The Nexus between Women's Decision-Making Autonomy and Antenatal Care Utilization in India: Insights from National Family Health Survey (NFHS)-5

Background: Women's ability to make decisions within households is crucial for better maternal and child health outcomes and for empowering women. This study examines the effect of women's decision-making autonomy on the number of ANC visits during pregnancy among reproductive-aged women aged 15-49 years in India. Methods: This study used data from National Family Health Survey (NFHS)-5 2019-21, a nationally representative survey. Women's decision-making autonomy was measured through women's participation in four key decisions within the households related to their healthcare, household major purchase, visits to family or relatives and use of husband's earnings. Binary logistic regression models were used to assess the effect of women's decision-making autonomy and likelihood of attending at least 4 or more ANC visits. Results: The findings reveal that women with medium and high decision-making autonomy were 1.3 times (AOR= 1.30, p<0.001) and 1.25 times (AOR= 1.25, p<0.001) more likely to attend at least 4 or more ANC visits compared to those with low decision-making autonomy within the households. Other socioeconomic factors, such as women's education, household wealth index, husband's presence during ANC visits, also influence attending adequate ANC visits. Conclusions: This underscores that to improve adequate ANC visits, policy makers should prioritize interventions that enhance women's decision-making autonomy, such as promoting education, financial independence, and gender sensitive healthcare programs.