Fielding School of Public Health, University of California, Los Angeles (UCLA), California, United States of America.
PLoS One. 2019 Feb 13;14(2):e0212038. doi: 10.1371/journal.pone.0212038. eCollection 2019.
Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women's empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method-structural equation modeling (SEM)-to investigate the complex and multidimensional pathways through which women's empowerment affects SBA use. The results show that women's education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations.
撒哈拉以南非洲地区的孕产妇和新生儿死亡率仍然高得令人无法接受，而分娩时使用熟练接生员（SBA）的比例仍然很低。尽管人们认识到增强妇女权能是孕产妇和新生儿健康的关键决定因素，但撒哈拉以南非洲地区的证据更为有限。本研究利用 2010 年坦桑尼亚人口与健康调查（n=4340）的数据，采用稳健的方法——结构方程建模（SEM）——来研究妇女权能影响 SBA 使用的复杂和多维途径。结果表明，妇女的教育和家庭决策与 SBA 的使用呈正相关。然而，并非所有赋权维度都具有相同的影响。在坦桑尼亚，对性谈判和暴力以及早婚的态度不是重要因素。中介分析还证实了教育对 SBA 使用的间接影响仅通过家庭决策。研究结果强调了在检查赋权等复杂和多维结构时使用结构方程建模的效用，并证明了潜在的因果推断可以更好地为政策和方案建议提供信息。
