Reproductive health of women in developing countries and human development: A test of Sen's theory

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, thus contributing to 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 used secondary data for the analysis, collected by various international nongovernmental organizations such as the U.N., WHO, and the 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 (percent 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 received prenatal care (Precare), (3) 1-year-olds fully immunized (Immun1), (4) contraceptive prevalence rate (Contra), (5) abortion policies (Abopol), and (6) percentage of 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 was measured using Cronbach's alpha. The model was tested using both path analysis and the structural equation method.;Study results from path analysis found total support for all paths specified as well as overall model fit. However, the structural equation method did not find support for overall model fit; in addition, 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 for the field of social work as well as for 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 bring reproductive health, a field of study that is on the backburner of social work practice, to the forefront.