Global Health
Joint Associations of Individual- and Community-level Women’s Empowerment with Complete use of Maternal Healthcare Utilization in 34 Sub-Saharan African Countries Yun-Jung Eom* Yun-Jung Eom Rockli Kim
Background: Gender norms and practices in a community may importantly shape individual’s access to healthcare. However, evidence on the associations between women’s empowerment (WE) and pregnancy-related healthcare are restricted to individual-level analysis. We examined how individual- and community-level WE are jointly associated with complete use of maternal healthcare services in sub-Saharan Africa (SSA).
Methods: We pooled data from Demographic and Health Surveys (post-2010) across 34 SSA countries (N=194,905). Complete care was defined as having four or more antenatal care visits, facility delivery, and postnatal care. Based on a globally validated survey-based WE index (SWPER), a composite variable was constructed for individual- and community-level WE in terms of attitude to violence, social independence, and decision-making: low-low (reference), low-high, high-low, and high-high. Sociodemographic factors were adjusted in multilevel linear probability models.
Results: One-third of women (35.4%) completed all pregnancy-related healthcare. Highly empowered women living in high empowered communities (high-high) had the highest probability of complete care (b=0.059; 95% CI=0.051,0.066 for attitude to violence, b=0.117; 95% CI=0.109,0.125 for social independence, and b=0.074; 95% CI=0.066,0.081 for decision-making). Less empowered women living in highly empowered communities (low-high) had a greater likelihood of receiving complete care than highly empowered women living in less empowered communities (high-low), which was particularly evident in social independence domain.
Conclusion: We found a strong contextual effect of WE on maternal healthcare utilization. Together with strengthening individual women’s agency, policies to change community-level gender norms are needed to encourage less empowered women to engage in maternal healthcare practices in SSA.
