PropertyValue
is nif:broaderContext of
nif:broaderContext
is schema:hasPart of
schema:isPartOf
nif:isString
  • We use data from the 2011 Nepal Demographic and Health Survey (DHS) for this analysis. The DHS was collected under the guidance of Population Division, Ministry of Health and Population of the Government of Nepal and with technical assistance from ICF International. The DHS is a nationally representative household survey of women of reproductive age, defined as 15–49 years of age, conducted every 5 years using a stratified, two stage cluster design with a 97.6% response rate in 2011 [28]. It has household level as well as individual level modules for men and women. For this analysis we link the household level and individual women’s modules. The household module (which includes the household food insecurity questions) was answered by the household head and the individual women’s module was answered by selected women of reproductive age in that household. A total of 12,674 women were interviewed in 2011. For this analysis, the sample is limited to currently married, non-pregnant women with at least one living child. Since one of the main variables of interest is household structure, we focus on married women who are living in different types of co-resident structures. Non-married women would likely have very different household structures and be subjected to different roles in their households. We limit the sample to non-pregnant women since family planning use is not relevant among pregnant women. Additionally, different norms are likely to apply to pregnant women’s access to food. We also restrict the sample to women who had at least one living child, since family planning use before the first child is born is very low in this setting. A total of 7,459 women have no missing data and fit these criteria. Two primary factors potentially associated with the outcome of interest (family planning use) are explored in this analysis. The first is the household co-residence structure in which the woman lived. This variable is created by grouping women by household ID in the Nepal DHS data, since more than one woman of reproductive age per household was eligible to participate in the survey. Then, based on whether or not more than one woman in the household was included in the sample, and combined with information from the question “What is your relationship to the household head?” we categorize women into the following four groups: Group 1 includes women who were not co-residing, defined as women who reported that they were married to the head of the household or were the head of the household and were not living with another woman of reproductive age in the household, nor with a mother-in law. These women are the referent group as we assume them to be the highest status group. Group 2 includes woman living in a household with in-laws, but no sister-in-laws who took the survey. Group 3 includes women living in household where there was at least one other woman in the same household, and their husband was older than the other woman’s husband. This is the “elder” sister category. Group 4 includes women living with at least one other woman from the survey in the same household, and the husband being younger than the husband of the other woman in the household. If more than two women were included in the survey who lived in the same household, then the one with the oldest husband was in group three and all of the younger ones in group 4 (Fig 2). We hypothesize that Group 4 women have the lowest status in the household, and Group 1 the highest, however, it is unclear whether elder (Group 3) women or women with no sisters-in-law (Group 2) would be of higher status. Figure data removed from full text. Figure identifier and caption: 10.1371/journal.pone.0176127.g002 Categories of women’s position in the household. The second factor of interest is household level food insecurity. Food insecurity was measured using the household food insecurity access scale collected in the 2011 Nepal DHS [28]. The 2011 Nepal DHS asked 7 of the 9 questions in Household Food Insecurity Access Scale indicators developed in USAID’s Food and Nutrition Technical Assistance (FANTA) project [33]. These questions were modified to be culturally relevant to Nepal and the time frame was expanded to 12 months (from the standard 1 month) because of seasonal variability in the Nepali setting. Questions were answered by the head of the household (generally a male in this setting) and asked about insufficient quantity and quality of foods and anxiety and uncertainty about food supply. Compared to other measures, this set of questions does not address either individual household members access or more distal factors such as livelihood production [32]. We use a validated scoring algorithm, to create a four-group categorical variable ranging from “food secure” (1) to “severe food insecurity”, as is categorized by the Nepal DHS (4). For the interaction model, we created a binary variable, collapsing none/mild/moderate vs. severe food insecurity. The primary outcome of interest is a binary for current use of a modern family planning method compared to no method or a non-modern method. We use multivariate logistic regressions to assess for associations between food insecurity, women’s household status, and modern family planning use. We control for socio-demographic factors found in past literature to be associated with women’s household status, food insecurity and/or family planning use in this setting. At the household level, these include wealth quintile (calculated by the DHS Program, provided in the dataset), urban/rural status, geographic region (mountains, hills or Terai), caste/ethnicity (Brahmin/Chhetri, Newar, Dalit, Janajati, other), and religion (Hindu compared to any other religious group). At the individual level we control for women’s age (in 10 year age groups), education (none, primary, secondary, and higher than secondary, as categorized by the DHS Nepal), type of occupation (professional occupation vs. not), if she is the head of the household (yes/no), and the total number of living children that the woman has (continuous). Furthermore, we include a variable of the ratio of the number of boys divided by the number of girls that a woman has at the time of the survey, to account for the effect of having a son on a woman’s position in the household and probability of using modern family planning. We also include a score of women’s decision making level in the household. This is comprised of six binary questions about who (the woman alone, woman and her husband, husband alone, other) makes decisions about the following: what to do with money that the husband earns, what to do with the money the respondent earns, using family planning, the respondents health care, large purchases, and visits to family/relatives. These were then summed to create the final score (ranging from 0–6). Since more than one woman could live in each household and the main predictor is a household level variable, each woman received a weight based on the number of women in the sample in her household (0.5 if there were two women, 0.33 if there were 3 women, etc.). This weight is multiplied by the survey weight provided by ICF Macro. Data were analyzed using STATA 12.
rdf:type