柬埔寨婦女賦權和流產及使用避孕措施之關係

Introduction: Women’s empowerment refers to giving women the choices and ability to control every aspect of her life. Although steady progress throughout history in empowering women has been achieved, vast obstacles still exist in particular areas such as sexual and reproductive health. In Cambodia, a rapid fertility transition is apparent, and the legalization of abortion as early as 1997 demonstrates a relatively radical policy in a conservative Asia. However, the advent of medically approved abortion services and modern methods of contraception may not be resources Cambodian women are prepared to readily accept. Cultural stigmas and misconceptions stand in the way. Appropriate measures to inform women and their husbands/partners on their family planning options and shed light on circulating myths surrounding newly available forms of fertility control would be beneficial.
Objective: To identify women’s current empowerment situation in Cambodia, and analyze the association of women’s empowerment on abortion and contraceptive use.
Methods: This study is based on data from the 2014 Cambodia Demographic and Health Survey. Women’s empowerment was composed of three dimensions: education, household decision-making power, and workforce participation. The sample for abortion was married and cohabiting women (N = 11,668) and the sample for contraceptive use was married, cohabiting, and non-pregnant women (N = 10,707). Bivariate analysis using Pearson’s chi-square examined the associations between the two outcome variables (abortion and contraceptive use) and the predictive factors. Lastly, binary and multinomial logistic regression models were used to study the impact of different levels of women’s empowerment on abortion and contraceptive use; more specifically, the differences in empowerment levels and other characteristics between modern and traditional contraceptive method users.
Results: About one-third of women reported abortion in the past (32.3%). 39.4% were not using any method of contraception, 18.3% were on a traditional method, and 42.3% used a modern method. Secondary and higher educational attainment, high household decision-making power, rural residence, and ≥ 21 years of age at first marriage decreased the risk of abortion. Women that were educated, working, between 25-34 years, living in rural areas, and in plateau / mountainous region and Phnom Penh showed a positive association with modern method use. Results for traditional method use also demonstrated a positive association with higher education and workforce participation; being 25-34 years of age, in the Tonle Sap and plateau / mountainous region, and rich; having media access; and not viewing distance to health facility as a big problem. Education was the only empowerment dimension to significantly influence method choice among users after sociodemographic characteristics were controlled for.
Conclusion: Empowered women were less likely to get an abortion and more likely to be using contraception than less empowered women in Cambodia. The empowerment of women, as observed through individual-level characteristics, makes a considerable difference on sexual and reproductive health behavior. However, to highlight the underlying cultural themes at work, more anthropologic perspectives should be incorporated into future research for a more complete picture. Increasing education and labor market opportunities can also enhance the household position of women by changing social attitudes and norms about women. The combination of these efforts to empower women and change social constructs for a more gender-equal world could have far-reaching positive effects that stem beyond improvements on sexual and reproductive health behaviors.