Descriptive statistics by type of facility.

<p>¹ 43 people did not report their age.</p><p>² 164 people did not know the distance</p><p>³ P-Values calculated using chi-squared test for categorical variables and Student’s t-test for continuous variable age.</p><p>Descriptive statistics by type of facility.</p

Sources of prior care and sources of referrals.

<p>¹ HEW: Health extension worker</p><p>² PHCU: Primary health care unit</p><p>³ Other includes follow up, non-governmental organizations, Emmanuel Mental Health hospital, care abroad, and traditional medicine.</p><p>⁴ N = 13 people seeking care at a hospital had sought care at more than 1 prior facility, and N = 3 people seeking care at a health center had sought care at more than 1 prior facility.</p><p>Sources of prior care and sources of referrals.</p

Factors associated with being referred from prior source of care.

<p>CI: Confidence interval</p><p>*P-Value < 0.05</p><p>Factors associated with being referred from prior source of care.</p

Categorization of Chief Complaint.

<p>Categorization of Chief Complaint.</p

Qualitative interview discussion guide.

<p>Qualitative interview discussion guide.</p

Quotations illustrating demotivating factors.

<p>Quotations illustrating demotivating factors.</p

Quotations illustrating motivating factors.

<p>Quotations illustrating motivating factors.</p

Healthcare utilization and empowerment among women in Liberia

Background: Many efforts have been undertaken to improve access to healthcare services in low-income settings; nevertheless, underutilization persists. Women’s lack of empowerment may be a central reason for underutilization, but empirical literature establishing this relationship is sparse. Methods: We conducted a cross-sectional study using data from the 2007 Liberia Demographic and Health Survey. Our sample included all non-pregnant women who were currently married or living with a partner (N=3,925 unweighted). We used multivariate logistic regression to assess the associations between constructs derived from the Theory of Gender and Power (TGP) and healthcare utilization. Results: Two-thirds of women (65.6%) had been to a healthcare facility for herself or her children in the past 12 months. Constructs from the three major theoretical structures were associated with healthcare utilization. Women with no education, compared with women with some education, were less likely to have been to a healthcare facility (OR=0.77; 95%CI=0.64, 0.94) as were women who had experienced sexual abuse (OR=0.63, 95%CI=0.42, 0.93) and women who were married (OR=0.69, 95%CI=0.54, 0.88). Women in higher wealth quintiles, compared with women in the next lower wealth quintile, and women with more decision-making power had greater odds of having been to a healthcare facility (OR=1.22; 95%CI=1.09, 1.36 and OR=1.46; 95%CI=1.03, 2.08; respectively). Conclusions: Strong associations exist between healthcare utilization and empowerment among women in Liberia, and gender imbalances are prevalent. This fundamental issue likely needs to be addressed before large-scale improvement in health service utilization can be expected

Adjusted associations between health insurance benefit design (comparing having both inpatient and outpatient coverage to having only inpatient coverage) and health care utilization.

<p>Note: Covariates in all models include gender, age, education level, employment status, household size, household wealth, self-assessed health, distance from home to health facilities, and county variables.</p

Characteristics of surveyed population (N = 9,762).

<p>Characteristics of surveyed population (N = 9,762).</p