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Gender Differences in Decision-making in Honduras.
Lisa Whittle & Ilene Speizer
When available data on wanted and unwanted fertility are compared in the Central American region, Honduras has the highest unwanted fertility. Women (15-44) participating in the Honduran 2001 Epidemiology and Family Health Survey indicated that for all those live births occurring in the three year period prior to the survey, a quarter of these births were unwanted and a quarter were mistimed (earlier than desired). Unwanted and mistimed births are often grouped together as unintended pregnancies. About half of live births in Honduras were unintended. While both men and women prefer smaller family sizes than they currently have, women at all ages and levels of economic status were more likely than their male counterparts to report having have had more children than they wanted.
Given the social and health consequences and effects on health of unintended pregnancy and childbearing, health care researchers, providers and policy makers need to better understand how people make reproductive decisions. We know that cultural values regarding sexuality and gender roles as well as economic disadvantage, community, couple and individual factors exert powerful influences over the decision-making processes. Health decision-making models often focus on the individual's weighing of costs and benefits without considering the individual's power to make such decisions in their specific historical socio-cultural context. In particular, aspects of gender such as ideologies of masculinity and femininity have a strong impact on a woman or man's role in decision- making and on the power dynamics of sexual behaviors and contraceptive use. Such ideologies make up the normative context which can exert a strong influence especially for youth who are still forming their sexual and gendered identities. In some social settings, women and men are socialized to prioritize male pleasure and control in sexual partnerships. Beyond gender dimensions, economic and social inequalities as well as age disparity between partners, influence an individual's ability to make reproductive health decisions.
Reproductive health survey data from Central America present the opportunity for new exploration of the social and cultural context of reproductive decision-making for both men and women. These data allow us to link patterns of gender ideology and decision-making with specific outcomes such as childbearing, contraceptive use and pregnancy intendedness. We propose to use national survey data from Honduras collected in 1996 and 2001 (National Survey of Masculine Health (ENSM-96), National Survey of Feminine Health (ENSF-96), Epidemiology and Family Health National Survey (ENESF-2001), and National Survey of Masculine Health (ENSM-2001), to quantitatively analyze the relationships between attitudes and opinions on general decision-making questions as compared to personal decision-making by gender, generation, and over time. The main objectives and research question are:
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Compare how general attitudes have changed over time concerning who should make fertility and family planning decisions (1996 and 2001 data). Are there differences among women and men according to their social and economic
characteristics?
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Compare general attitudes on who should make decisions with responses to questions on who actually makes decisions within respondents' unions. Are there differences between stated attitudes and actual behavior? How do these differences compare among women and men, among those with more and less education, among those living in rural and urban areas, according to partner age, and by
parity?
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Compare the above differences in attitudes and behaviors as they relate to contraceptive use and pregnancy intendedness for men and women.
These results will provide further understanding of how decision-making and reproductive practices are influenced by gender, generation and other demographic factors in the Honduran context. This information can be used to develop reproductive health programs and messages that address gender roles and relations with the underlying goal of reducing unwanted fertility in Honduras.
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