Reproductive Health Of Women In Developing Countries And Human Development: A Test Of Sen's Theory
Jayasundara, Dheeshana Sugandhi
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The purpose of this study is to extend prior research on reproductive health in developing countries and to examine the utility of the extended model for the social work profession. This study applied Nobel Prize winning economist, Amartya Sen's theoretical propositions on human development to reproductive health of women in developing countries. His approach is a social development based capability and freedom method to improve human well-being. Applications of this method considerably modify the previous, epidemiological, coercive and value based models and provide a more comprehensive humanistic model of reproductive health. This contributes toward an improved public health model of reproductive health of women in developing countries. Sen's theoretical propositions argue that political and economic growth has a direct effect on social development and that social development has a direct effect on both reproductive capability or freedom and reproductive health. Additionally, reproductive capability or freedom is argued to have a direct effect on reproductive health. The data for this study was obtained from 142 developing countries This study utilized secondary data for the analysis, collected by various international nongovernmental organizations such as UN, WHO, and World Bank. Economic growth was measured using GDP per parity. Political Development was measured using (1) the Economists Intelligence Unit's Index of Democracy (Demindex), (2) two of the indicators of the Vanhanen Scale of democratization: (i) the percentage share of the smaller parties and independents of the votes cast in parliamentary elections or seats in the parliament (Compete) and (ii) the percentage of the population that voted in the previous election (Partici).Social development was measured using (1) adult literacy rate (% ages 15 and above) (adultlit), (2) total public expenditure as a percent of health expenditure (Pubex), (3) social security expenditure as percent of public expenditure on health (Socialsec), (4) population without access to water sources (Water1), and (5) telephone and Internet users per 10,000 population (Tele). Reproductive freedom was measured by (1) deliveries attended by skilled attendants (Skillper), (2) pregnant women who receive prenatal care (Precare), (3) 1-year-olds fully immunized (Immun1), (4) contraceptive prevalence rate (Contra), (5) abortion policies (Abopol), and (6) percent girls married before age 18 (bmage18). Reproductive health was measured by (1) births per 1,000 women aged 15-19 (Birthwo), (2) Infant mortality rate (per 1,000 live births) (Infant), (3) maternal mortality rate (per 100,000) (Matmort), (4) total fertility rate (TFR), and (5) percentage of children stunted under the age of 5 (Stuntnew). Measures were tested for validity using factor analysis and confirmatory factor analysis, reliability is measured using Cronbach's alpha. The model was tested using both path analysis and structural equation method. Study results from path analysis found total support for all paths specified as well as overall model fit. However, structural equation method did not find support for overall model fit, as well as, no direct effect was found between social development and reproductive health; only an indirect effect through reproductive capability. It is clear that this study suffered from measurement error because of using cross-national data coming from several bodies, collected from several different years. Despite partial support, Sen's theory has several implications to the field of social work as well as to the field of reproductive health of women in developing countries. It is a theory that is congruent with social work values, as well as a more advanced theory than current perspectives guiding social work. Additionally, this theory can help us place reproductive health, a field of study that is in the backburner of social work practice to the forefront.