Husbands' and wives' reports of women's decision-making power in Western Guatemala and their effects on preventive health behaviors.

Surveys have attempted to measure married women's decision-making power by asking women who has a say and/or final say in a number of household decisions. In several studies where the same questions were posed to husbands, considerable discrepancies in reports were found. This paper assesses husband and wife reports of decision-making on four matters (whether or not to buy household items; what to do if a child becomes ill; whether or not to buy medicine for a family member who is ill; what to do if a pregnant women becomes very ill) and the relationship of these reports to three recent health behaviors (having an emergency plan during pregnancy; delivering in a health facility; having a postpartum checkup within 4 weeks). A sample of 1000 women in 53 communities in three departments of western Guatemala was selected using a stratified random sampling approach. A standard household questionnaire was used to identify the respondents as well as to obtain data on household characteristics. Husbands of interviewed women were interviewed in every other household giving information on 546 couples for this analysis. Women and men's questionnaires were similar and were designed to obtain information on the respondent's knowledge, attitudes and behaviors regarding maternal health. Consistent with other research, results show that relative to their husbands' report, wives tend to under-report their household decision-making power. In couples with both partners educated and in couples in which women work for pay, both partners were significantly more likely to report that both of them participate in the final decisions than was the case in couples without education or in which the wife did not work for pay. Women's reports of their decision-making power was significantly related to the household having a plan for what to do in case of a maternal emergency, but was not associated with place of childbirth or with having a postpartum checkup, while husband's reports of the wife's decision-making power was negatively associated with the likelihood of having the last birth in a health facility.