Influence of women’s empowerment indices on the utilization of skilled maternity care: evidence from rural Nigeria

Abstract

There is increasing evidence that women with the ability to exercise control over their sexual and reproductive lives have greater access to prompt prevention and treatment of maternal health disorders, resulting in a concomitant reduction in maternal morbidity and mortality. This study assessed the association between indices of women’s empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Data were taken from a household survey conducted in July and August 2017, and the study sample comprised 1245 ever-married women currently in a union who had given birth in the 5 years preceding the survey. A Gender Roles Framework guided the selection of independent women’s empowerment variables. Using hierarchical logistic regression, the likelihood of receiving all three levels of skilled maternal health care service (antenatal, intrapartum and postnatal) by women’s empowerment variables, grouped into resource, decision-making and influencer domains following the model of Anderson and Neuman, was assessed. Of the resource domain variables, respondent’s education and respondent’s participation in payment for their own health care positively predicted their use of all three levels of skilled maternal care, whereas their ownership of land negatively predicted this. Two decision-making domain variables were significantly associated with respondent’s use of all three levels of service: those who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others, while respondent making decisions alone about what food to cook each day was a negative predictor. Of the influencer variables, religion and a large spousal education gap were strong positive factors, whereas living in a consensual union rather than being legally married was a negative factor. Although health system factors are important, interventions geared towards changing gender norms that constrain women’s empowerment are critical to achieving maternal health-related development goals in Nigeria. A composite strategy that targets all women’s empowerment indices is recommended, as Nigeria strives towards achieving SDG-3.

Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age

“…We found out that women who reported costs of care as barriers to maternal care utilization were less likely to undertake ≥ 4 ANC and the newly recommended ≥ 8 antenatal contacts. This finding conforms to the reports made by past studies both for Nigeria and elsewhere ( 4 , 12 , 20 , 32 ). Despite the free maternal care policy in the state, some women still experience costs as a barrier because of ignorance of the free maternal care policy, and due to the fact that free maternal care policy does not cover all costs, particularly indirect costs relating to transportation charges, waiting time in health facilities, opportunity costs of time in traveling to health centers, and the costs of drugs ( 11 , 38 ).…”

“…We noted that maternal education has significant positive impacts on both ≥ 4 ANC and the newly recommended ≥ 8 antenatal contacts. Our finding of a significant positive association between maternal education and ≥ 4 and the recommended ≥ 8 antenatal contacts conforms to past studies, both for Nigeria and elsewhere ( 7 , 17 , 20 , 28 – 30 ). However, this finding contradicts the reports made by some other studies conducted in Nigeria and elsewhere ( 2 , 31 ).…”

“…Enabling characteristics include family resources (income, health insurance, access, availability of health facilities, and social network support) and community characteristics (the ratio of health personnel and facilities per 100,000 of the population cost of health services, and rural-urban location). Several studies have shown that accessibility is a core determinant of health-seeking behavior and health outcomes ( 4 , 20 ). Need-based characteristics are the perception of the need for health services.…”

“…Out of this, 31.1% were within the age group (35)(36)(37)(38)(39) years. The majority of the mothers got married within the age group (18)(19)(20)(21)(22)(23)(24) years. The highest proportion of the women reported non-formal education (31.0%).…”

“…Household socioeconomic status is the main focus because we believe that in the era of free maternal care policy, the household socioeconomic status will have no significant impact on ANC utilization, since the free maternal care policy will resolve financial barriers and issues relating to the affordability of maternal care services (11,19). The study focuses on rural communities in Nigeria due to the fact that maternal mortality is higher among rural Nigerian women, and evidence shows that several barriers to maternal care utilization confront rural Nigerian women (12,16,20). The study undertook the following research objectives: (i) It examined the effect of household socioeconomic status on a minimum of eight ANC contacts (ii) It examined the effect of other sociodemographic factors on a minimum of eight antenatal contacts (iii) It compared the determinants of the new recommended ≥ 8 ANC contacts and that of the focused ANC of ≥ 4.…”