Overall, the evidence suggests that women’s lower control or autonomy (for example lack of freedom of movement outside the home, lack of authority to access healthcare for sick children) was associated with poorer mental and physical health for women and higher morbidity and mortality for their children, after adjusting for their socioeconomic circumstances.
A systematic review of observational evidence was conducted on the health impacts of women’s low control/autonomy in the living environment in societies with profound gender discrimination and gender bias. Thirty observational studies of varying methodological quality were included. Current evidence on the health impacts of control in the living environment is less well developed and disparate, compared with the formal work environment. ‘Living environment’ is defined by the authors as the households, communities and societies in which people live and go about their daily lives. Population health theories suggest that lack of control and narrowly circumscribed autonomy in the living environment may have adverse effects on women’s health and the survival of their children. One pathway between women’s low control/limited autonomy and health is through reduced access to key determinants of health – including limited control over access to preventive and curative health services, education and paid employment opportunities, food and nutrition, fertility and reproductive rights; in turn, reducing access to determinants of health may lead to poorer health outcomes including higher levels of anxiety and depression, malnutrition, health risks from greater numbers of pregnancies and childbirth, and domestic violence against women. Survival of the women’s children may be adversely affected by not being allowed to take a sick child to hospital or for immunisations and other preventive procedures. In addition, in societies with marked son preference, lower female survival rates may also occur through mechanisms such as neglect or infanticide of girl babies and, in recent decades, as sex determination and selection technologies have become widely available, the practice of sex-selective abortion. Although women’s autonomy in the living environment is generally constrained in cultures with profound gender discrimination, there is still variation across households and communities in the degree to which a woman is free to make decisions concerning key determinants of health. This variation provides opportunities for research to make comparisons between women with relatively low and high levels of control. Further studies are needed to disentangle and understand the pathways between low control and health outcomes in contexts of profound gender discrimination. The review also highlights a pressing need for higher quality, longitudinal studies in the future.
