The Impact of Women’s Agency on Accessing and Using Maternal Healthcare Services: A Systematic Review and Meta-Analysis

Abstract

Agency, defined as the ability to identify one’s goals and act upon them, has been recognized as a prominent strategy to access maternal healthcare services (MHS). The purpose of this study was to synthesize evidence of the association between women’s agency and MHS utilization. A systematic review was performed on five academic databases, comprising Scopus, PubMed, Web of Science, Embase, and ProQuest. Meta-analysis was performed with a random-effects method using the STATA™ Version 17 software. A total of 82 studies were selected following the PRISMA guidelines. The meta-analysis demonstrated that an increase in women’s agency was associated with a 34% increase in the odds of receiving skilled antenatal care (ANC) (OR = 1.34, 95% CI = 1.18–1.52); 7% increase in the odds of initiating the first ANC visit during the first trimester of pregnancy (OR = 1.07, 95% CI = 1.01–1.12); 20% increase in the odds of receiving at least one ANC visit (OR = 1.20, 95% CI = 1.04–1.4); 16% increase in the odds of receiving more than four ANC visits during pregnancy (OR = 1.16, 95% CI = 1.12–1.21); 17% increase in the odds of receiving more than eight ANC visits (OR = 1.17, 95% CI = 1.04–1.32); 13% increase in the odds of facility-based delivery (OR = 1.13, 95% CI = 1.09–1.17); 16% increase in the odds of using skilled birth attendants (OR = 1.16, 95% CI = 1.13–1.19); and 13% increase in the odds of receiving postnatal care (OR = 1.13, 95% CI = 1.08–1.19) compared to low level of agency. Any efforts to improve MHS utilization and reduce maternal morbidity and mortality should include the promotion of women’s agency.

Understanding communication in community engagement for maternal and newborn health programmes in low- and middle-income countries: a realist review

“…Additionally, factors such as gender, power and agency may have an influence on MNH, decision-making and care-seeking ( Manda-Taylor et al , 2017 ; Amosse et al. , 2023 ; Vizheh et al , 2023 ). Low- and middle-income countries (LMICs) have become a setting of particular focus for these MNH CE activities largely due to the fact that this is where the majority of global maternal and neonatal deaths occur ( Silver and Singer, 2014 ; Langer et al.…”

Maternal and child health care access to skilled delivery services among Ghanaian rural mothers

“…The findings of this study confirmed the findings of the Ghana Demographic and Health Survey [31] and Ghana Demographic and Health Survey [44] studies, which found that a woman's education was important in ANC utilisation in Ghana. Also, Vizheh et al [14] discovered, through an analysis of DHS data from Bangladesh, Malawi, Bolivia, and the Philippines, that a woman's education was a key determinant of mothers' use of ANC services, just as Stanton et al [24] did in their review of DHS data from developing countries. The North East Region's high percentage of educated mothers using ANC services calls for girl-child education.…”

“…Similarly, the cost of medications may discourage mothers from seeking maternal healthcare services. Additionally, the availability of health personnel and maternal health policies were among the majority of reasons for mothers not using medications while pregnant; the review that follows provides empirical research on why mothers do or will not seek medications and health worker assistance when pregnant [13,14].…”

Is parental engagement associated with subsequent delayed marriage and marital choices of adolescent girls? Evidence from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey in Uttar Pradesh and Bihar, India

“…Parental support may improve self-efficacy among girls and empower them, which could help to exercise their agency and raise their voices against marriage proposals at an early age. Women's agency and decision-making power can lead to better utilization of maternal healthcare and optimal health outcomes ( Vijayaraghavan et al, 2022 ; Vizheh et al, 2023 ). Although self-resistance is important for preventing early marriage, social support, particularly from fathers, is instrumental in stalling the forthcoming marriage proposals ( McDougal et al, 2018 ).…”