Bargaining Power Within Couples and Use of Prenatal and Delivery Care in Indonesia

TLDR: Both economic and social dimensions of the distribution of power between spouses influence use of services, and conceptualizing power as multidimensional is useful for understanding couples' behavior.

Abstract: Indonesian women's power relative to that of their husbands is examined to determine how it affects use of prenatal and delivery care Holding household resources constant, a woman's control over economic resources affects the couple's decision-making Compared with a woman with no assets that she perceives as being her own, a woman with some share of household assets influences reproductive health decisions Evidence suggests that her influence on service use also varies if a woman is better educated than her husband, comes from a background of higher social status than her husband's, or if her father is better educated than her father-in-law Therefore, both economic and social dimensions of the distribution of power between spouses influence use of services, and conceptualizing power as multidimensional is useful for understanding couples' behavior

Figures

Table 3: Relationships among different indicators of power Partial correlations based on multivariate OLS regressions

Table 4: Prenatal check-ups and location of delivery Most recent pregnancy (conditional on any pregnancy in last 5 years)

Table 5: Relationship between prenatal care and distribution of power between husband and wife Regression estimates

Table 1: Socio-economic and demographic characteristics of married couples and couples who had a pregnancy in the last 5 years

Table 6: Relationship between type of delivery and distribution of power between husband and wife Multinomial logit regression estimates Reference category: Delivery at home with traditional birth midwife

Table 2: Indicators of power Shares of assets, relative education of spouses, family background

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UCLA
On-Line Working Paper Series
Title
Bargaining Power Within Couples and Use of Prenatal and Delivery Care in Indonesia
Permalink
https://escholarship.org/uc/item/180736vt
Authors
Beegle, Kathleen
Frankenberg, Elizabeth
Thomas, Duncan
Publication Date
2001-04-01
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Kathleen Beegle
Elizabeth Frankenberg
Duncan Thomas
CCPR-002-01
April 2001
California Center for Population Research
On-Line Working Paper Series

Bargaining power within couples
and use of prenatal and delivery care in Indonesia
Kathleen Beegle
RAND
Elizabeth Frankenberg
RAND
and
Duncan Thomas
RAND and UCLA
October, 2000
This version: March, 2001
The comments of Victoria Beard, Anastasia Gage and Bondan Sikoki have been very helpful.
Financial support from NICHD grants P50-HD12639 and R29-HD32627, P01HD28372, The POLICY
Project and the International Food Policy Research Institute is gratefully acknowledged.

Abstract
This paper examines whether a woman's power relative to her
husband's affects decisions about use of prenatal and delivery care
in Indonesia. Measures of power that span economic and social
domains are considered. Holding household resources constant,
control over "economic" resources by a woman affects the couple’s
decision-making. Relative to a woman with no assets that she
perceives as being her own, a woman with some share of
household assets influences reproductive health decisions.
Evidence suggests these decisions also vary if a woman is better
educated than her husband, comes from a higher social status
background than her husband, or if her father is better educated
than her father-in-law. We conclude that both economic and
social dimensions of the distribution of power between spouses
influence decision-making and that it is useful to conceptualize
power as multi-dimensional in understanding the behavior of
couples.

Although reproductive health and family planning programs provide services with potentially
numerous benefits for women and their families, uptake of services offered by these programs is far
from universal, even in settings where services are widely available at subsidized prices. Recent
efforts to understand barriers to service use have recognized that although women are typically the
primary point of contact for reproductive health programs, the decisions that lead women to adopt
services occur within the context of a marriage, a household, or a family (Becker, 1996). If a
woman and her partner differ in the extent to which they value reproductive health services, then use
of those services will be the result of a negotiation between the couple, with the outcome reflecting
each person’s perception of the value of the services relative to their costs and the relative power of
individuals in asserting their own preferences in decision-making.
The emphasis of this study is on the association between a series of indicators of the relative
power of a man and woman within a couple and the woman’s reproductive health behaviors in
Indonesia. We focus on the use of prenatal care and choice of location of delivery. These outcomes
are of special interest in Indonesia, where maternal mortality rates are relatively high.
Background
Social scientists have a long-standing interest in how a woman's status relative to that of her
partner affects behaviors and outcomes related to fertility and mortality (see Mason, 1984, for a
review).
1
In recent years a number of papers have focused explicitly on discordance between
partners with respect to reproductive goals and the nature of communication between partners with
respect to family planning (Mason and Taj, 1987; Ezeh, 1993; Becker, 1996). Some of the studies
go on to relate discordance in reproductive goals and patterns of communication about family
planning to contraceptive use (Salway, 1994; Blanc et al., 1996; Lasee and Becker, 1997; Bankole
and Singh, 1998; Wolff, Blanc, and Ssekamatte-Ssebuliba, 2000). Other studies have considered how
a woman's status more generally is related to contraceptive use (Gage, 1995; Hogan, Berhanu, and
Hailemariam,1999; Eckhardt, 1999). In an excellent review of this literature, Becker (1996)
1
The terms power, control, status and autonomy are often used in this literature to refer to a woman’s position in the
marriage and society more generally. We make no attempt to distinguish among these terms in this paper; they
should be viewed as synonymous.
1

Frequently asked questions

Q1. What contributions have the authors mentioned in the paper "Bargaining power within couples and use of prenatal and delivery care in indonesia" ?

This paper examines whether a woman 's power relative to her husband 's affects decisions about use of prenatal and delivery care in Indonesia. The emphasis of this study is on the association between a series of indicators of the relative power of a man and woman within a couple and the woman ’ s reproductive health behaviors in Indonesia. Evidence suggests these decisions also vary if a woman is better educated than her husband, comes from a higher social status background than her husband, or if her father is better educated than her father-in-law. Although reproductive health and family planning programs provide services with potentially numerous benefits for women and their families, uptake of services offered by these programs is far from universal, even in settings where services are widely available at subsidized prices. 

Q2. How many prenatal visits should women make during pregnancy?

In Indonesia, the Ministry of Health program recommends that during pregnancy womenshould make a total of four prenatal care visits: one during each of the first two trimesters and two during the third trimester. 

Q3. What are the common examples of assets that are held by a woman?

In the ethnographic literature, a number of studies have documented that resources brought to a marriage by a woman tend to be held under her control; gold and jewellery are commonly cited as examples of such assets. 

Q4. How many years of education has the average woman completed?

In the analytical sample, the average women has completed slightly under seven years of schooling; on average, her husband has completed almost an additional year (Table 1). 

Q5. What is the role of family background in moderating power?

social domains of power are potentially important and family background may play a role in moderating power within the household. 

Q6. What is the meaning of the term power, control, status and autonomy?

In an excellent review of this literature, Becker (1996)1The terms power, control, status and autonomy are often used in this literature to refer to a woman’s position in the marriage and society more generally. 

Q7. What are the complexities associated with the effects of heterogeneity in these models?

In addition to measurement issues, there are complexities associated with the effects ofunobserved heterogeneity in these models. 

Q8. What is the effect of labor earnings on household decisions?

It is not obvious that treating labor earnings as predetermined in these models is appropriate; if the assumption is violated then estimates of the effect of individual income on household decisions will be subject to simultaneity bias. 

Q9. How much more likely are women from higher social status to get care in the third trimester?

10Relative to other women, those from higher social status families tend to obtain moreprenatal care and they are about 5% more likely to get care in the third trimester.