Women empowerment and skilled birth attendance in sub-Saharan Africa: A multicountry analysis

Kwamena Sekyi DICKSON*, Kenneth Setorwu ADDE, Edward Kwabena AMEYAW

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

14 Citations (Scopus)


In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women's functionality and healthcare utilisation including use of SBAs' services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA.

Materials and methods:
This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs).

The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51-0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88-0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03-2.22), or higher education (OR = 4.40, 95% CI = 3.81-5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29-3.73) had higher likelihood of skilled birth attendance.

These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

Original languageEnglish
Article numbere0254281
Number of pages11
JournalPLoS ONE
Issue number7
Publication statusPublished - 7 Jul 2021
Externally publishedYes

Bibliographical note

We appreciate the Measure DHS for granting us data for this study.

Publisher Copyright:
Copyright © 2021 Dickson et al.


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