Association between women's household decision-making autonomy and health insurance enrollment in sub-saharan Africa

Betregiorgis Zegeye; Dina Idriss-Wheeler; Bright Opoku Ahinkorah; Edward Kwabena Ameyaw; Abdul-Aziz Seidu; Nicholas Kofi Adjei; Sanni Yaya

doi:10.1186/s12889-023-15434-z

Association between women's household decision-making autonomy and health insurance enrollment in sub-saharan Africa

BMC Public Health. 2023 Mar 30;23(1):610. doi: 10.1186/s12889-023-15434-z.

Authors

Betregiorgis Zegeye¹, Dina Idriss-Wheeler², Bright Opoku Ahinkorah³, Edward Kwabena Ameyaw⁴, Abdul-Aziz Seidu^{5

6}, Nicholas Kofi Adjei⁷, Sanni Yaya^{8

9}

Affiliations

¹ HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia.
² Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.
³ School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia.
⁴ Lingnan University Graduate School, Tuen Mun, Hong Kong.
⁵ Centre for Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.
⁶ College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD4811, Townsville, Queensland, Australia.
⁷ Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
⁸ School of International Development and Global Studies, University of Ottawa, 120 University Private, K1N 6N5, Ottawa, ON, Canada. sanni.yaya@uOttawa.ca.
⁹ The George Institute for Global Health, Imperial College London, London, UK. sanni.yaya@uOttawa.ca.

Abstract

Background: Out of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women's decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women's decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women's household decision making autonomy and health insurance enrollment in SSA.

Methods: Demographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women's household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI).

Results: The overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03-1.72) compared to women who had no household decision-making autonomy. Other covariates such as women's age, women's educational level, husband's educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women.

Conclusion: Health insurance coverage is commonly low among married women in SSA. Women's household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA.

Keywords: DHS; Global health; Health insurance; Sub-saharan Africa; Universal health coverage; Women’s decision-making autonomy.

MeSH terms

Family Characteristics*
Female
Ghana
Health Surveys
Humans
Insurance, Health
Marriage*
Social Class