Women empowerment and uptake of antenatal care services : A meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African countries

Gebretsadik Shibre,Ghose Bisjawit,Edward Kwabena Ameyaw,Betregiorgis Zegeye,Sanni Yaya,Helena Yeboah

doi:10.1186/s13690-021-00604-5

Abstract

BackgroundWomen empowerment has been linked to increased skilled antenatal care (ANC) service use. However, there is no evidence on the net effect of women empowerment on ANC in the Sub-saharan African (SSA) region. We aim to address the knowledge gap on whether or not women empowerment positively influences the uptake of ANC at the SSA regional level.MethodsWe analyzed the Demographic Health Survey (DHS) datasets from 33 SSA countries. Following the DHS data analysis guideline, we measured women empowerment using two indicators. The first indicator is an index, which comprises decision-making on women’s own health, household purchase and visit to family or relatives whilst disagreeing statements that husband is justified in beating his wife constitutes the second indictor. We performed confounder-adjusted logistic regression analysis for the two indicators with ANC attendance in each of the 33 countries. Then, we pooled the adjusted Odds Ratios (OR) using the random effect model through the two-stage Individual Participant Data meta-analysis technique. Summary findings are reported in OR and corresponding 95 %CI and are presented in a forest plot.ResultsModerately empowered women had marginally higher odd of skilled ANC service across the SSA region (aOR = 1.19; 95 %CI: 1.03, 1.38, with a prediction interval of 0.58, 2.45). Conversely, being involved in the three decisions (aOR = 1.15; 95 %CI: 0.99, 1.33, with prediction interval 0.57, 2.31), and attitude towards wife-beating (aOR = 0.97; 95 %CI: 0.88, 1.06, with prediction interval of 0.63, 1.48) had no statistically significant relationship with ANC.ConclusionsWomen empowerment did not predict the use of skilled ANC in the context of the SSA region. We recommend that further studies be conducted in order to understand how women empowerment affects skilled ANC service utilization in the region.

Highlights

Women empowerment has been linked to increased skilled antenatal care (ANC) service use
In Togo and Cote d’Ivoire, women who disagree to wife-beating justified questions had an increased odd of using skilled ANC (Fig. 3)
In the metaanalysis, compared with women who are categorised as not empowered, women who are in the category of moderate empowerment had a higher odd of attending ANC though the prediction interval crossed the null (Fig. 1)

Summary

Introduction

Women empowerment has been linked to increased skilled antenatal care (ANC) service use. There is no evidence on the net effect of women empowerment on ANC in the Sub-saharan African (SSA) region. We aim to address the knowledge gap on whether or not women empowerment positively influences the uptake of ANC at the SSA regional level. Maternal mortality remains a global health problem and one of the key health challenges in most low and middle-income countries, sub-Saharan African (SSA) countries. Nine out of the top ten countries that had the highest global estimates of maternal mortality in 2017 were found in the SSA region [1]. In spite of all these, there has been limited progress in reducing maternal mortality rates in many countries in SSA [4, 5]. Women in SSA face 1 in 38 chance of dying from pregnancy and childbirthrelated causes in comparison to 1 in 5,400 in developed countries [6]

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