Association between women’s empowerment dimensions and use of skilled birth attendance in southwest Ethiopia: a community-based cross-sectional study design

Abstract

Skilled birth attendance is a proven intervention for reducing maternal and neonatal mortality; yet, its utilization remains suboptimal in Ethiopia. Women’s empowerment has been recognized as an important factor of maternal health service utilization; however, the specific dimensions of its association with the use of skilled birth attendance in Ethiopia have not been adequately examined. This study aims to address this gap by providing evidence to inform targeted interventions that enhance skilled birth attendance utilisation and ultimately reduce preventable maternal and neonatal deaths. The objective of this research is to assess the association between women’s empowerment dimensions and use of skilled birth attendance. A community-based cross-sectional study design was employed from May 20 to June 30, 2023. A stratified and multistage sampling method was used. A systematic sampling technique was employed to select 592 participants. Data was collected by a pretested interviewer-administered questionnaire. The data were entered into Epidata 4.6 and exported to the Statistical Package for the Social Sciences (SPSS) 26 for analysis. Descriptive analysis and binary logistic regression were done. First bivariate logistic regression was performed to screen candidate variables with P-valeu of < 0.25. Then backward elimination multivariable logistic regression analysis were conducted to identify a statistically significant factor. From a total of 592 respondents, 66.8% (95% CI: 63–71) of participants used skilled birth attendance during their last births. High household decision-making power (AOR = 3.22; 95% CI: 1.99–5.20, attitude towards justifying wife beating [AOR = 0.43; 95% CI: 0.27–0.69, utilizing media [AOR = 2.02; 95% CI: 1.24–3.27, self-efficacy [AOR = 3.20; 95% CI: 2.16, 4.74 and locus of control [AOR = 1.61; 95% CI: 1.31–1.99 showed a significant associations with the use of skilled birth attendance. Locus of control and self-efficacy were analyzed as continuous variables, and their AORs were interpreted per one‑unit increase in their respective mean scores. The sudy shows that the majority of participants reported using skilled birth attendants during their most recent delivery. Women’s empowerment dimensions, including decision‑making power, media exposure, increased self‑efficacy, and locus of control, were positively associated with SBA utilization, while harmful norms such as attitude towards justifying wife beating were negatively associated. These findings demonstrate that distinct empowerment dimensions play a significant role in shaping SBA use in Southwest Ethiopia. Empowering women’s decision‑making power, challenging harmful attitudes that justify wife beating, expanding media‑based health communication, and strengthening women’s self‑efficacy and internal locus of control may improve the use of skilled birth attendance.