Temporal relationship between Women’s empowerment and utilization of antenatal care services: lessons from four National Surveys in sub-Saharan Africa

Abstract

Background In November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women’s empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women’s empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women’s empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model. Methods The most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women’s empowerment captured in the DHS. The 30 variables on women’s empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results. Results The proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women’s empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries. Conclusion This study highlights the significant impact of women’s empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.

Number of antenatal care utilization and associated factors among pregnant women in Ethiopia: zero-inflated Poisson regression of 2019 intermediate Ethiopian Demography Health Survey

“…The finding was supported by previous researches in Western Ethiopia [ 62 ], Ethiopia [ 56 ], rural Ethiopia [ 51 ], Kenya [ 90 ], Guinea [ 55 , 91 ], Afghanistan [ 64 ], Angola [ 54 ], East African countries [ 60 ], India [ 92 , 93 ], Ghana [ 94 ], Nepal [ 95 ], Nigeria [ 96 ]. Educated women might empowered to get services [ 97 – 102 ], education make women to have decision making [ 103 , 104 ]. Moreover educated women have knowledge on danger sign [ 105 – 108 ].…”

Magnitude and determinants of unmet need for family planning among reproductive age women in East Africa: multilevel analysis of recent demographic and health survey data

“…This finding is in line with study conducted in Nigeria [ 13 ]. This could be due to the empowerment of women and increased life decision which associated with maternal health service use among the women [ 40 ]. The other possible reasons is female headed household may increase resource gain and control.…”

Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey

“…Following the revised World Health Organization guidelines on the recommended number of ANC visits [8], the responses were categorized as <8 visits or ≥8 visits, where ≥8 visits were considered complete ANC visits and <8 incomplete ANC visits. Similar categorizations have been used in previous studies [20][21][22].…”

“…Based on theoretical and practical significance and the availability of the variables in the dataset, we considered both individual-and household-level factors in our study. The selection of the variables was influenced by their association with the number of ANC visits in previous studies [20][21][22].…”