HOW THE VALUE OF AUTONOMY IMPACTS HEALTHCARE OUTCOMES FOR WOMEN.

The amount of research being done on healthcare and health decisions over the past two years has increased exponentially, for obvious reasons. The pandemic brought with it a new-found urgency for many health-related behavioral problems, not least among them encouraging individuals to get the COVID-19 vaccine.

We've been fortunate enough to have had the opportunity to work on several healthcare problems across the continent over the last year, with a strong focus on girls and young women. During this research, we noticed an interesting trend: perceptions of autonomy were frequently a driving force for health decisions.

We found that young women would often make healthcare
decisions based on affective or emotional responses to their perceived autonomy in a given situation.

One example of this finding occurred in Kenya: when women were told that they should not get the vaccine, they were more likely to express an intent to get vaccinated than women who had not spoken about the vaccine with those in their social network. The inverse was also true: women who had been told that they should get vaccinated were less likely to express an intent to get vaccinated.

This result persisted, regardless of who had given the women the instructions – friends, family, parents, and partners were all included in the analysis and the pattern remained the same. The pattern was slightly less strong for those who had been given instructions by their pastors or religious leaders and the only instance in which it was not statistically significant was when the instructions came from teachers.

The pattern also persisted regardless of the woman’s trust in the vaccine. Many who believed the myths and misinformation about the vaccine would still express an intent to get vaccinated if they had been told that they shouldn’t by those around them.

When we first noticed this trend, we began exploring it further. Using Honey, we looked at the perceived autonomy that women had over their own healthcare decisions and aimed to compare this to the actual autonomy experienced. In almost all cases, women reported that they were responsible for their own healthcare decisions. This was true regardless of age and was reported by girls as young as 14.

The perceived autonomy was also persistent regardless of the real level of autonomy that the women had. We measured real autonomy by asking a randomized series of questions on healthcare decisions and barriers to receiving desired healthcare. While many women reported that a parent or spouse prevented them from getting some sort of desired healthcare – most commonly related to reproductive health – these same women still reported a belief that they had full autonomy over their own health.

So, in short: women are making healthcare decisions that they don’t
necessarily agree with, for the sole purpose of expressing their own autonomy.

While the research and data currently available to us don’t allow us to dive deeply into the “why” of this finding, we’ve continued to monitor these perceptions and responses over the course of the past year. We’ve found that the strength of the affective responses has decreased slightly and that these decreases generally coincide with the lowering of social distancing restrictions in the area where the women reside.

Our hypothesis, then, is that the two years of highly regulated decision-making and social interactions have likely increased the value of autonomy among these women. Two years of having governments and social communities dictate their movements and interactions with others has created a forceful desire to make their own decisions.

Of course, for the moment this is only a hypothesis and there is still a lot
of research to be done before we can confidently understand the effects we’re seeing. Regardless, if these effects are persistent and generalizable, they present an interesting new component for consideration in policy and communications design. If the desire for autonomy is so strong, then government policies that instruct women on what they should do will most likely fail.

The question remains: what do we replace it with? How do we encourage autonomy in decision-making without the desire for this autonomy overpowering real beliefs? And how do we take perceived autonomy and use it to create actual autonomy so that women truly are in control of their own healthcare decisions?