Abstract
Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women’s empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method–structural equation modeling (SEM)–to investigate the complex and multidimensional pathways through which women’s empowerment affects SBA use. The results show that women’s education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations.
Highlights
Maternal and newborn mortality remain unacceptably high in low- and middle-income countries, where 99.7% of global maternal deaths and 98.5% of newborn deaths occur
This study aims to address these needs by employing structural equation modeling (SEM), which is an approach that is useful for investigating potentially complex and multidimensional pathways
This study investigated the mechanism through which women’s status and empowerment affect skilled birth attendant (SBA) use during childbirth in Tanzania
Summary
Maternal and newborn mortality remain unacceptably high in low- and middle-income countries, where 99.7% of global maternal deaths and 98.5% of newborn deaths occur. Women’s status and empowerment have been recognized as important influences on a range of health and social behaviors as well as outcomes, including contraceptive use, fertility, delivery care, and, more broadly, poverty reduction and economic growth [11, 13, 21,22,23]. “Achievements” are the outcomes of empowerment and conceptualized as the ability to make “strategic life choices”, including marriage and childbearing [21] This domain is increasingly recognized as an important marker of women’s status and empowerment in that the timing and circumstances surrounding these events reflect the extent to which women have a choice in these decisions [25,26,27,28]. “Women’s status”, on the other hand, is generally considered to be a measure of “women’s overall position in the society” [24], which is often represented by a woman’s educational attainment as well as her economic or employment status
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