Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa
Abstract Background Out of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women’s decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women’s...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-15434-z |
| _version_ | 1827974305567211520 |
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| author | Betregiorgis Zegeye Dina Idriss-Wheeler Bright Opoku Ahinkorah Edward Kwabena Ameyaw Abdul-Aziz Seidu Nicholas Kofi Adjei Sanni Yaya |
| author_facet | Betregiorgis Zegeye Dina Idriss-Wheeler Bright Opoku Ahinkorah Edward Kwabena Ameyaw Abdul-Aziz Seidu Nicholas Kofi Adjei Sanni Yaya |
| author_sort | Betregiorgis Zegeye |
| collection | DOAJ |
| description | Abstract Background Out of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women’s decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women’s decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women’s household decision making autonomy and health insurance enrollment in SSA. Methods Demographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women’s household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI). Results The overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03–1.72) compared to women who had no household decision-making autonomy. Other covariates such as women’s age, women’s educational level, husband’s educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women. Conclusion Health insurance coverage is commonly low among married women in SSA. Women’s household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA. |
| first_indexed | 2024-04-09T19:52:11Z |
| format | Article |
| id | doaj.art-a14ff3601bcb439aa89597aef93c832b |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-09T19:52:11Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-a14ff3601bcb439aa89597aef93c832b2023-04-03T05:43:30ZengBMCBMC Public Health1471-24582023-03-0123111210.1186/s12889-023-15434-zAssociation between women’s household decision-making autonomy and health insurance enrollment in sub-saharan AfricaBetregiorgis Zegeye0Dina Idriss-Wheeler1Bright Opoku Ahinkorah2Edward Kwabena Ameyaw3Abdul-Aziz Seidu4Nicholas Kofi Adjei5Sanni Yaya6HaSET Maternal and Child Health Research Program, Shewarobit Field OfficeInterdisciplinary School of Health Sciences, University of OttawaSchool of Public Health, Faculty of Health, University of Technology SydneyLingnan University Graduate SchoolCentre for Gender and Advocacy, Takoradi Technical UniversityDepartment of Public Health, Policy and Systems, University of LiverpoolSchool of International Development and Global Studies, University of OttawaAbstract Background Out of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women’s decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women’s decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women’s household decision making autonomy and health insurance enrollment in SSA. Methods Demographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women’s household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI). Results The overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03–1.72) compared to women who had no household decision-making autonomy. Other covariates such as women’s age, women’s educational level, husband’s educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women. Conclusion Health insurance coverage is commonly low among married women in SSA. Women’s household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA.https://doi.org/10.1186/s12889-023-15434-zWomen’s decision-making autonomyHealth insuranceUniversal health coverageDHSSub-saharan AfricaGlobal health |
| spellingShingle | Betregiorgis Zegeye Dina Idriss-Wheeler Bright Opoku Ahinkorah Edward Kwabena Ameyaw Abdul-Aziz Seidu Nicholas Kofi Adjei Sanni Yaya Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa BMC Public Health Women’s decision-making autonomy Health insurance Universal health coverage DHS Sub-saharan Africa Global health |
| title | Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa |
| title_full | Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa |
| title_fullStr | Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa |
| title_full_unstemmed | Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa |
| title_short | Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa |
| title_sort | association between women s household decision making autonomy and health insurance enrollment in sub saharan africa |
| topic | Women’s decision-making autonomy Health insurance Universal health coverage DHS Sub-saharan Africa Global health |
| url | https://doi.org/10.1186/s12889-023-15434-z |
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