Women’s Decision-Making Autonomy In Maternal Health Service Utilization And Associated Factors Among Reproductive Age Women In Southern, Ethiopia

doi:10.21203/rs.3.rs-521248/v2

Background: Women autonomy is the ability of women to make self-regulating decisions to meet their requirements without any one initiation. Women who can autonomously decide about their health utilized maternal health care is poor, even though a lot of effort has been made. Only less than 32% of developing countries, women have decision making power to visit maternal health service.

Objective: To assess the women’s decision making autonomy in their maternal health service utilization and its associated factors among reproductive age group women in southern Ethiopia, from March1, 2019 to March 30, 2019.

Methods and material: A cross-sectional study design was conducted. Data were analysed using descriptive statistical tests and binary logistic regression was used. All independent variables with p- value of < 0.25 at bivariate analysis were included in multivariate models to determine the predictors of the outcome variable, and to control the confounding factors. For all statistical tests, a P value of <0.05 was a cut off point for statistical significant.

Results: Prevalence of women decision making autonomy in their maternal health service utilization was 58.2% [(AOR= 58.2% (95 %CI (54.2 – 62.0). Number of family size 2.2 [AOR (95% CI) =2.2, 95% CI (1.3-3.72)], occupation, 4.3 [AOR (95% CI) =4.3 95% CI (1.10-9.3)] economic status, 2.2[AOR (95% CI) =2.2, 95% CI (1.3-.3.72)] respondent age above 35 4.8[AOR(95%CI=4.8,95%CI(2.3-10)] were the factors significantly associated with decision making autonomy.

Conclusion: prevalence of women’s decision making autonomy in their maternal health service utilization was 58.2% which were found to be low. Decision making autonomy was more common with low income, large family size, respondent age and lack women occupation. Improved the women’s decision making by giving Health education on the importance of maternal health services and gender equality recommended to reduce the problem.

Maternal & Fetal Medicine

Sexual & Reproductive Medicine

women

decision making

autonomy

maternal health service utilization

southern Ethiopia.

Women’s autonomy is ability of women’s to make a self-regulating decision to meet requirements without any one initiation (1). Autonomy of deciding for her maternal health service utilization means the capacity of a woman to make self-regulating decisions regarding for her reproductive wants and to look for maternal health services such as antenatal care (ANC), postnatal care (PNC), and service delivery care (SDC) (2).

In particular findings suggest autonomy from no contribution to significantly utilize maternal health service, including antenatal care and institutional delivery (3). Despite various efforts has been made to enhance women autonomy majority of women in Africa has no decision making power to utilized various reproductive, maternal health service during pregnancy and childbirth (4). Illiteracy, wealth index, sociocultural habits religiously and lack of information were attributed to low decision making on health care in women (5). Good maternal and child health outcome observed among individuals who have autonomous decision power as compare to their counterpart (6).

In developing country, women’s Decision making power regarding reproduction and sexuality is extremely restricted and most of the time Decisions on maternal health care are frequently made by partners or other relatives; which affects women’s to visits health facility (7).

In developing country women are Less autonomous to decide to visit a health facility for maternal health service (8). Absence of autonomy in decision making directly results in poor utilization of maternal health service and this situation amends maternal morbidity and mortality through delay (9).

Indonesia Demographic and Health Survey (DHS) showed that 23% of teenage mothers reported their husbands or others made decisions for their health care which affects women to go health facility by them self (10)

Studies indicate that 23% of teenage mother claimed that their husband or other person decide on their health service this pave for three delays that deadly affect maternal wellbeing. In developing country extent of women decision making to seek maternal service ranges from 21.9–31.6% (11). Without increasing autonomy, increasing level of women decision making power archiving sustainable development goal to reduce maternal and child mortality seems impossible (12, 13).

Ethiopian demographic, health survey 2016 shows that only 15.4% of where autonomous in house decision make alone and use health services to meet reproductive health goal, including safe motherhood, women who did not participate in any household decision and those who have not freedom movement were much less likely to receive antenatal care (44%) delivery care (24%) from skilled provider and postnatal cheek up (8%) (14).

The extent of women decision making power to visit to visit maternal health service and its associated factors is not known in the study area therefor we aim to assess women decision making power for maternal health service and to identify it predictors of in southern, Ethiopia .

Study setting and Period

The study was conducted in southern, Ethiopia from March 1, 2019 to March 30; 2019.

Study Design and Population

Community Based Cross Sectional Study was conducted among all reproductive age group of married women in southern, Ethiopia.

Sample Size Determination and Sampling Technique

To determine the sample size for studying factors associated with women’s autonomy of decision making regarding their maternal health service utilization, the formula for a single population proportion was used and the following assumption was made. Significance level of 95% confidence interval and 5% margin of error were taken the study on factors associated with women autonomy of decision making regarding their maternal health service utilization in, Southern Nations, Nationalities and Peoples Republic, Ethiopia. 58.4% of women have autonomy on decision making similar as study conduct in Wolaita and Dawro zones, Southern Ethiopia (5) Let as women autonomy of decision making regarding their maternal health service utilization is the. Prevalence = 58.4%; and use 10% non-response rate.

Sample size was calculated by using the single population proportion formula as follows.

Where, n = desired sample size, p = expected prevalence of women autonomy of decision making 58.4%; z = confidence interval – 95%, d = desired precision- 5 %, n = required sample size, N = final sample size and Design effect 1.5

Data Collection Procedures

A structured interviewer administered questionnaire which was adapted from the EDHS(15), 2016(16) and different literatures(17), (18),(19).Were used to collect data. The questionnaire included all the questions that assess women’s autonomy of decision making on maternal health service utilization. Data was collected by interviewing eligible subjects using a pre-tested structural questionnaire. The tool was prepared in English version and it was translated to Amharic, Amharic again translated back to English language to check consistency.

Data Processing and Analysis

All data were checked for completeness and internal consistency by cross checking and coded and entered onto EPI-DATA version 3.1 and then exported to SPSS 20.0 for analysis. Principal component analysis was conducted to produce wealth Quintiles and reveal the socioeconomic status of the households. Multi co-linearity test was carried out to see the correlation between independent variables using standard error. Model fitness was checked by using Hosmer –Leme show. Descriptive statistics were used to describe the study population in relation to relevant variables. Both bivariable and multivariable logistic regression models were used to identify factors associated with the outcome variable. In order to enter factors in final multivariable model, only variables with p-value ≤ 0.25 during bivariable analyses were entered into the multiple logistic regression models. Odds Ratio along with 95% Confidence Intervals was estimated to measure the strength of the association between dependent and independent variables. Levels of statistical significance were considered at p - value less than 0.05.

Ethical Considerations

The study was conducted after obtaining ethical clearance from Haramaya University College of health and medical sciences institutional health research ethical review committee through ethical letter with protocol number 0576/2019, written on February 20, 2019. The study was also done as per the declaration of Helsinki. All procedure was conducted after completing permission from the postgraduate office of Haramaya University. After permission letter obtained from school of graduate office, letter was submitted to each Zone. An informed, voluntary, written and signed consent was obtained. Participants were informed clearly about the purpose and benefits of the study and written informed consent was obtained from the participants. Those who are signed written consent were only participating in the study and the confidentiality of respondents was maintained throughout the research process by giving code for participant. Personal privacy and cultural norms were respected. The respondents were having the right not to participate in study or withdraw from the study at any time/stage of interview.

Operational Definitions

A Women’s decision making Autonomy in their maternal health service utilization

is dictated as “Yes” on the options women are participating in health service utilization if she have the right to use health care, freedom of movement and if she has right to use household purchases. If a woman decides alone and with their husband jointly they are autonomous if only husband and someone give decision she is not autonomous in decision making(16).

Maternal health services refers a service given by a skilled health professional before pregnancy, during pregnancy and the postpartum period (20).

Antenatal Care

- a care provided by skilled healthcare professionals to women in order to ensure the best health conditions for both mother and baby during pregnancy (20)

Post-natal care

a care service given to the delivered mother by skilled birth attendance after birth (20).

Delivery care service

a care given by skilled health care professionals to women during childbirth (20).

Knowledgeable

- those women who scored at least 84% and above in knowledge questions.

Moderately knowledgeable

- those women who score 50–84% of knowledge questions.

Less knowledgeable

- those women who score less than 50% of knowledge questions (7).

Out of 615 respondents expected to participate in the study 588 respondents were interviewed which makes a response rate of 96%. The mean age of the respondents was 30.23 with SD± 6 years. The majority of respondents 208 (35.4%) were attained secondary education and 552 (93.9%) were in monogamous marriage. Around one-third of 200 (34%) were high percentile group of wealth. Almost half of 248 (44.9%) respondents have family size less than five (Table1).

A majority of 496 (84.4%) the respondents have exposure to media like watching TV and also 92 (15.6%) respondents were listening to the radio. Half of respondents 294 (50%) have poor knowledge on maternal health service utilization and decision making autonomy (Table2).

Almost half (43.4%) has decided by themselves to go health facility and most of respondents have the right to participate in family health care 33 (43.4%) alone and 371 (56.6%) jointly with husband. Besides for these most of women visit to a health facility by themselves 33 (5.6%) jointly with husband 371 (63.1%) the rest 168 (28.6) respondents can’t visit without their husbands permission. Related to place of delivery the majority of respondents 339 (57.7%) can’t decide place of delivery 103 (17.5%) decide jointly with husband. Less than half of 194 (33.0%) only decided by the husband. The majority around 533(90%) of respondents were not have post-natal care (Table3).

The majority of respondents 270 (45.9%) get permeation for spending money. Similarly 72 (12.8%) respondent decided on her earning. Also, only 92 (15.6%) respondents can decide on her husband earning jointly 293 (49.8%) husband alone 197 (46.8%).majority of respondents can’t decide alone for buying medication and Majority of respondents can’t decide alone to go to outside house compound 97 (16.5%) majority of respondents decide jointly 291(49.5%) and only husband 194 ( 33%). Similarly, 128(21.8%) of study participants decide on visiting their family by themselves, whereas 276 (46.9%) made decisions jointly and only husband185 (31.3%) and also majority 259 (44.0%) of respondents decide together to go public places (Table4).

The prevalence of women decision making autonomy is 58.2% [(AOR= 58.2% (95 %CI (54.2 – 62.0) (Figure1).

Age, educational status of respondents, educational status of respondent’s husband, family size, wealth index, respondent occupational status, husband occupational status, media access, marital status, were analyzed in bivariable analysis, age of respondent, educational status of respondents, educational status of respondents husband, family size, wealth index, respondent occupational status, husband occupational status ,distance to health facility, media access, marital status significantly associated with health care decision making autonomy in bivariate analysis (Table5).

In a multivariable analysis age of respondent, wealth index, women’s occupation, family size, women educational status were significantly associated with women decision making autonomy on their maternal health service utilization. Participants who have age category more than 35 years 4.8[AOR(95%CI)= 4.8(2.3-10)] times more likely autonomous in decision making autonomy in maternal health care utilization as compared to less than 25 years. Also women’s in age category of 24-35 years 9.5[AOR (95%CI=9.5(3.10-22.46)] times more likely participate in decision making autonomy than less than 24 years. Participants who have employed 18.5 [AOR (95% CI) =18.5, 95% CI (4.951-69.294)] times more likely participate in decision making autonomy to maternal health care utilization as compared to house wife’s. Those women with one-two family size was 2.2 [AOR (95% CI=2.2 (1.3-3.7)] times more likely have a decision making autonomy on maternal health care utilization than those who have family size more than five children.

The richest women’s was found strong significant associations with women’s decision making autonomy on maternal health service utilization than those who were in reach category women’s have 2.2 [AOR (95% CI) =2.2, 95% CI (1.3-3.72)] times more likely they were autonomous in decision making maternal health service utilization than in the lowest category (Table5).

This study showed that overall prevalence of women decision making autonomy in their maternal health service utilization among reproductive age group women was 58.2 % (95 %) CI= (54.2 – 62.0). The following factors were significantly associated with women decision making autonomy like respondent age, family size, occupation and economic status. The prevalence of women’s decision making autonomy among reproductive age group women in this study was found to be 58.2% this finding was higher than that of a study conducted in Asian country Nepal (27.3%), Bangladesh (45.7%) and India (49%). The presence of low prevalence of women decision making in this area might be due to traditional beliefs’ and tribes most of decision made by male partners and family members. Related to African studies, this study was lower than study done in Nigeria 62% (21) and in Wolaita and Dawro 58.4% (22) and in Mizan Aman (67.2%) (23). This discrepancy could be due to the difference in the sample size. In this study Participants who with age group of above 35 years were more autonomous in decision making than less than 24 years and women’s with age group of 25-34 years were more autonomous in decision making than less than 24 years. Another study done in out of our country in Nigeria shows women’s above 35 years has 1.82 times more autonomous in decision making than younger women’s (24). This study also indicates that family size associated with women’s decision making autonomy as family size increases, the probability of the woman participating in health care decision making decreases. In this study, women with a family size of more than five have a 1.5 times more likely chance of participating in health care decision making as compared to women with a family size of less than five persons(24).

Those participants who had a higher wealth index household were 2.2 times more likely autonomous in decision making maternal health service utilization than their counterparts. This report agrees with research conducted in eastern Ethiopia shows that women In higher wealth index 3.5 times more likely autonomous in decision making than lower (17). This study also showed that employment status has a significant association with a women’s decision making autonomy in their maternal health service utilization women in employing women 4.3 times more likely autonomous in decision making than house wife’s this is in lined with a study done in eastern Ethiopia which identify employed women’s 4.10 times more likely to have decision making autonomy in their maternal health service utilization (25).

This study shows that the prevalence of women’s decision making autonomy in maternal health services was poor. Age, woman’s occupation, family size, wealth index was significantly associated with women’s decision making autonomy in maternal health services utilization. Every woman has the right to participate in decisions making about her own health care. More than half participants have no role in making health care decisions. Husbands/partners play a major role in making health care decisions about their wife’s. The majority of women with the highest health care decision making autonomy in southern Ethiopia also have significantly higher odds of having high wealth index, high age, small family size, women and employment. Even if a household has adequate resources, a woman’s limited participation in household decision making leads to low uptake of maternal health services. This study concludes that a woman’s health care decision making autonomy is broadly influenced by participant’s age, household economy, family size, and occupation.

ANC: antenatal care AOR: Adjusted odds ratio CDC: communicable disease controls CI: Confidence Interval COR: Crude odds ratio EDHS: Ethiopian Demographic Health Survey MDG: Millennium Development Goal MHS: Maternal Health Service PNC: postnatal care SD: standard deviation SDC: service delivery care USAID: United States Agency for International Development WHO: world health organizations.

Ethics Approval and Consent to Participate

The study was conducted after obtaining ethical clearance from Haramaya University College of health and medical sciences institutional health research ethical review committee through ethical letter with protocol number 05231/20219, written on January 29, 20219. The study was also done as per the declaration of Helsinki. Letters of permission and support were provided to the respective Region and Zones from Haramaya University. The Letter was provided to each region and Zone administrative body to get their informed consent for data collection before starting to collect data. Prior to administering the questionnaires, the objectives of the study were clearly explained, informed, voluntary written and signed consent were obtained. Confidentiality was ensured. To keep the anonymity of study participants, code numbers rather than personal identifiers were used.

Consent for Publication

This part is not applicable because the manuscript contains no any individual person’s data in any form (including individual details, images or videos).

Authors’ contributions

KE: involved in designing of the study, data collection, data analysis, drafting and critically reviewing the manuscript. BG, AA, TL, & TD: Originating research concept, involved in designing of the study, analysis of the data and critically reviewing the manuscript. All authors read and approved the final manuscript.

Availability of data and materials

The data sets used and/or analysed during the current study are available from the Corresponding author upon reasonable request.

Competing of Interests

The authors declared that they have no competing interests.

Funding

Not applicable

Acknowledgements

We would like to express our heartfelt gratitude to all selected study site officials whom we have communicated, and indorsed as to conduct this study. Our special thanks also extended to the study participants, data collectors, supervisors and staffs.

1. Yuji S., Roger Antabe, Kilian Nasung Atuoye, Joseph A. Braimah, Sylvester Z. Galaa, Luginaah I. Married women’s autonomy and post-delivery modern contraceptive use in the Democratic Republic of Congo. jornal of BMC Women's Health 2018;7(18:49).

2. Sadik A. Women Autonomy and the use of Antenatal and Delivery Services in Nigeria. MOJ Public Health. 2017;6(2):00161.

3. GDPC. Assessing the Role of Women’s Autonomy and Acceptability of Intimate Partner Violence on Maternal Health Care Utilization in 63 Low- and Middle-Income Countrie. HCI WORKING PAPER 2018;004.

4. Bhandari T. WOMEN’S AUTONOMY AND UTILIZATION OF MATERNAL HEALTH SERVICES IN KAPILVASTU DISTRICT NEPAL. 2015.

5. Mihiretu A. and Mengistu M. Health care decision making autonomy of women from rural districts of Southern Ethiopia. International Journal of Women’s Health. 2017;9.

6. Yohannes D. Women’s autonomy and reproductive health-care-seeking behavior in Ethiopia,. Women & Health. 2017.

7. Dabere N, Gebremariam A, Abera M, Setegn T, Deribe K. Factors associated with women’s autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study. BMC Women's Health. 2014.

8. Ghose B., Da Feng, Shangfeng Tang, Sanni Yaya, Zhifei He, Ogochukwu Udenigwe, et al. Women’s decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey. BMJ Open. 2017.

9. sadik A. U. Women Autonomy and the Use of Antenatal and Delivery Services in Nigeria. MOJ Public Health. 2017 6(2).

10. Ramesh A. Effect of Women’s autonomy on maternal health service utilization in Nepal. BMC Women's Health. 2016(16):26.

11. Chima.V. Women autonomy and maternal healthcare services utilization among young ever-married women in Nigeria. International Journal of Nursing and Midwifery. 2018;10(6):62-73.

12. USAID. Women’s Empowerment and the Use of Antenatal Care Services in Southeast Asian Countries. DHS WORKING PAPERS. 2017 129.

13. WHO. The Global Strategy for Women’s, Children’s and Adolescents’ Health. 2016.

14. CSA, ICF. Ethiopia Demographic and Health Survey 2016: KeyIndicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA. CSA and ICF. 2016.

15. Lee R, Kumar J, Al-Nimr A. Women’s Healthcare Decision-Making Autonomy by Wealth Quintile from Demographic and Health Surveys (DHS) in Sub-Saharan African Countries. Int J Womens Health Wellness. 2017;3(054):2474-1353.

16. Nkwantabisah EH. A correlational study on the relationship between peer mentoring support and novice nurse intent to stay in the field: Capella University; 2016.

17. Tiruneh FN, Chuang K-Y, Chuang Y-C. Women’s autonomy and maternal healthcare service utilization in Ethiopia. BMC health services research. 2017;17(1):1-12.

18. Deependra K. WOMAN’S AUTONOMY AND HUSBAND’S INVOLVEMENT IN MATERNAL HEALTH CARE UTILIZATION IN NEPAL. 2012.

19. Osamor P, Grady C. Women’s autonomy in health care decision-making in developing countries: a synthesis of the literature. International journal of women's health. 2016;8:191.

20. WHO. Fact sheets on sustainable development goals: health targets. 2018.

21. Umar AS. Does female education explain the disparity in the use of antenatal and natal services in Nigeria? Evidence from demographic and health survey data. African health sciences. 2017;17(2):391-9.

22. Alemayehu M, Meskele M. Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study. International journal of women's health. 2017;9:213.

23. Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet. 2016;388(10053):1459-544.

24. Glover V, O'Donnell KJ, O'Connor TG, Fisher J. Prenatal maternal stress, fetal programming, and mechanisms underlying later psychopathology—a global perspective. Development and psychopathology. 2018;30(3):843-54.

25. Belay AD, Mengesha ZB, Woldegebriel MK, Gelaw YA. Married women’s decision making power on family planning use and associated factors in Mizan-Aman, South Ethiopia: a cross sectional study. BMC women's health. 2016;16(1):1-6.

Table 1 Socio demographic and socio economic factors of women decision making autonomy among women living in southern Ethiopia 2019

Variables Frequency Percentage

Age in years

15-24 246 41.8

25-35 180 30.6

Above 35 162 27.6

Religion

Protestant 207 35.2

Orthodox 195 33.2

Muslim 153 26.0

Catholic 33 5.6

Marital status

Polygamous 36 6.1

Monogamous 552 93.9

Educational status

No education 74 12.6

Primary 208 35.4

Secondary 214 35.4

College and above 92 15.6

Husband educational status

No education 30 5.1

Primary 282 48.1

Secondary 201 34.1

College and above 74 12.6

Number of Family size

1-2 130 23.6

3-5 248 44.9

>5 174 31.5

Women Occupational Status

Government-employee 63 10.7

Merchant 174 29.6

Self-Employee 298 50.7

House-wife 53 9.0

Husband Educational Status

Government-employee 96 16.3

Self-employee 203 34.5

Merchant 227 38.6

Other 62 10.5

Economic Status

Lowest 182 31.0

Medium 205 35.0

Highest 200 34.0

Table 2 Results of Bivariable and multivariate Factor Independently associated with Women’s Decision Making autonomy On Maternal Health Care Service Utilization, Southern Ethiopia, 2019.

Media Access

Watch TV

Yes 496 84.4

No 92 15.6

________________________________________________________________________

Distance to Health Facility

15-30 minutes 250 42.5

30-60 minutes 281 47.8

More than 60 minutes 57 9.7

Knowledge of women

Less knowledgeable 294 50

Moderate knowledgeable 212 36.1

Knowledgeable 82 13.9

Table 3: women decision making autonomy on maternal health service utilization

Do you decide to go to health facility when you want?

No 255 43.4

Yes 333 56.6

Who takes the decision in the family to seek healthcare services, when you want?

Respondent 33 5.6

Respondent and husband 371 63.1

Husband 168 28.6

Who decide when you want to visit maternal health care?

Respondent 79 13.4

Respondent and husband 283 48.1

Husband 152 25.9

Someone 74 12.6

Can you decide place of delivery when you were pregnant

Yes 249 42.3

No 339 57.7

Who decide your place of delivery?

Respondent 103 17.5

Respondent and husband 194 33.0

Husband 223 37.9

Someone 68 11.8

Are you visiting 4 focused ANC check-up when you were pregnant

Yes 377 64.1

No 211 35.9

Who decide when you want for antenatal cheek up?

Respondent 140 23.8

Respondent and husband 237 40.3

Husband 211 35.9

Do you have post natal check-up after delivery?

Yes 55 9.4

No 533 90.6

Who decide to go for post natal cheek up?

Respondent 140 23.8

Respondent and husband 237 40.3

Husband 11 20.0

Table 4 women’s decision making on freedom of movement and house hold purchase

Who decide when you need to go to outside the house/compound?

Respondent 97 16.5

Respondent and husband 291 49.5

Husband 194 33.0

Who decide when you need to go to natal family or relative/s' house

Respondent 128 21.8

Respondent and husband 276 46.9

Husband 185 31.3

Who decide when you need to go to public places/programmes?

Respondent 136 22.6

Respondent and husband 259 44.0

Husband 193 33.3

Who decide when you need to go to marketing/shopping?

Respondent 72 12.2

Respondent and husband 306 52.0

Husband 209 35.5

Do you need permission to spend money for household affairs?

Yes 270 45.9

No 318 54.1

Who decides how the money you earn will be used

Respondent 72 12.8

Respondent and husband 240 40.

Husband 275 46.8

Who usually decides how your husband's/partner's earnings will be us

Respondent 92 15.6

Respondent and husband 293 49.8

Husband 197 46.8

Who usually decide when you want to buy medication for yourself?

Respondent 20 12.8

Respondent and husband 322 54.8

Husband 246 41.5

Table 5 Results of Bivariable and multivariate Factor Independently associated with Women’s Decision Making Autonomy On Maternal Health Care Service Utilization, Southern Ethiopia, 2019 (n=588).

Variables	Categories	Status of decision makers autonomy		COR(95% CI)	AOR(95% CI)
		Autonomous	Not autonomous
Economic status	Low	171	136	1	1
	Medium	63	55	-	-
	High	109	55	1.576(1.06-2.34)	2.202(1.31-3.72)*
Women occupational status	Employed	85	16	4.994(2.792-8.932)	4.3(1.10-9.3)***
	Merchant	108	88	-	-
	House wife and others	150	141	1	1
Media access	Yes	297	217	1.2(0.727-1.982)
Media access	No	46	28	1
Maternal age	15-24	19	33	1	1
	25-34	81	38	-	9.5(3.10-22.46)***
	Above 35	243	175	1.2(0.93-1.5)	4.8(2.3-10)**
Marital status	Monogamous	23	13	0.780(0.387-1.571)
Marital status	Polygamous	320	232	1
Family size	1-2	100	56	1	1
	3-5	160	86	-	-
	More than 5	62	88	0.6(0.94-0.788)	2.2(1.3-3.7)*
Husband occupation	Government employee	63	16	0.7(0.543-0.809)
	Self-employee	110	67	-
	merchant	134	134	-
	Other	30	28	1
Women educational status	No education	8	12	1
	Primary	116	93	-
	secondary	112	117	-
	College and above	62	23	1.09(0.876-1.35)
Husband educational status	No education	19	19	1
	Primary	91	76	-
	secondary	152	123	-
	College and above	81	27	1.4(1.13-1.7)

*= p <=0.05, **= p <= 0.01, ***= p <= 0.001

No competing interests reported.

Women’s Decision-Making Autonomy In Maternal Health Service Utilization And Associated Factors Among Reproductive Age Women In Southern, Ethiopia

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Abstract

Figures

Background

Methods

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Tables

Additional Declarations

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