Shibre Gebretsadik, Zegeye Betregiorgis, Yeboah Helena, Bisjawit Ghose, Ameyaw Edward Kwabena, Yaya Sanni
Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
HaSET Maternal and Child Health Research Program, Shewa Robit, Ethiopia.
Arch Public Health. 2021 May 27;79(1):87. doi: 10.1186/s13690-021-00604-5.
Women empowerment has been linked to increased skilled antenatal care (ANC) service use. However, there is no evidence on the net effect of women empowerment on ANC in the Sub-saharan African (SSA) region. We aim to address the knowledge gap on whether or not women empowerment positively influences the uptake of ANC at the SSA regional level.
We analyzed the Demographic Health Survey (DHS) datasets from 33 SSA countries. Following the DHS data analysis guideline, we measured women empowerment using two indicators. The first indicator is an index, which comprises decision-making on women's own health, household purchase and visit to family or relatives whilst disagreeing statements that husband is justified in beating his wife constitutes the second indictor. We performed confounder-adjusted logistic regression analysis for the two indicators with ANC attendance in each of the 33 countries. Then, we pooled the adjusted Odds Ratios (OR) using the random effect model through the two-stage Individual Participant Data meta-analysis technique. Summary findings are reported in OR and corresponding 95 %CI and are presented in a forest plot.
Moderately empowered women had marginally higher odd of skilled ANC service across the SSA region (aOR = 1.19; 95 %CI: 1.03, 1.38, with a prediction interval of 0.58, 2.45). Conversely, being involved in the three decisions (aOR = 1.15; 95 %CI: 0.99, 1.33, with prediction interval 0.57, 2.31), and attitude towards wife-beating (aOR = 0.97; 95 %CI: 0.88, 1.06, with prediction interval of 0.63, 1.48) had no statistically significant relationship with ANC.
Women empowerment did not predict the use of skilled ANC in the context of the SSA region. We recommend that further studies be conducted in order to understand how women empowerment affects skilled ANC service utilization in the region.
妇女赋权与增加熟练的产前保健（ANC）服务利用有关。然而，在撒哈拉以南非洲（SSA）地区，没有证据表明妇女赋权对ANC的净影响。我们旨在解决关于妇女赋权是否在SSA区域层面积极影响ANC利用的知识差距。
我们分析了来自33个SSA国家的人口与健康调查（DHS）数据集。按照DHS数据分析指南，我们使用两个指标衡量妇女赋权。第一个指标是一个指数，它包括关于妇女自身健康、家庭购买以及拜访家人或亲戚的决策，而不同意丈夫殴打妻子有理的陈述构成第二个指标。我们对这两个指标与33个国家中每个国家的ANC就诊情况进行了混杂因素调整的逻辑回归分析。然后，我们通过两阶段个体参与者数据荟萃分析技术，使用随机效应模型汇总调整后的比值比（OR）。汇总结果以OR和相应的95%置信区间（CI）报告，并以森林图呈现。
在整个SSA地区，中度赋权的妇女获得熟练ANC服务的几率略高（调整后的OR = 1.19；95%CI：1.03，1.38，预测区间为0.58，2.45）。相反，参与三项决策（调整后的OR = 1.15；CI：0.99，1.33，预测区间0.57，2.31）以及对殴打妻子的态度（调整后的OR = 0.97；95%CI：0.88，1.06，预测区间为0.63，1.48）与ANC没有统计学上的显著关系。
在SSA地区的背景下，妇女赋权并不能预测熟练ANC服务的使用情况。我们建议进行进一步研究，以了解妇女赋权如何影响该地区熟练ANC服务的利用情况。
