Do women’s participation in public life, alongside other empowerment dimensions, associate with healthcare access and food security in sub-Saharan Africa? Evidence from the 2023 Afrobarometer survey

Abstract

Women’s empowerment influences health, nutrition, and well-being through economic autonomy, decision-making, participation in public life, digital access, and attitudes toward gender-based violence. In sub-Saharan Africa (SSA), women face high food insecurity and healthcare barriers, particularly in rural, poor, and undereducated populations. This study examines how different dimensions of women’s empowerment influence food insecurity and barriers to healthcare access across 34 Sub-Saharan African countries. We performed a secondary analysis of data collected from women in 34 SSA countries using the 2023 Afrobarometer Survey, a cross-sectional study. Dependent variables were household food insecurity and barriers to healthcare access. Independent variables included women’s participation in public life, decision-making power, economic empowerment, digital engagement, and attitudes toward gender-based violence, alongside socio-demographic factors. Logistic regressions were used to identify factors associated with the dependent variables/outcomes p ≤ 0.05. Factor analysis and Cronbach’s alpha were used to evaluate the reliability and validity of participation in public life. Analyses were conducted in SPSS v25 using anonymized, publicly available data. In total, data from 23,726 rural (12,915) and urban (10,811) women were analyzed. We showed that rural women had higher rates of food insecurity (66.2%) and healthcare access barriers (71.3%) than urban women, who had better education, employment, and asset ownership. Urban women had higher economic empowerment, decision-making power, and digital engagement, while rural women reported greater participation in public life. Adjusted logistic models revealed that in both rural and urban areas, low participation in public life was associated with lower chances of experiencing food insecurity (rural OR = 0.44, 95% CI: 0.30–0.67; urban OR = 0.67, 95% CI: 0.46–0.98) and fewer healthcare barriers (rural OR = 0.57, 95% CI: 0.38–0.86; urban OR = 0.61, 95% CI: 0.41–0.90). In contrast, women with digital access/social media use (rural OR = 2.22, 95% CI: 1.97–2.50; urban OR = 1.73, 95% CI: 1.57–1.91) faced higher likelihoods of food insecurity. Women justifying gender-based violence were also more vulnerable to both food insecurity (rural OR = 1.35, 95% CI: 1.18–1.56; urban OR = 1.62, 95% CI: 1.38–1.91) and healthcare access barriers (rural OR = 1.22, 95% CI: 1.05–1.40; urban OR = 1.56, 95% CI: 1.32–1.84). Economic autonomy, digital engagement, and rejection of gender-based violence were associated with better food security and fewer healthcare access barriers, while participation in public life highlighted gaps in institutional support. Rural–urban disparities persisted, highlighting the role of socioeconomic inequalities. Policies should prioritize economic inclusion, digital access, and gender-equitable norms alongside effective services.