Her Health Behavior, Her Choice? Decision-Making Power Over Key Health and Nutrition Behaviors Among Pregnant and Lactating Women in Jordan.

Women's participation in family diet and health decisions is strongly associated with better family outcomes.  We examined decision-making power among participants in a Community Health and Nutrition Program in Jordan, which sought to improve maternal, infant, and young child nutrition (MIYCN) and modern contraception through service-provider training and media campaigns. Cross-sectional surveys in Amman, Karak, and Zarqa governates enrolled 3518 pregnant/lactating women (PLW) in the program (2021-23).  PLW respondents indicated whether receiving messages about MIYCN and contraceptive use changed their practices, and whether their decision-making was total, shared with other family members (husbands, mothers, mothers-in-law), or not possible for these choices. Results were analyzed using chi-square tests and multiple linear regressions.  After receiving program messages, 78% of PLW changed ≥ 1 practice. Between 52.8% and 90.3% of PLW had decision-making power to accept or reject recommendations for the six targeted behaviors. Compared to Amman, Zarqa residence was negatively associated with decision-making power over women's dietary diversity (OR = 0.418, p < 0.05) and early initiation of breastfeeding (OR = 0.493, p < 0.05), while Karak residence was negatively associated with decision-making power over modern contraceptive use (OR = 0.419, SE = 0.116, p < 0.01). Number of children was positively associated with decision-making power over exclusive breastfeeding (OR = 1.18, p < 0.01). Nationality, age, and wealth were not associated with decision-making power over these practices. Decision-making power varied among PLW in the program: PLW living outside Amman and those with fewer children had less autonomy to change practices. Further research is needed to understand how to best support decision-making power among these populations. Trial Registration: Registered at clinicaltrials.gov (NCT05365698).