Whose Decision Is It Anyway? Men’s Perceptions of Women’s Decision-Making Autonomy in Maternal and Child Health in Western Kenya

Robsan Tura () and Nema C. M. Aluku
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Robsan Tura: Minnesota Department of Health, St. Paul, MN 55164, USA
Nema C. M. Aluku: Africa Community Leadership and Development, Nairobi P.O. Box 24619, Kenya

Social Sciences, 2025, vol. 14, issue 8, 1-15

Abstract: Women’s decision-making autonomy is widely recognized as a critical determinant of maternal, newborn, and child health (MNCH). However, prevailing measures often conflate genuine autonomy with decisions made within traditional gender roles, risking an overstatement of women’s empowerment. This study examines the extent to which reported female decision-making autonomy reflects authentic agency versus role-based compliance in a patriarchal context. A cross-sectional study was conducted among 280 male household heads in Kakamega County, Kenya, whose partners were pregnant or recently postpartum. Using multi-stage cluster sampling and structured interviews, men reported on household and MNCH decision-making and their rationales, categorized as gender-role conformity, belief in gender equality, or other reasons. Although 40.4% reported that their partners made decisions independently, only 11.4% attributed it to a belief in women’s equality; 28% framed it within traditional gender roles. Men were over four times more likely to perceive women’s decisions as role-based than autonomous (AOR = 4.40; 95% CI: 2.48–5.78). Younger men (18–34) were more likely to report female decision-making (AOR = 5.54; 95% CI: 5.08–7.27), without necessarily endorsing egalitarian norms. Findings highlight the urgent need for gender-transformative MNCH interventions that move beyond surface-level autonomy to address deeper structural inequities.

Keywords: Kenya; women’s autonomy; maternal and child health; decision-making gender equity; male partner perceptions (search for similar items in EconPapers)
JEL-codes: A B N P Y80 Z00 (search for similar items in EconPapers)
Date: 2025
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