Autonomy in Health, Nutrition, and Reproductive Decision-Making and Its Association with Self-Efficacy and Esteem: A Mixed Methods Study

Abstract

Decision-making autonomy across health, reproductive, and nutritional domains is theoretically linked to psychological well-being. Most research treats psychological resources as preconditions for autonomy rather than examining whether autonomy restriction itself undermines self-efficacy and self-esteem. This mixed-methods study examined these associations among Indian adults aged 21-40 in Gujarat. The quantitative phase (N = 90) used domain-specific autonomy scales alongside the General Self-Efficacy Scale and the Rosenberg Self-Esteem Scale. Results showed no gender differences in autonomy, though males reported higher self-efficacy and self-esteem. Health and nutritional autonomy consistently exceeded reproductive autonomy. Autonomy showed modest associations with psychological outcomes, with couple communication quality emerging as the strongest predictor of self-esteem. Education predicted higher general autonomy but lower reproductive autonomy. The qualitative phase involved semi-structured interviews with men, women, couples, and service providers, revealing layered constraint structures – mothers-in-law as primary gatekeepers, husbands displaying supportive absence, and service providers legitimizing family involvement as culturally appropriate. Findings suggest that autonomy restriction operates through relational networks rather than individual barriers, with implications for reframing empowerment interventions beyond individual capacity-building.