The role of women's empowerment in the uptake of maternal health services in low- and middle-income countries: a propensity score-matched analysis.

Background: Women's empowerment directly influences the quality and timeliness of the maternal health care they receive; a lack thereof, particularly in low- and middle-income countries (LMICs), is likely to contribute to poor uptake of maternal healthcare. We aimed to evaluate the role of women's empowerment in maternal healthcare in LMICs. Methods: We used the recent Demographic and Health Survey (DHS) data on 71 077 married/partnered women from 35 LMICs. We categorised women as empowered if they participated in all decision-making activities and were able to disagree that a husband is justified in hitting or beating his wife for any reason. We used logit propensity score matching (PSM) analysis to estimate the effect of women's empowerment on maternal health services. Result: Only one-third (33.8%) of reproductive-age women in LMICs (95% confidence interval = 27.7-40.8) were estimated to be empowered. Women's empowerment was associated with an 11.2 percentage point increase in having adequate antenatal care (ANC) visits (average treatment effects on the treated (ATT) = 0.112, standard error (SE) = 0.026) and an 8.0 percentage point increase in the likelihood of health facility childbirth (ATT = 0.078, SE = 0.039). However, there was insufficient evidence for early postnatal care visits. Conclusions: Empowering women has a positive association with the utilisation of adequate ANC visits and health facility childbirth in LMICs. These findings underscore the necessity for public health programmes to empower women and enhance their decision-making abilities to improve maternal healthcare uptake, such as health facility childbirth and ANC visits.