WOMEN’S AUTONOMY ON MATERNAL HEALTH SERVICES UTILIZATION AND ASSOCIATED FACTORS AMONG REPRODUCTIVE AGE GROUP WOMEN IN CENTRAL TIGRAY, ETHIOPIA, 2025, A CROSS-SECTIONAL STUDY.

Abstract

Background: The ability of a woman to make decisions pertaining to herself and the closest members of her family are all considered aspects of women's autonomy. Many studies revealed women’s decision-making autonomy of maternal services utilization is low in many parts of the world, particularly in developing countries. The absence of previously studied research and the presence of a protracted and complex crisis in the Tigray region create a need to assess women's autonomy in maternal health service utilization and associated factors among the reproductive age group in Ethiopia. Objective: To assess women's autonomy on maternal health service utilization and associated factors among reproductive-age group women in the Central Zone, Tigray, Ethiopia, 2025. Methodology: A community-based cross-sectional study design was carried out from January to April 2025. Multi-stage sampling technique was used, and design effect was considered. The total sample size was 836, which was proportionally allocated for each randomly selected 21 kebeles of 07 woredas in the central zone of Tigray and the study participants were chosen using a systematic random sampling technique. Data were collected using Kobo Toolbox and analyzed using SPSS version 26. A pretest was done on 5% of the sample size. In the Bivariate analysis, variables with p-value < 0.25 were a candidate for the multivariable logistic regression analysis and statistical significance was declared at a p-value of <0.05. Results: Women who had autonomy in deciding whether to utilize maternal health services was 70.3% [95% CI: 67.2-73.4]. women who attend secondary education or above (AOR=18.9, 95% CI: 8.8-40.9) over no formal education, increased household annual capital by 1000 Ethiopian birrs (AOR=1.02, 95% CI: 1.01-1.03), women who get married by their choice (AOR = 6.6, 95% CI: 3.5-12.7) over their counter parts were positively associated with women’s autonomy. Conversely, increased age difference between spouses by 01 year (AOR=0.7, 95% CI: 0.6-0.8), increased women’s family size by one family member (AOR=0.4, 95% CI: 0.34-0.52) were negatively associated with women’s autonomy. Conclusion and recommendation: Women’s ability to utilize maternal health care services depends on women’s autonomy in making decisions for their health care. Accordingly, this study shows three-fourths (70.3%) of the participants were autonomous in deciding whether to use maternal health services or not. Factors significantly related to women’s autonomy in maternal health services utilization were women’s educational status, women’s annual capital, how they got married (willingness/choice), age difference between spouse, family size, and type of family. A great emphasis should be given to empowering women in terms of education, job opportunities, protecting their rights and choices during marriage, and the use of contraceptive methods to limit their family size and burden.