Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
Department of Public Health, Busitema University, Mbale, Uganda.
BMC Health Serv Res. 2023 Feb 2;23(1):109. doi: 10.1186/s12913-023-09122-2.
Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone.
We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities.
The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34-3.78), northern (aOR = 1.69,95% CI: 1.01-2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03-6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69-0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02-1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21-2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31-4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization.
These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.
妇女赋权被认为是促进分娩时利用卫生设施的潜在有利因素。然而，妇女赋权与利用卫生设施之间的关系在孕产妇死亡率较高的国家研究甚少。因此，我们调查了塞拉利昂妇女赋权指数与分娩时利用卫生设施之间的关系。
我们分析了 2019 年塞拉利昂人口与健康调查（SLDHS）的二次数据。我们纳入了在调查前五年内分娩的 5997 名已婚妇女，并对她们进行了妇女赋权问卷的抽样调查。该研究采用了哈佛国际发展研究所制定的性别角色框架，对妇女赋权指数进行了选择和分类，其中包括影响、资源和决策因素。我们使用 SPSS 版本 25.0 复杂样本包进行逻辑回归分析，以确定妇女赋权指数与利用卫生设施之间的关联。
分娩时利用卫生设施的总体流行率为 84.1%（5042/5997）：95%CI：83.6-85.4。在影响者领域变量中，来自南部（aOR=2.25，95%CI：1.34-3.78）、北部（aOR=1.69，95%CI：1.01-2.82）和东部地区（aOR=3.71，95%CI：2.03-6.77）的妇女比西部地区的妇女更有可能利用卫生设施，而一夫多妻制婚姻的妇女（aOR=0.82，95%CI：0.69-0.98）比一夫一妻制婚姻的妇女更不可能利用卫生设施。此外，首次分娩年龄在 18 岁以下的妇女比 18 岁及以上的妇女更有可能利用卫生设施（aOR=1.22，95%CI：1.02-1.45）。在资源领域变量中，接受过中学后教育的妇女（aOR=1.58，95%CI：1.21-2.06）比没有接受过教育的妇女更有可能利用卫生设施，而属于最富有五分位数的妇女（aOR=2.42，95%CI：1.31-4.46）比属于最贫穷五分位数的妇女更有可能利用卫生设施。决策领域的变量均与卫生设施的利用无显著关联。
这些发现强调，成功实施卫生设施利用干预措施应优先考虑妇女赋权，并采取更务实的努力。政策和方案应面向所有妇女，更侧重于教育程度较低（小学及以下）、属于最贫穷五分位数、在 18 岁之前分娩和处于一夫多妻制婚姻的妇女。
