Women's decision-making autonomy in the household and the use of maternal health services: An Indonesian case study

Objectives: The study aimed to examine the influence of Indonesian women's decision-making within the household regarding the use of maternal health services. It explored whether women who had high involvement in household decision-making experienced a higher likelihood of using antenatal care services, delivery services assisted by skilled birth attendance, and facility-based delivery compared to those with limited autonomy. Methods: The study used the individual subset data on women from the 2017 Indonesia Demographic and Health Survey, which included 3435 women of reproductive age (15-49 years) who had given birth within one year preceding the survey. The study also used the Women's Participation Index to measure women's decision-making autonomy in the household. Descriptive statistics and multiple logistic regression analyses were conducted to identify the association of women's autonomy with the use of three key maternal health services. Results: The Women's Participation Index had a significant positive relationship to adequate antenatal care service use, but no effect on the use of skilled birth attendance and facility-based delivery, after adjusting for maternal and sociodemographic variables. Women with more autonomy experienced 1.7 (95% confidence interval: 1.17-2.45) times higher odds of using adequate antenatal care services. In addition, the likelihood of the utilization of adequate antenatal care services, skilled birth attendance, and facility based delivery was higher among women who were age >= 35 years at birth, attained a higher education level, and were in the richest quintile compared to their respective counterparts. Conclusion: Women's decision-making autonomy had a significant effect on the use of adequate antenatal care services only. Initiatives that are more gender-sensitive to promote husband involvement should be conducted to increase men's awareness of the importance of maternal health services. (c) 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)