Gender Relations, Women Empowerment and Maternal Health Care in sub-Saharan Africa: A Bayesian Multilevel Analysis

Abstract

Maternal health care utilization still remains crucial in ensuring good pregnancy outcomes and a reduction in maternal and child mortality especially in developing countries. Although several studies have been conducted to investigate determinants of maternal health care utilization, the innfluence of gender relations and women empowerment on maternal healthcare in cross-national context has received little attention. This paper sought out to examine the influence of gender relations and women empowerment on maternal healthcare utilization in sub-Saharan Africa. The analysis pools sample data of 245,955 respondents from the most recent Demographic and Health Surveys (DHS) and World Development Indicators of 35 sub-Saharan African countries. Separate Bayesian multilevel logistic regression models are fitted for adequate antenatal care and institutional delivery in relation to several factors indicating gender relations and women empowerment at three levels. Several components of gender relations and women empowerment were significantly associated with maternal health care after adjusting for covariates. In addition, significant between country and between community variations in the odds of maternal health care utilisation were observed. These results underscore the importance of prioritising contextual gender equity and women empowerment to achieve better utilisation of maternal healthcare services and subsequently, a reduction in maternal mortality in sub-Saharan Africa.