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Abstract
BackgroundIn the context of global health priority, understanding the role of power dynamics among women as an important intervention required towards achieving optimum maternal and child health outcomes is crucial. This study examined the influence of women's decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria.MethodsThe data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 20,100 births in the last five years that preceded the survey among married/cohabiting childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using the binary logistic regression model.ResultsThe study revealed that despite a large number of women initiating antenatal care visits before 12 weeks of pregnancy (75.9%), far fewer numbers had at least eight antenatal care visits (24.2%) and delivered in a health facility (58.2%). It was established that the likelihood of having at least eight antenatal care visits was significantly increased among women who enjoyed decision-making autonomy on their healthcare (aOR: 1.24, CI: 1.02–1.51) and how their earnings are spent (aOR: 2.02, CI: 1.64–2.48). Surprisingly, women’s decision-making autonomy on how their earnings are spent significantly reduced the odds of initiating antenatal care visits early (aOR: 0.75, CI: 0.63–0.89). Some socio-economic and demographic factors were observed to have a positive influence on quality antenatal care utilisation and delivery in a health facility.ConclusionIn conclusion, women’s decision-making autonomy on their healthcare and how their earnings are spent was significantly found to be protective factors to having eight antenatal care visits during pregnancy. Conversely, women’s autonomy on how their earnings are spent significantly hindered their initiation of early antenatal care visits. There is a need for more pragmatic efforts through enlightenment and empowerment programmes of women to achieve universal access to quality maternal healthcare services in Nigeria.
Highlights
Pregnancy and childbirth are significant events in a woman’s life and her family even though they represent a period of heightened vulnerability [1]
In sub-Saharan Africa, which Nigeria is an integral part of, improving maternal and newborn health remains a major challenge, leading to preventable unacceptably high levels of maternal and child deaths [8, 11]. This plausibly could be attributed to power dynamics in the family, especially women decision-making autonomy relating to the utilisation of healthcare services
The results showed that the likelihood of having first antenatal care (ANC) visit before 12 weeks of pregnancy significantly increased among women who made joint decisions with partners and independent decisions on their healthcare, large household purchases and visits to family or relatives, relative to those in the reference category
Summary
Pregnancy and childbirth are significant events in a woman’s life and her family even though they represent a period of heightened vulnerability [1]. Quality antenatal care (ANC) services and delivery in a health facility are important interventions required during pregnancy and childbirth to achieve optimum maternal and child health. In sub-Saharan Africa, which Nigeria is an integral part of, improving maternal and newborn health remains a major challenge, leading to preventable unacceptably high levels of maternal and child deaths [8, 11]. This plausibly could be attributed to power dynamics in the family, especially women decision-making autonomy relating to the utilisation of healthcare services. This study examined the influence of women’s decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria
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