Research shows that 78% of pregnant and nursing women in Jordan changed at least one health behavior after receiving education, but their ability to make these decisions varied significantly by location and family size. A Gram Research analysis of 3,518 women found that between 53% and 90% had decision-making power over specific health choices like nutrition and breastfeeding, with women in certain cities and those with fewer children having substantially less autonomy. This reveals that health programs work better when they address not just knowledge, but women’s actual power to make decisions.
A study of over 3,500 pregnant and nursing women in Jordan reveals important differences in who gets to make decisions about their own health and nutrition. Researchers found that most women who received health messages changed at least one health habit, but not all women had equal power to make these choices. Women living in certain cities and those with fewer children had less control over decisions about what they eat, how they feed their babies, and whether to use birth control. According to Gram Research analysis, this shows that women’s ability to improve their family’s health depends partly on where they live and their family situation.
Key Statistics
A 2026 cross-sectional study of 3,518 pregnant and nursing women in Jordan found that 78% changed at least one health behavior after receiving program messages about nutrition and contraception.
Among 3,518 Jordanian women surveyed in 2021-2023, decision-making power over health behaviors ranged from 52.8% to 90.3%, with women in Zarqa having significantly less power over dietary diversity decisions compared to those in Amman (odds ratio 0.418).
A study of 3,518 pregnant and lactating women in Jordan (2021-2023) found that women with more children had greater decision-making power over exclusive breastfeeding, with each additional child increasing odds of autonomy by 18%.
Research analyzing 3,518 women in three Jordanian cities revealed that location significantly affected women’s health autonomy, with Zarqa residents having 58% lower odds of deciding about dietary diversity compared to Amman residents.
The Quick Take
- What they studied: Whether pregnant and nursing women in Jordan could make their own decisions about nutrition, breastfeeding, and birth control after receiving health education messages.
- Who participated: 3,518 pregnant or nursing women living in three cities in Jordan (Amman, Karak, and Zarqa) between 2021 and 2023. These women were part of a health program designed to improve nutrition and family planning.
- Key finding: About 78% of women changed at least one health behavior after receiving messages, but decision-making power varied significantly. Between 53% and 90% of women could actually make choices about the six health behaviors studied, depending on the specific behavior and where they lived.
- What it means for you: If you’re a woman in a developing country, your ability to make health decisions for yourself and your family may depend on your location and family structure. Health programs work better when they recognize that not all women have equal power to make changes, even when they want to. This research suggests programs should focus on helping women gain more decision-making power, not just providing information.
The Research Details
Researchers surveyed 3,518 pregnant and nursing women in three Jordanian cities between 2021 and 2023. The women were part of a health program that taught health workers and used media campaigns to share information about nutrition, breastfeeding, and modern birth control methods. The women answered questions about whether they received these health messages, whether they changed their habits, and who made the final decisions about their health choices—whether they decided alone, shared the decision with family members like husbands or mothers-in-law, or couldn’t make the decision at all.
The researchers looked at six specific health behaviors: eating a variety of foods, starting breastfeeding early, exclusively breastfeeding (only breast milk, no other foods), continuing to breastfeed, using modern contraception, and spacing pregnancies. For each behavior, they recorded whether women had full decision-making power, shared power with family members, or no power at all.
They used statistical tests to see if certain factors—like where women lived, how many children they had, their age, wealth, or nationality—affected their decision-making power. This approach let them identify which groups of women had the least control over their own health choices.
Understanding who can make health decisions is crucial because research shows that when women have more control over family health choices, the whole family benefits. If a health program teaches women about nutrition but they can’t actually decide what the family eats, the program won’t work as well. This study helps health workers understand that simply providing information isn’t enough—they need to help women gain the power to act on that information.
This study is a snapshot in time (cross-sectional), meaning it shows what was happening during 2021-2023 but doesn’t prove cause-and-effect. The large sample size of 3,518 women makes the findings fairly reliable for the three cities studied. However, the results may not apply to other countries or regions with different cultures and family structures. The study was registered in a clinical trial database, which is a good sign of transparency. The researchers used standard statistical methods to analyze the data, making the findings credible for the population studied.
What the Results Show
After receiving health messages from the program, 78% of pregnant and nursing women reported changing at least one health behavior. This shows that when women get good health information, many are willing to make changes. However, the ability to actually make these changes varied widely depending on the specific health behavior and where the women lived.
Decision-making power ranged from 52.8% to 90.3% across the six health behaviors studied. For example, more women could decide about eating diverse foods (90.3%) compared to using modern contraception (52.8%). This suggests that some health decisions are more culturally acceptable for women to make alone than others.
Location made a significant difference. Women living in Zarqa (compared to Amman, the capital) had much less power to decide about eating a variety of foods and starting breastfeeding early. Women in Karak had less power to decide about using modern contraception. This suggests that cultural attitudes about women’s decision-making vary between cities.
The number of children a woman had also mattered. Women with more children had more power to decide about exclusively breastfeeding. This may be because experienced mothers are trusted more by their families to make feeding decisions.
Surprisingly, factors like a woman’s age, wealth, and whether she was Jordanian or a refugee did not significantly affect her decision-making power. This suggests that the barriers to women’s autonomy in health decisions are more about location and family structure than about individual characteristics. The study also found that women’s willingness to change (78% did change at least one behavior) was higher than their actual decision-making power in some areas, suggesting that lack of power—not lack of motivation—is the real barrier.
Previous research has shown that women’s participation in family decisions leads to better health outcomes for mothers, babies, and children. This study confirms that women’s decision-making power varies and identifies specific groups with less power. It adds to our understanding by showing that location and family size matter more than individual wealth or age. The finding that 78% of women changed behaviors after receiving messages is encouraging and suggests that health education programs can work, but they need to address decision-making barriers for maximum impact.
This study only looked at three cities in Jordan, so the results may not apply to rural areas or other countries. Because it’s a snapshot in time, we can’t know if women’s decision-making power changed over time or what caused these differences. The study relied on women’s self-reports about who made decisions, which might not always be accurate. We don’t know why women in some cities had less decision-making power—the study identifies the problem but doesn’t fully explain the reasons. Finally, the study doesn’t tell us whether women with more decision-making power actually had better health outcomes for themselves and their babies.
The Bottom Line
Health programs should recognize that providing information alone isn’t enough—they need to help women gain decision-making power. Programs should be tailored to different regions, as cultural attitudes about women’s autonomy vary by location. Community leaders and family members should be involved in health programs to help shift attitudes about women’s decision-making. For women with less decision-making power, programs should focus on building family support and understanding rather than just individual education. These recommendations are based on solid evidence from a large study, though more research is needed to test which approaches actually work best.
Health workers and program designers in developing countries should care about this research, especially those working in the Middle East and North Africa. Women’s health advocates and organizations focused on maternal and child health should use these findings to improve their programs. Policymakers in countries with similar cultural contexts should consider how to support women’s decision-making power. Individual women may find this research validating if they’ve struggled to make health decisions in their families. However, this research is most relevant to women in developing countries with family structures similar to Jordan’s; women in countries with stronger legal protections for women’s autonomy may not face these same barriers.
Health behavior changes can happen quickly—this study found that 78% of women changed at least one behavior after receiving messages. However, building lasting decision-making power in families takes longer, likely months to years. Women should expect to see some changes in their health practices within weeks of receiving good health information, but gaining full autonomy over health decisions may require ongoing support and cultural shifts in their communities.
Frequently Asked Questions
Can pregnant women in developing countries make their own health decisions?
It depends on where they live and their family situation. A study of 3,518 Jordanian women found that 53-90% could make decisions about nutrition and breastfeeding, but women in certain cities and those with fewer children had significantly less autonomy. Location and family structure matter more than wealth or age.
Do health education programs work if women can’t make their own decisions?
Partially. Research shows 78% of women changed at least one behavior after receiving health messages, but programs work better when they also help women gain decision-making power. Simply providing information isn’t enough if women can’t act on it independently.
What factors affect whether a woman can make health choices?
A study of 3,518 women found that location and number of children significantly affected decision-making power, but age, wealth, and nationality did not. Women with more children had more power over breastfeeding decisions, and women in capital cities had more autonomy than those in other areas.
How can health programs better support women’s decision-making?
Programs should recognize that decision-making power varies by region and involve family members and community leaders, not just individual women. Tailoring programs to local cultural contexts and building family support appears more effective than one-size-fits-all education approaches.
Does women’s decision-making power affect family health outcomes?
Previous research shows it does, though this study didn’t measure outcomes directly. The study found that women with more autonomy were more likely to change health behaviors, suggesting decision-making power is important for implementing health improvements.
Want to Apply This Research?
- Track which health decisions you can make independently versus those you need to discuss with family members. Create a simple log noting: (1) the health behavior (eating variety, breastfeeding, contraception), (2) whether you made the decision alone, shared it, or couldn’t make it, and (3) any barriers you faced. Review monthly to see if your decision-making power increases.
- Start with one health behavior where you already have decision-making power (like eating diverse foods) and use the app to set a specific goal and track progress. Once you succeed, use that success to build confidence for discussing other health decisions with family members. Share your progress with your partner or family to help them understand why these changes matter.
- Use the app to document your decision-making experiences over 3-6 months. Track not just whether you changed behaviors, but whether your family’s attitudes about your decision-making power shifted. Note conversations with family members about health choices. If you’re struggling with decision-making power, use the app to identify which family members might be allies in supporting your health choices, and plan conversations with them.
This research describes decision-making patterns among pregnant and nursing women in Jordan and should not be interpreted as medical advice. The findings apply specifically to the three Jordanian cities studied and may not reflect other regions or countries. Women should consult with their healthcare providers about individual health decisions. If you’re experiencing barriers to making health decisions, speak with a healthcare provider, counselor, or women’s health advocate who can provide personalized support. This study was observational and does not prove that increasing decision-making power causes better health outcomes, though previous research suggests this relationship exists.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.