Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa
Zegeye, Betregiorgis, Idriss-Wheeler, Dina, Ahinkorah, Bright Opoku, Ameyaw, Edward Kwabena, Seidu, Abdul-Aziz, Adjei, Nicholas Kofi, and Yaya, Sanni (2023) Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa. BMC Public Health, 23. 610.
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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.
| Item ID: | 78280 |
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| Item Type: | Article (Research - C1) |
| ISSN: | 1471-2458 |
| Keywords: | DHS, Global health, Health insurance, Sub-saharan Africa, Universal health coverage, Women’s decision-making autonomy |
| Copyright Information: | © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
| Date Deposited: | 08 Aug 2023 00:21 |
| FoR Codes: | 42 HEALTH SCIENCES > 4206 Public health > 420606 Social determinants of health @ 100% |
| SEO Codes: | 20 HEALTH > 2004 Public health (excl. specific population health) > 200401 Behaviour and health @ 100% |
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