The Effects of Social Autonomy on BMI Scores: A Study of Women in Nepal
Furr, L. Allen, Das, Nandita, Contributions to Nepalese Studies
Gender differences in health and health care services have become the focus of an unprecedented mobilization of social resources and research in South Central Asia. Women in Nepal, India, and elsewhere in the region experience poorer health than men, and social factors, particularly inequities in status, account for these differences (Dreze and Sen 2002; DeRose, Das, and Millman 2000; Gittelsohn 1991). Accordingly, women's autonomy and self-empowerment have been central concepts in researching the relationship between women's social status and health.
Although research in both western and non-western societies has demonstrated the positive effects of women's autonomy on quality of life in general and health in particular (Jun, Subramanian, Gortmaker, and Kawachi 2004; Kalipeni 2000), these studies have not defined autonomy consistently. Women's autonomy is often described operationally without consideration of autonomy as a broad, multi-dimensional concept. Studies typically have relied upon a varied number of indicators of autonomy without clarifying which facet of women's agency may be most salient in predicting women's quality of life. With this in mind, the purpose of this paper is twofold: first, we want to investigate the relationship between autonomy, using a broad operationalization of the term, and a specific and objective measure of health status (Body Mass Index (BMI)); and, second, we will compare the effects of different indicators of autonomy on BMI.
Autonomy and Women's Health
At the core of the international women's movement has been efforts to invigorate and enhance women's autonomy and reduce women's dependence on and vulnerability to men (c.f. Nelson, et al., 1996). Empowerment is both mantra and strategy to individuals, groups, and societies that strive to reduce gender-based social, economic, and political divisions, and has considerable influence over health and health behavior. For example, increasing women's social agency in westernizing cultures has positive results on self-reported health (Berhane, Gossagye, Emmelin, and Hogberg 2001), antenatal care (Bloom, Wypij and Das Gupta 2001), and contraceptive use (Al Riyami, Afifi, and Mabry 2004), and a negative impact on fertility in India (Murthi, Guio, and Dreze 1995) and Nepal (Axinn and Fricke 1996; Morgan and Niraula 1995).
Although enhancing women's agency in both western and westernizing societies has a positive effect on health and health behavior, the causal mechanisms linking autonomy to improved health intersect in a complex web of factors that bridges all levels of social life, albeit with cultural variations. In essence, raising women's social capital reduces dependency and heightens both status and bargaining power. In taking control of their economic and political lives, women are more likely to invest in themselves and their daughters and lessen their dependence on sons for security in old age (MacCormack 1988). As an example of cultural specificity in this process, increasing women's labor force participation in India lowers dowry levels, which has reduced the cost of raising girls (Murthi, Guio, and Dreze 1995). Given the weight of the findings of the studies cited above, among others, it is clear that empowerment improves women's health and well-being. Based on these ideas, the research hypothesis driving the first part of the present study predicts that ,among women in Nepal, greater autonomy will be associated with better health as measured by BMI levels.
A problem in this literature, however, is that studies lack consistency in defining what is meant by autonomy. Autonomy is a complex, multifaceted concept, yet studies rarely include more than a couple of autonomy's attributes in their operationalizations. Consequently, when a study concludes that autonomy influences health, it is not clear which facets of autonomy are contributing to the effects, and a certain degree of meaning is lost. …