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

Distribution in outpatient service utilization by health insurance benefit design.

<p>Note: Bold CI indicate significant difference from zero at 10%.</p

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

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

Unadjusted associations between health care utilization and health insurance benefit design.

1<p>0.092 can be interpreted as there were 9.2 village-level outpatien visits per 100 respondents in last month.</p

Distribution in inpatient service utilization by health insurance benefit design.

<p>Note: Bold CI indicate significant difference from zero at 10%.</p

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