Objectives To examine the association between women’s autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries.
Design, setting and participants We analysed the Demographic and Health Survey (DHS) (2010–2016) data collected from married women aged 15–49 years. We used four DHS measures related to women’s autonomy: attitude towards domestic violence, attitude towards sexual violence, decision making on spending of household income made by the women solely or jointly with husbands and decision making on major household purchases made by the women solely or jointly with husbands. We used multiple logistic regression analyses to examine the association between women’s autonomy and the utilisation of maternal healthcare services adjusted for five potential confounders: place of residence, age at birth of the last child, household wealth, educational attainment and working status. Adjusted ORs (aORs) and 95% CI were used to produce the forest plots.
Outcome measures The primary outcome measures were the utilisation of ≥4 antenatal care visits and delivery by skilled birth attendants (SBA).
Results Pooled results for all 31 countries (194 883 women) combined showed weak statistically significant associations between all four measures of women’s autonomy and utilisation of maternal healthcare services (aORs ranged from 1.07 to 1.15). The strongest associations were in the Southern African region. For example, the aOR for women who made decisions on household income solely or jointly with husbands in relation to the use of SBAs in the Southern African region was 1.44 (95% CI 1.21 to 1.70). Paradoxically, there were three countries where women with higher autonomy on some measures were less likely to use maternal healthcare services. For example, the aOR in Senegal for women who made decisions on major household purchases solely or jointly with husbands in relation to the use of SBAs (aOR=0.74 95% CI 0.59 to 0.94).
Conclusion Our results revealed a weak relationship between women’s autonomy and the utilisation of maternal healthcare services. More research is needed to understand why these associations are not stronger.
- antenatal care
- sub-Saharan Africa
- skilled birth attendants
- maternal health services
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Contributors The concept was initiated by CC, who also collected the data, produced the tables, figures and wrote the first draft. All authors contributed to the study design and review of the manuscript with vital input from KEA and RGC. KEA contributed significantly to the statistical analyses. JN provided critical contributions to the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval This study is based on publicly available DHS data. CC was granted access to the data by the MEASURE DHS/ICF International, Rockville, Maryland, USA.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data used in this study are freely accessible to the public at the DHS website https://www.dhsprogram.com/Data/.
Patient consent for publication Not required.
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