Women's Empowerment and Maternal Healthcare Service Utilization: A Population-Based Study in the Democratic Republic of the Congo

OBJECTIVES: Many regions in Africa bear high maternal mortality while the maternal healthcare services utilization still remains inadequate. The utilization of high-quality and comprehensive healthcare services is a crucial intervention to reduce maternal mortality rates. However, the disadvantaged position of women in African regions potentially constitutes a barrier to maternal healthcare service use.We aimed to employ a composite indicator to measure women's empowerment and investigate its association with healthcare services utilization throughout the entire continuum of maternal healthcare, particularly within the African context.

METHODS: This study used data from the Multiple Indicator Cluster Surveys 6 (MICS6) conducted in the Democratic Republic of the Congo (DRC). We used the principal component analysis (PCA) to determine the dimensions of women’s empowerment and weighted logistic regressions to examine the association of women's empowerment with the utilization of antenatal care (ANC), intrapartum care (IPC), and postnatal care (PNC).

RESULTS: According to the inclusion criteria for PCA, a total of 12664 women aged 15 and 49, who were either married or currently in a partnership and had previously given birth, without missing items of women’s empowerment, were included in our study. Considering Kaiser’s criterion, the first three factors with eigenvalues ≥ 1 accounted for over 50% of the variance. The first three factors are identified as intrinsic agency, enabling resources, and social independence based on our framework. The regression results demonstrated that women with higher levels of empowerment had increased odds of utilizing healthcare services, with odds ratio values of 1.44 (p=0.001) in ANC, 1.86 (p = 0.001) in IPC, 1.91 (p = 0.000) in PNC for intrinsic agency dimension and 1.31(p=0.079) in IPC for social independence dimension.

CONCLUSIONS: Higher levels of women’s empowerment, especially intrinsic agency, were associated with ANC use in the DRC. Initiatives for women empowerment is crucial for improving the utilization of maternal healthcare services.