Influence of Women's Decision-Making Autonomy on Maternal Healthcare Utilisation Among Married Women in Rivers State, Nigeria

Tamunoboma Gloria Ibulubo; Anthony Ike Wegbom; Clement Kevin Edet.; Priscillia; Nyekpunwo Ogbonda; Corresponding author

doi:10.56201/ijhpr.vol.11.no8.2026.pg97.111

Influence of Women's Decision-Making Autonomy on Maternal Healthcare Utilisation Among Married Women in Rivers State, Nigeria

Tamunoboma Gloria Ibulubo, Anthony Ike Wegbom, Clement Kevin Edet., Priscillia, Nyekpunwo Ogbonda,, Corresponding author

Abstract

Despite high antenatal care attendance in Rivers State, skilled birth attendance remains low, with women's decision-making autonomy posited as a key determinant. This study examined the influence of women's decision-making autonomy on maternal healthcare utilisation. A cross-sectional study was conducted among 600 randomly selected married women who delivered at least one year preceding the survey using a semi-structured questionnaire. Descriptive, Bivariate and multivariate logistic regression analysis was carried out to identify the influence of women's decision-making autonomy on maternal healthcare utilisation. The findings revealed that women's decision-making autonomy significantly influenced maternal healthcare utilization, but autonomy was low. The deficit was most severe for place of delivery, the most male-controlled domain (38.0% husband-alone against 24.0% self-alone), indicating husband dominated decision making on place of delivery. The effect of autonomy was continuum-specific. For antenatal care [ANC] ≥4 visits, autonomy was not an independent driver after Adjustment (aOR=1.82, 0.88-3.78, p=0.106). For skilled birth attendance [SBA], self-led autonomy remained significant [aOR=1.94, 1.15-3.28, p=0.003] - women who decided alone were twice as likely to have skilled delivery against husband-alone - alongside tertiary education [aOR=2.74, 1.55-4.83] and high income [aOR=2.01, 1.16- 3.47]. Joint decision was not significant [aOR=1.31, 0.81-2.10]. For postnatal care , neither autonomy [aOR=1.31, 0.81-2.10] nor education was significant, reflecting generally low PNC across all strata. This study demonstrates that women's decision-making autonomy emerged as a critical yet continuum-dependent determinant of maternal healthcare utilization in Rivers State. Programs that enhance women’s autonomy in household decision-making, particularly in health-related matters should be implemented.

Keywords

Women's Autonomy; Decision-Making; Maternal HealthcareUtilisation Married WomenRivers State

References

Adebayo, A., & Iweala, O. (2024). Economic empowerment and maternal health in Lagos and Kano. African Journal of Health Sciences, 30(2), 45–60. Adewuyi, E. O., Auta, A., & Khanal, V. (2022). Autonomy and maternal healthcare utilisation in Nigeria. BMC Public Health, 22(1), 123. Babitsch, B., Gohl, D., & von Lengerke, T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: A systematic review of studies from 1998–2011. Psychosocial Medicine, 9. https://doi.org/10.3205/psm000089 Bloom, S. S., Wypij, D., & Das Gupta, M. (2001). Dimensions of women's autonomy and maternal healthcare utilisation. Demography, 38(1), 67–78. Cresswell JA, Alexander M, Chong MYC (2025) Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis. Lancet Global Health. S2214-109X(24)00560- 6. doi: 10.1016/S2214-109X(24)00560-6. Fapohunda B, Orobaton N. (2013). Factors influencing the selection of delivery with no one present in Northern Nigeria: implications for policy and programs. International Journal of Women's Health; 6:171-83. Fawole, O. I., & Adeoye, I. A. (2015). Women’s status within the household as a determinant of maternal health care use in Nigeria. African Health Sciences, 15(1), 217–225. https://doi.org/10.4314/ahs.v15i1.28 Fawole, O. I., & Adeoye, I. A. (2015). Women’s status within the household as a determinant of maternal health care use in Nigeria. African Health Sciences, 15(1), 217–225. https://doi.org/10.4314/ahs.v15i1.28 Ghani A, Hassan ZBH, Carlo DP (2022)“Cultural Beliefs and Practices Regarding Maternal Health: a case study of rural areas of PUNJAB”, Pakistan Journal Social Research 4, (03), 1208–1219. Ifelunini, I. A., Agbutun, A. S., Ugwu, S. C., & Ugwu, M. O. (2022). Women autonomy and demand for maternal health services in Nigeria: Evidence from the Nigeria Demographic and Health Survey. African Journal of Reproductive Health, 26(4). https://doi.org/10.29063/ajrh2022/v26i4.7 Jahan I (2025) The Role of Women’s Decision-Making Power in Household Maternal Health Assistance: Exploring Interlinked Factors and Pathways to Development. Global Research Journal of Public Health and Epidemiology. 13 (5):11-19. Kumari K, Srivastava RK, Srivastava M, Purwar N. (2019) Maternal mortality in rural varanasi: delays, causes, and contributing factors. Indian Journal of Community Medicine. 44(1):26–30. Obasohan PE, Gana P, Mustapha MA, Umar AE, Makada A, Obasohan DN. (2019) Decision Making Autonomy and Maternal Healthcare Utilization among Nigerian Women. International Journal of Maternal and Child Health and AIDS;8(1):11-18. Osamor PE, & Grady C (2016) Women's autonomy in health care decision-making in developing countries: a synthesis of the literature. International, Journal for Women’s Health. 8:191-202. Singh K, Bloom S, Brodish P. (2015) Gender equality as a means to improve maternal and child health in Africa. Health Care for Women International. 36(1):57-69. Titaley, C. R., Hunter, C. L., Dibley, M. J., & Heywood, P. (2010). Why do some women still prefer traditional birth attendants and home delivery? A qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy and Childbirth, 10, 43. Walker T, Woldegiorgis M, Bhowmik J. (2021) Utilisation of skilled birth attendant in low- and middle-income countries: trajectories and key sociodemographic factors. International Journal of Environmental Research and Public Health;18(20):12. Woldemicael, G. (2010). Do women with higher autonomy seek more maternal and child health care? Evidence from Eritrea and Ethiopia. Health Care for Women International, 31(7), 599–620. World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization.

Influence of Women's Decision-Making Autonomy on Maternal Healthcare Utilisation Among Married Women in Rivers State, Nigeria

Abstract

Keywords

References

More Articles from INTERNATIONAL JOURNAL OF HEALTH AND PHARMACEUTICAL RESEARCH