), Kabeer and Mahmud (2004) and Alam, etal. (2004) mentioned that women are employed as full-time and part-time workers due to seasonal variations in demands and in down season, unskilled workers are fired from job and in peak season, they are hired with lower salary (as cited by Jahan, 2012). Although female garment workers have income, their low income salary empowers them is in doubt. Whether and the extent to which female garment factory workers' lives is changed to the better health by the garment factory employment is still the subject of much debate nowadays (Hossain, 2011). So, this study will try to focus on women empowerment level assessment among female garment factory workers regarding health in Bangladesh and it will help us to get a reflection of women empowerment regarding health of low paid female garment workers of Bangladesh which might in turn raise a broad research agenda.
Empowerment has been defined in various ways by different authors. Most widely accepted definition of empowerment according to Kabeer (2001) is "expansion of people's ability to make strategic life choices in a context where this ability was previously denied to them." Women empowerment is a process through which they start gaining more power and control over their own lives and circumstances than that of the previous times. Measures of women's empowerment are economic participation, education, wage work, fertility, female to male sex ratio of living children and ideal female to male sex ratio (Haque, Tareque, Islam and Mostofa, 2011).
Empowerment regarding health
It means empowerment of women regarding on their own health care including family planning, empowerment regarding decision on child health care, violence against women and refusing toward sexual intercourse with husband.
Women autonomy is certain power of women by which they can do whatever they like to, without seeking permission or without having consent of others (Haque, Tareque, Islam and Mostofa, 2011). In this study, it will mean women alone making decision on their own health care including family planning and child health care.
Female Garment Factory Workers
It means all currently married females of all ages who are working in garment factories of Dhaka.
To assess female garment factory workers' empowerment regarding health in Dhaka, Bangladesh
To assess level of empowerment regarding health among female garment factory workers and also autonomy regarding health
To identify the factors associated with women empowerment
To understand the perceptions of female garment factory workers regarding their positions in family and community
The study was the cross sectional study design to assess the level of empowerment among female garment factory workers regarding health at only one point in time in factories of Dhaka, Bangladesh.
The study was mixed method. Specific objective (1) to assess level of empowerment and autonomy and specific objective (2) to identify factors associated with women empowerment was answered by quantitative method. Specific objective (3) to understand perceptions of female factory workers regarding their positions in family and community was answered by qualitative method.
Quantitative survey and qualitative (IDI and FGD) interviews was done concurrently due to time limitation of data collection period. Face to face in depth interview was performed to explore individual perception and FGD was done to elicit broad overview of the perceptions of female garment workers regarding their positions in family and community.
The survey was conducted in one purposively selected garment factory in Uttara in Dhaka, Bangladesh. I had chosen that factory according to feasibility and accessibility.
IDIs and FGD were conducted in female garment workers' houses in Uttara in Dhaka, Bangladesh.
The study participants were the currently married female garment factory workers of all ages. But due to child labor law, minimum age of the respondents was 18 years of age.
Sample size was calculated by using formula of
n= z2 p q = 1.962 Ã- [0.7(1-0.7)]
According to research paper on women empowerment done by Haque, Tareque, Islam and Mostofa (2011), women empowerment level is about 70%. So, with 70% empowerment level, 95% confidence level and 5% marginal error, ideal sample size was 323. However, due to time limitation of data collection period, feasible sample size was 89, based on 70% empowerment level with 95% confidence level, 10% marginal error and 10% attrition rate.
For quantitative survey, total 89 respondents and for qualitative component, 8 in depth interviews and 1 focus group discussion (6 participants) were conducted due to time limitation. In depth interview and focus group discussion were conducted to those respondents who agreed to participate and who could give time and who were not respondents in quantitative survey. Qualitative study was done for more understanding of the perceptions of female garment factory workers regarding their positions in their families and communities.
Although the factory has many sections like: cutting, sewing and finishing sections supervised by the separate managers, the researcher chose one section (sewing section) because the manager allowed to do in that section. The researcher did the systematic random sampling method like: chose one starting number randomly beginning with 2nd person and chose every 5th person in each line for interview, if they could give time, they were currently married and had interest to participate. If they refused to participate or if they were not currently married women, skipped to next randomly chosen respondent until getting the feasible sample size (89 respondents).
The researcher used purposive sampling method for qualitative interview and respondents were those who could give time and who were interested to participate in interview.
Key Study variables:
By considering the objectives of the study, the following variables will be investigated:
Socio demographic variables: Respondent's name, respondent's age, respondent's income, respondent's education, respondent's duration of working, respondent's job title, religion of respondent, family type, media exposure, husband's age, age at first marriage, husband's education, husband's occupation, husband's income, religion of husband, current use of contraceptive methods, if respondent has child; number of living children, antenatal care from health personnel in last pregnancy, delivery assistance from health personnel in last pregnancy, postnatal care from health personnel within the first two days since delviery in last pregnancy.
Empowerment indexes: Household decision making indicators like: who make decision about own health care, who make decision on how many children to have, who make decision on whether to use contraception, who make decision on what to do if child is sick. Physical movement indicators like: are respondent allowed to go to health facility alone, only with someone, not at all, who make decision to visit to respondent's family or relatives. Economic decision making indicators like: who decide how to spend what respondent earns. Attitudes toward acceptance of normative gender role like: A husband is justified in hitting or beating his wife if: she goes out without telling him, she neglects the house or children, she argues with him, she refuses to have sexual intercourse with him, she doesn't cook properly, husband suspects she is unfaithful, she does not obey elders in the family. Attitude toward refusing sexual intercourse with husband: respondent agree or not that a wife is justified in refusing to have sex with her husband when she: knows husband has a sexually transmitted disease, knows husband has sex with other women, is tired or not in the mood.
Perceptions of female factory workers regarding their positions in family and community: decision making role in seeking health care for themselves and family members, child education, any other problems in their families and also their own experiences, position of women in family, perception on having daughter or son in family, participation in social activities in community.
For Quantitative method, the face to face interview was conducted using a structured questionnaire. The questionnaire was referenced from women's empowerment and demographic and health outcomes from Bangladesh Demographic Health Survey (BDHS) (2007) and National Family Health Survey (NFHS-3) (n.d.).
For Qualitative method, guidelines were used for conducting the in depth interviews and focus group discussion.
These instruments were firstly pre tested with local language (Bangla) in 10 respondents for quantitative surveys and 1 respondent for IDI and according to pre test result, the questionnaires were edited. All questionnaires were translated and interviewed in local language (Bangla).
Data collection method:
The interview was conducted with assistance from the two female research assistants. Before going to the field, the researcher explained the objective of the study and questionnaires to research assistants, clarified their questions and gave them research proposal for more understanding on the topic. The factory manager gave one separate room for interview and interviews could be conducted with privacy and no disturbance. Before starting the interview, research assistants introduced the researcher and themselves, explained the objectives of the survey, their participation was completely voluntary and took informed written consent. Each interview last about 20 minutes and all the respondents agreed to answer until finish the survey. After finishing each survey, the researcher checked for missing data and if there was any confusion, researcher clarified it immediately.
The quantitative survey was conducted for 10 days and qualitative interview was done in two days after quantitative survey. The garment factory production line depends on the production of each female garment workers. So, the garment manager didn't allow interviewing each respondent for long time. So, to get sufficient time and in depth information for IDI and FGD, the researcher collected contact addresses from female garment workers, who were interested to answer interview in their holiday and who had time for answering the interview. Then, the researcher and two research assistants went to their familiar places (in their houses) and did interviews. All interviews were planned during their free time and according to the conveniences of respondents. For IDI, each interview lasts about 30 minutes. For FGD, researcher recruited 6 respondents in one respondent's house, which had privacy and enough space to make interview and last about 50 minutes. One research assistant performed as interviewer and the other research assistant did as note taker and the researcher did as observer during FGD and gave the numbers to the respondents clock wisely. Before doing the IDIs and FGD, research assistants requested permission from the respondents for recording the whole interview, except respondent's particular with recorders and research assistants recorded the interviews, which respondents allowed. For IDIs and FGD, researcher and two research assistants discussed together and translated respondent's answer into English language with the help of field notes and recordings and developed transcript on the same day of interview.
Data analysis technique:
For quantitative data, the data was coded properly and entered into SPSS software version (20) and analyzed by using STATA Special Edition version (12).
According to the Bangladesh Demographic Health Survey (BDHS) (2007) and National Family Health Survey (NFHS-3) (n.d.), women empowerment and autonomy in family were assessed by asking who make decision on household decisions on women's own health care, number of children to have, whether to use contraception, to seek care outside home for child sickness, physical mobility indicators on access to attend health facility, visit to family or relatives, economic decisions on spending respondent earning. All the questions have 5 responses: mainly respondent, respondent and husband jointly, respondent and someone else jointly, mainly husband and mainly someone else, except question on access to attend health facility, on which responses can be attend health facility alone, only with someone, not at all and if husband at home, not permitted.
To assess the women acceptance of normative gender roles, women were asked by two sets of questions, which are exploring their attitudes towards acceptance of normative gender role and refusing sexual intercourse with husband.
As described in BDHS (2007) and NFHS-3 (n.d.), women attitudes towards wife beating was assessed by asking whether a husband is justified in hitting or beating his wife under conditions like: she goes out without telling him, she neglects the house or children, she argues with him, she refuses to have sexual intercourse with him, she doesn't cook properly, husband suspects she is unfaithful and she shows disrespect in-laws.
According to NFHS-3 (n.d.), women attitudes towards refusing sexual intercourse was assessed by interviewing whether a wife is justified in refusing to have sex with her husband when she: knows husband has a sexually transmitted disease, knows husband has sex with other women and is tired or not in the mood.
Descriptive frequency analysis was done to describe socio demographic characteristics, empowerment level, autonomy level, sociodemographic characteristics and empowerment indexes and among the empowerment indexes. The frequency and percentages were used to describe the results of descriptive frequency analysis.
For bivariate analysis, Pearson Chi-square test was run to find the association between sociodemogrphic characteristics (independent variable) and empowerment indicators (dependent variable). To make the Chi-square test, sociodemographic characteristics was categorized and empowerment indicators was categorized as dichotomous (empower or not) in each question. If the expected value in each cell was not more than 5 in Chi-square test, Fisher's exact test was used. T-test was used to find association between number of decisions in which women participate or number of reasons for which wife beating is justified agreed by women or number of reasons given for refusing to have sexual intercourse with husband agreed by women (continuous variable) and socio-demographic variable, which had only 2 categories. If the socio-demographic variable was more than 2 categories, ANOVA test was used instead of T test.
For qualitative data, the content analysis of data was done to get the emic views of the respondents. All data were debriefed and translated into English and developed transcripts and transcribed verbatim in the day of interview. To familiarize with the data, the researcher read transcripts several times. Data reduction was performed by identifying general codes and sub codes related to main themes.
Member checking was done by researcher and other master of public health students to check inter-coding reliability and identify new themes and inductive codes, clarify some words in transcripts and understand their emic views and avoid researcher bias. In order to avoid the recall bias, the researcher clarified and gave time to consider and each IDI last for 30 min and FGD last for 50 min. The researcher developed data displays, checklist, quotations linked to perceptions regarding female garment workers position in family and community to facilitate further data analysis. The researcher summarized and condensed the data by highlighting the important quotes. Finally, compared the findings of IDI, FGD and quantitative results to find out whether there was data consistency within these results or not. The researcher also related the findings with the other research studies.
The thesis proposal was submitted to the ethical review committee of JPGSPH, Brac University to get ethical clearance before conducting thesis. The permission of garment factory's owner for conducting thesis in that factory was obtained prior to data collection. The study participants were fully informed about the objective of the study, confidentiality of private information and harm and benefit of the study. Informed written consent was taken prior to interviewing with the survey questionnaire and conducting in depth interviews and focus group discussion. Interviews were performed in rooms which had privacy. Participation in this survey was totally voluntary and the participants could withdraw themselves at any time during study and they were also free not to answer any individual question or questions that they did not like or want to answer. The information that the study participants provided was kept strictly confidential and used only for this study purpose. Names and any other particulars of the respondents were not be used in this thesis to avoid their identity being revealed. Professional ethic of researchers and rules and regulations of garment factory was also be maintained.
Findings of Quantitative Survey
8.1. Sociodemographic characteristics of the respondents
Sixty eight percent of total respondents were under 25 years old. Fifty eight percent of the respondents married when they were under 18 year of age. About half of the respondents and respondents' husbands had no education or primary level of education. Nearly one third of the female garment workers had income of less than 4000 taka and less than 6 months of working duration. Among all the female garment factory workers, two third of the respondents (66%) were operators. One third of the husbands of respondents (31%) were also garment factory workers. Seventy nine percent of the respondents had nuclear type of family and 73% of the respondents had exposure to media (i.e, expose to newspaper or magazine or television or radio or combination of these media). Regarding religion, all respondents were Muslim and only 2 respondents' husbands were Hindu and the rest were Muslim. When looking at the contraceptive use among female garment workers, one fourth of the respondents were not currently using any contraceptive methods. Although 75% of the respondents received antenatal care from health personnel in last pregnancy, it decreased to 41% for receiving delivery assistance and further decreased to 24% for receiving postnatal care within the first two days since delivery from health care personnel. The other socio demographic characteristics are described in detail in table 1.
8.2. Women Empowerment and Autonomy
Table 2 shows the empowerment and autonomy level of women, which reflects the status of women in their households. It only describes the percentage of responses, which respondents answered in this study.
Decision making power of women varied with types of decision. Only half of the respondents (52%) could contribute decisions on their own health care and it was the same for whether to use contraception and spending respondents' earnings. Although sixty eight percent of the female garment workers participated in decision making of how many children to have and child sickness, they participated less in a decision on whether they visited to their family or relatives (40%). Only one third of the respondents (31%) could go to health facility alone.
Twenty to twenty five percent of the respondents made decisions alone on own health care, whether to use contraception, child sickness and spending respondent's earnings. They were less likely to make decision alone in how many children to have and visit to family/relatives.
The most widely accepted reason for wife beating among female garment factory workers was showing disrespect for in-laws (70%) followed by arguing with husband (62%). About half of the respondents agreed with the reasons for wife beating like: going out without telling husband (46%), neglecting the house or children (54%) and husband suspects she is unfaithful (48%). Most of the women got lower score on reasons for wife beating like: refusing sex with husband and doesn't cook properly.
The most widely accepted reason by female garment workers for refusing sexual intercourse with husbands was wife is tired or not in the mood (66%). The next reason was a wife knows husband has sex with other women (58%), which was followed by a wife knows husband has a sexually transmitted disease (53%).
8.3. Women's Participation in Decision Making by Background Characteristics
Table 3 shows the percentage of women who usually make five specific decisions alone or jointly with husbands, according to background characteristics. Only 11.2% of women participated in all five decisions and same percentage of women didn't participate in any decisions.
Women whether they participate or not in all five decisions varied according to their sociodemographic characteristics. Participation in all decision making was 13% in less than 20 years of respondent's age, which decreased prominently to 3% in 21 to 25years of age and again increased to 18% in more than 25 years of age. Participation in decision making also showed the same trend, if we look according to their husband age. Female garment workers who married when they were less than 15 years of age were more likely to participate in decision making (23%) than the other women (5%). When we look at the participation according to the respondent's education, the percentage was the same at 14% in both women with no education group and 8 or more years completed education group and 10% in women with less than 7 years education. Percentage of participation increased in women with 4000-6000 TK (18%) than the women who earned different amount. The percentage of female garment workers who participated in all five decisions increases with the respondents' duration of working increases, starting from zero percent in less than 6 months duration of working group to 22% among women who had more than 2years duration of working. Respondents who were working as helpers in garment factory were less likely to participate (4%) in decision making than the other types of workers. Respondents who had non nuclear type of family were more likely to participate (16%) than the nuclear type of family (10%). Percentage of participation among women who had media exposure (14%) was more than those who didn't have media exposure (4%). Percentage of women who participated in decision making increased with increasing the number of children. It increased from 3% in women who didn't have child to about 15% in women group who had 1 child and more children.
When the researcher found out whether there was association between empowerment indicators and sociodemographic characteristics, there was an association between women empowerment in making decision regarding women's own health care and socio demographic variables. Empowerment in own health care decision making was statistically associated with respondent's age at p-value <0.05 (p value = 0.034) at 95% confidence interval, husband age at p value <0.1 (p value = 0.087) at 90% confidence interval and respondent's income at p value <0.01 (p value =0.001) at 99% confidence interval in Chi-square tests.
One of the women empowerment indicators like: decision making on whether to use contraception and husband education were statistically associated with p value at <0.05 (p value = 0.02) at 95% confidence interval in Chi-square test.
Participation in decision making on visit to family/relatives was associated with age at first marriage at p value <0.05 (p value = 0.044) at 95% confidence interval in Chi square test.
Empowerment in decision making on how to spend respondent earning was associated with respondent's living duration in current place at p value <0.05 (p value = 0.021) and respondent's education at p value <0.1 (p value = 0.071) in Chi square test.
Association between women empowerment in decision making on number of children to have and duration of working in current factory was statistically significant at p-value of <0.1 (p value = 0.082) at 90% confidence interval in Chi square test.
8.4. Attitudes towards Wife Beating
Table 4 describes the percentage of female garment workers who agree with different reasons for wife beating together with their background characteristics. Eighty seven percent of female garment workers agreed with at least one reason for beating wife. It is interesting to note that percentage of female garment workers who agreed with at least one specified reason increased with increasing age. It was 83% in women less than 20 years of age, which increased to 87% among 21 to 25 years of age and 89% among female workers who were older than 26 years of age. The percentage of female workers who agreed with at least one reason showed increasing trend according to increasing respondent's education up to 5-7 years complete (90%). But it decreased to 82% among respondents who completed 8 or more years of education (82%). The other interesting thing is when the husband's income amount increased, women agreement level decreased. Those women who lived with nuclear family, who didn't expose to any type of media, who were working as helpers in garment factory, whose working duration and living duration was more than two years and who had one child were less likely to accept wife beating for any reason.
8.5 Indicators of Women's Empowerment
To examine women empowerment regarding health, the three sets of questions on women's participation in decisions regarding their health, women's attitudes towards wife beating and attitude towards refusing sex with their husbands are summarized in table 5. All indices are based on women's responses only.
The first index which ranges from 0 to 5 is the number of decisions (see Table 3 for the list of decisions) in which currently married female factory workers participate alone or jointly with their husbands. The second index is the number of reasons that the respondents accept that husband is justified in wife beating and which ranges from 0 to 7 (see table 2 for the list of reasons). The last index is the number of reasons that the respondent is justified in refusing sexual intercourse with the husband (see table 2 for the list of reasons).
Table 5 describes the relationship between these three indexes. When the number of decisions in which female garment workers participate increased, percentage who disagree with all the reasons for wife-beating increased, except it decreased a little among women who participate in 1-2 decisions. Ten percent of women who rejected all the reasons for wife beating participated in zero decision making, nine percent of women rejected all the reasons for wife beating participated in 1-2 decision making and twenty percent who rejected participated in all five decisions. Percentage of women who agreed with all the reasons for refusing sexual intercourse with husband was 40% among women who didn't participate in any decision and who participated in 3-4 decisions. The percentage of women who accepted all the reasons for refusing sexual intercourse with husband was about 30% among women who participated in 1-2 decisions and who participated in 5 decisions.
When the number of reasons for which wife beating is justified increased, the percentage who agreed with all the reasons for refusing sexual intercourse with husband also increased. Percentage who accepted with all the reasons for refusing sexual intercourse with husband was 8% among women who agreed with none of the reasons for which wife beating is justified. It increased whenever the agreement on the number of reasons for which wife beating justified increased up to 75% among women who agreed with all the reasons justified for wife beating. This association was statistically significant at p value <0.01 (p value= 0.0078) at 99% confidence interval in ANOVA test.
There is a linear relationship between the percentage of women who disagree with all reasons for wife beating and number of reasons for refusing to have sexual intercourse. The percentage of women who disagreed with all the reasons for wife beating decreased, when the number of reasons given for refusing to have sexual intercourse with husband increased and the association was statistically significant at p value <0.05 (p value=0.0156) at 95% confidence interval in ANOVA test. It decreased from 33% among who rejected any reason for refusing sexual intercourse to 3% among who agree with all the reasons for refusing to have sexual intercourse.
8.6 Reproductive Health Care by Women's Empowerment
Table 6 shows whether the women empowerment is related to the reproductive health care by trained health care personnel or not. The table below includes only women who had child and the study examined whether they received antenatal care (ANC), delivery care, and post natal care (PNC) in their last pregnancy (BDHS, 2007).
It is interesting to see that when participation of women in decision making increased, the percentage of women who received delivery assistance from health personnel increased. It increased from 25% among women who didn't participate in any decision to 35% among women who participated in 1-2 decisions and 42% among women who participated in 3-4 decisions and up to 63% among women who participated in all decisions.
When look at the number of reasons for refusing to have sexual intercourse with husband and received ANC from health care personnel, the percentage of receiving ANC was about 72% among women who gave less than two reasons for refusing to have sexual intercourse with husband and it increased to 78% among women who agreed with all reasons to refuse sexual intercourse with husband.
An interesting point to note was there was a linear relationship between number of reasons given for refusing sexual intercourse and receiving delivery assistance. An increase in number of reasons given for refusing to have sexual intercourse with husband was followed by increase in percentage of women who received delivery assistance from health personnel. Among women who didn't answer any reason for refusing sexual intercourse, percentage was 18% and it increased to 36% among women who gave 1-2 reasons and 57% among women who gave all three reasons. This relation was statistically significant at p value <0.05 (p value = 0.0327) at 95% confidence interval in T test.
8.7. Association between Women Empowerment in Decision Making on Child Sickness and Sociodemographic Varibles
The table below describes that empowerment in decision making on child sickness was statistically associated with sociodemographic variable: respondent's education at p-value <0.01 (p value = 0.001) at 99% confidence interval, family type at p-value <0.05 (p value = 0.018) at 95% confidence interval, number of living children at p value <0.01 (p value = 0.000) at 99% confidence interval, age at first marriage at p-value <0.01 (p value = 0.003) at 99% confidence interval, husband education at p-value <0.1 (p value = 0.077) at 90% confidence interval, husband age at p-value <0.01 (p value = 0.003) at 99% confidence interval in Chi-square tests and contraceptive use at p-value <0.01 (p value = 0.005) at 99% confidence interval in Fisher's exact test.
8.8. Association between Women Empowerment in Decision Making on Spending Respondent's Earning and Received Delivey Assistance
Women empowerment in decision making on how to spend respondent earning was associated with respondent was receiving delivery assistance from trained health care personnel in last pregnancy at p-value <0.05 (p value = 0.034) in Chi square test.
8.9. Association between Women Empowerment in Decision Making on Going to Health Facility and Sociodemographic Variable
The table below described the association between women empowerment in decision making on going to health care facility and sociodemographic variables. The association was statistically significant at the p value <0.05 (p value = 0.013) for respondent's age at 95% confidence interval, p value <0.05 (p value = 0.028) for husband age at 95% confidence interval, p value <0.1 (p value = 0.068) for the exposure to media at 90% confidence interval and p value <0.01 (p value = 0.006) for receiving delivery assistance from health care personnel in last pregnancy at 99% confidence interval in Chi square tests.
8.10. Association between Number of Decisions in which Women Participate and Sociodemographic Variable
The table below shows the association between number of decisions in which women participate and sociodemographic variables. The association was statistically significant at pvalue <0.05 (p value = 0.0139) for age at first marriage with 95% confidence interval and pvalue <0.1 (p value = 0.0966) for number of living children with 90% confidence interval in ANOVA tests.
8.11. Association between the Two Gender Role attitudes and Husband's occupation
The number of reasons for wife beating reported by women was also associated with occupation of husband at p value <0.05 (p value = 0.0447) at 95% confidence interval in ANOVA test.
8. 12. Association between Number of Reasons given for Refusing to have Sexual Intercourse with Husband and Sociodemographic Variables
The table describes that there was the statistically significant association between number of reasons given for refusing to have sexual intercourse with husband reported by female garment workers and respondent's income at p value <0.1 (p value = 0.0676) at 90% confidence interval, respondent's education at p value <0.05 (p value = 0.0375) at 95% confidence interval, respondent's occupation at p value<0.05 (p value = 0.0937) at 95% confidence interval in Chi square tests.
Discussions on Quantitative Findings
The study was done to assess women empowerment regarding health among female garment workers in Dhaka as well as autonomy level and sociodemographic characteristics associated with women empowerment. The research team interviewed 89 married female garment workers with structured questionnaire.
According to studies done by Frankenberg, Elizabeth and Thomas (2001) and Mason and Karen (1998), women and husband status at marriage and social factors like: household structure and household characteristics are important factors related with women's decision making power. West (2006) said that younger women, low educated women and women who are poor and come from lower class are less empower. He also said that education is also one of the most important factors for women empowerment because it links with the life opportunities. Regarding the socio demographic characteristics of respondents, two thirds of the respondents were less than 25 years old. Seventy five percent of the respondents had less than 7 years of education. Almost 60% of the respondents married before 18 years of age and the age of marriage among female garment workers was still young. About one fifth of the respondents had non nuclear type of family. So, according to the literature review, female factory workers are less likely to empower by looking at their socio demographic characteristics.
When we compare the findings of this study regarding on the reproductive health care with the study done by BDHS (2007), the percentages of receiving antenatal care and delivery assistance were 20% higher and postnatal care was 3% higher than BDHS findings. So, female garment workers were more likely to receive reproductive health care.
Women ability of making decisions that affect their own lives is important for women empowerment. Women are considered as participate in decision making if they take such decisions alone or jointly with their husbands (BDHS, 2007). Regarding decision making on women's own health care, half of the respondents participated and this finding was consistent with the finding of the study done by Haque, Tareque, Islam and Mostofa (2011). Women participation in decision making on child sickness was consistent with the result from BDHS
(2007) with only 4% difference. The other participation percentages on decision making were 30%-38% less than the findings from BDHS (2007) and NFHS-3 (n.d.). The reason for the difference in findings may be due to this study focused in single population (female garment workers) and the study done by BDHS (2007) and NFHS-3 (n.d.) conducted in the whole population and also the female garment workers were less likely to participate in decision making and less empower.
According to Haque, Islam, Tareque and Mostofa (2011), a woman is autonomous in specific decision if she makes that decision alone. The percentages of woman autonomy in this study are more or less the same as the study that was done by Haque, Tareque, Islam and Mostofa (2011) with 5% variations in all decision making indicators except number of children to have and spending respondents' earnings.
The basic element for women empowerment is the rejection of social norms, which is control of men over women, unequal rights of men and women in family and taking privileges of sex of the individual. The normatively accepted husband's right is to put the power of husband over wives with controlling wives' behavior and manner by putting any type of violence over women (NFHS-3, n.d.). Women attitude towards wife beating can indicate her perception of her status. The lower the score in attitude towards wife beating, the more empower she is. In contrast, if she accepts that a husband is justified in beating wife for these reasons, she is considered to be low status and that perception could lead to limitation in accessing in every aspect of health care for herself and her children (BDHS, 2007). In this study, the most widely accepted reason for wife beating among female garment factory workers was showing disrespect for in-laws followed by arguing with husband. This finding on the most common reasons was consistent with the finding from BDHS (2007), although the percentages were different. The findings from BDHS (2007) and NFHS-3 (n.d.) shows that the agreement percentages on these seven reasons are not more than 40%. However, the lowest percentage on the agreement on social norms in this study was at least 33% and the highest percentage was 70%, which were very high than the other study. By looking into these results, we can say that female garment factory workers were less empowered regarding attitudes towards social norms.
According to NFHS-3 (n.d.), because of social norms, women are considered as they have no right to refuse sexual intercourse with their husband for any reasons and the three questions asked in this study are one of the good indicators of women empowerment. So, disagreement with any of the reasons for refusing to have sex with husband indicates a low level of women status and empowerment and vice versa. The results found in this study showed that 50% - 66% of the respondents agreed in each reason for refusing to have sex with husband and these percentages were very much lower than the findings from NFHS-3 done in India where the percentages were about 80%. By looking these percentages, female garment workers seem to be less empowered regarding the gender role attitude on refusing to have sexual intercourse.
When we look at the relationship between sociodemographic characteristics and women participation in decision making, participation in all decision making was related with the respondent's duration of working. Female garment workers who had media exposure were more likely to participate in decision making than those who didn't have. So, the finding proved what the literature said, because in the literatures; exposure to media can lead to women empowerment. Female garment workers with no child were less likely to participate in all decision making, which was consistent with the results from BDHS (2007).
One of the most critical problems women facing in Bangladesh is violence against women by their husband or partner. Domestic violence in Bangladesh is an important issue because it is associated with individual women right and security, which is fundamental element of all other rights (BDHS, 2007). Majority of female garment workers (87%) agreed with at least one reason for beating wife, which was very much higher percentage than the findings from the BDHS (2007), where there was only 36%. It is interesting to note that percentage of female garment workers who agreed with at least one specified reason increased with increasing age. The other interesting thing is when the husband's income amount increased, women agreement level decreased. Those women who lived with nuclear family, who didn't expose to any type of media, who were working as helpers in garment factory, whose working duration and living duration was more than two years and who had one child were less likely to accept wife beating for any reason.
In this study, the researcher compared women's participation in decision making and two gender role attitudes and the expectation is that if the women participate more in decision making, their attitudes towards wife beating may also lead to gender-egalitarian beliefs and women who have that beliefs are also more likely to participate in decision making (NFHS-3). The findings were when the number of decisions in which female garment workers participate increased, percentage who disagree with all the reasons for wife-beating increased, except it decreased a little among women who participate in 1-2 decisions. When the number of reasons for which wife beating is justified increased, the percentage who agreed with all the reasons for refusing sexual intercourse with husband also increased and this association was also statistically significant. The percentage of women who disagreed with all the reasons for wife beating decreased, when the number of reasons given for refusing to have sexual intercourse with husband increased and the association was statistically significant. Thus, there was the opposite relationship between the two gender role attitude variables and these findings were contradictory with the expectation. It may be due to sample size was small, although respondents were randomly selected. Thus, it needs more clarification by further research with ideal sample size.
Where the health care coverage is high, women empowerment may not affect the reproductive health care accessibility. But in other societies where the health care coverage is not high, women empowerment is directly related to health care seeking behavior and utilization of health services from trained health care providers for reproductive health care and safe motherhood (BDHS, 2007). It is interesting to see that when participation of women in decision making increased, the percentage of women who received delivery assistance from health personnel increased and this finding was consistent with the result from NFHS-3 (n.d.). Another interesting point was there was a linear relationship between number of reasons given for refusing sexual intercourse and receiving delivery assistance. An increase in number of reasons given for refusing to have sexual intercourse with husband was followed by increase in percentage of women who received delivery assistance from health personnel and this relation was statistically significant. Thus, if the female garment workers participate more in decision making and if their number of reasons for refusing sexual intercourse was increased, they were more likely to receive delivery assistance from the health care personnel.
In this study, there were associations between women empowerment indicators and sociodemographic variables. Respondent age was associated with participation in decision making on own health care and go to health facility, respondent income with decision making on own health care, child sickness and go to health facility, respondent education with decision making on child sickness, respondent occupation types with agreement on refusing to have sexual intercourse with husband, spending respondent money and agreement to refuse sexual intercourse with husband, age at first marriage with decision making on child sickness, visit to family/relatives, participation in all five decision, living duration of the respondents in current place with how to spend respondents earnings, working duration in current factory with how many children to have, exposed to media with going to health facility, receiving delivery assistance during last pregnancy with going to health facility, contraceptive use with decision making on child sickness, husband age with decision making on own health care, child sickness and go to health facility, husband education with decision making on whether to use contraceptive and child sickness, types of family with decision making on child sickness, husband occupation with agreement on wife beating, number of living children with decision making on child sickness and participation in all five decisions. Thus, from these findings, socio demographic background characteristics affect the level of women empowerment.
Findings & Discussions on Qualitative Interviews (IDI and FGD)
Generally female garment factory workers were treated well and they received respect from their family and community. Most of them took part in any decision making of the family and they also gave opinions to their family and community. Although they reported that they could contribute money for family matters, they rarely seek health care for themselves when they felt ill. Some of the findings on their perceptions regarding their status and position were incoherent with the literatures.
Health care seeking behavior
Most of the female garment factory workers said that they usually didn't seek health care when they could still do the job and they went to the health facility only when they were severely ill. The rest of the female factory workers usually seek health care when they felt ill and they went to the pharmacy first when they felt common diseases. Thirty-four years old female garment worker who earned 4000TK per month said that
"I avoid going to doctors unless and until I feel too much sick.Â Because we are poor, I think spending behind treatment is a luxury for us. As long as I can manage my illness myself, I usually do not seek health care."(IDI6: L 49, 51-53)
It is because the female garment workers are underprivileged, who usually do not have access to health care services and don't have awareness of health lifestyle. This can lead to unwillingness to go to health facility and late health seeking behavior. (Azad, 2009)
Perception regarding Female Factory Workers' current position in family
Female garment factory workers thought that their families supported and treated them well to work because husband's income for the whole family was not sufficient and their earnings added to the family welfare. In that case, they felt that they were more important than before and they really enjoyed it. Forty years old female factory worker who was working for 8 years in garment factory mentioned that .
"They welcome that I work. It is too difficult to maintain my family with only my husband's income. So I decided to start earning. My family members are supportive because my income adds to the family's benefits. We can eat well than before. We can spend for children when necessary. I think my decision of earning for the family has given my family a better life. I feel happy about it." (IDI7: L 58, 59, 61-63, 66, 67)
The perception of family members of the female garment workers on them regarding their work outside of the home changed nowadays. The finding was inconsistent with the previous literature studying on women workers mentioned that female garment workers who return late at night due to overtime work are opposed by the family members regarding this aspect of garment work (Jahan, 2012).
Decision Making Role in Family
Majority of the female garment workers took part in decision making of any problem in their families. But, some of the respondents were not the final decision makers of the family. Twenty year old female garment worker reported that
"I take part in most of the decision making of my family and in my family, I am always asked to give opinion. Any important decision of my family is made by discussion in my family."Â (IDI2: L 65-67)
United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) (1999) mentioned that having income improves the women's status within the household prominently, which gives them greater control over their earnings and household resources and generally improves their status and strength.
Twenty-two years old respondent mentioned that
"I can participate in decision-making, but I am not the ultimate decision maker. If I have something in mind then first I tell to my husband. If he approves of it, then he takes the decision." (IDI5: L 73-75)
Some literature mentioned that working is not enough to empower the women because the obstacles that women have to overcome to control over their lives and equality are too great to be passed by employment alone (West, 2006). So, some women are not the main decision makers in the family and they can't say anything over their husbands.
Perception regarding having Son or Daughter
Female garment factory workers perceived that having son or daughter is the same and their perception towards son preference changed. Forty year old respondent who had 3 children mentioned that
"As a mother, I can never discriminate among my children. They are all precious to me." (IDI7: L 82, 83)
It was different from literature, which mentioned that son preference in Bangladesh still exists (Unicef, 2010). This seems to reduce nowadays and some of the respondents prefer more on having daughters.
Empowerment regarding Child's Education
Majority of the respondents took part in decision making of their child's education and they could contribute to their child education expenses, as they were working mothers. One respondent who earned 5500 TK reported that
"I think I can contribute more in my family than before. I can bear my child's education expense. Earlier, when I didn't use to earn I couldn't say anything about my child's education. But now as I earn, I have decided to send him to school. I have even sent him to private tuition." (IDI5: L 66-69, L 92)
The finding was consistent with the studies done with poor women in Bangladesh describes that paid employment makes women empower and women who work in these works are more likely to make decisions in their homes (Dutta 2000; Salway 2005).
Giving suggestions among Family and Friends regarding Health
Female garments workers could give some help and suggestions according to their experiences to their family and friends regarding health care. One respondent reported that
"Yes, I do. A few days back, my sister in law was ill. So I asked my family to take her to hospital. Since my sister in law didn't have enough money, I sent her some money for the treatment." (IDI5: L 97, 99, 100, 104-106)
The interview finding is supported by the literature done by West (2006), which mentioned that women who work can contribute to empowerment because it can
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