Women’s decision making autonomy on maternal and neonatal health care utilization and associated factors in central Ethiopia: a community based cross-sectional study

Women’s decision-making autonomy is an important driver of maternal and neonatal healthcare utilization. However, in developing countries, women have limited autonomy over decisions related to their own and their newborns’ health. Limited autonomy hinders the utilization of maternal healthcare services and contributes to maternal-neonatal morbidity. This study assessed the levels and factors associated with women’s decision-making autonomy regarding maternal and neonatal healthcare service utilization in central Ethiopia. A cross-sectional study was conducted in Guraghe zone, central Ethiopia, from March 15, 2023, to April 15, 2023. A simple random sampling technique was used to select 466 study participants. The data were gathered through structured pretested interviews with mothers. The data were entered into EpiData 3.1 and exported to the Statistical Package for the Social Sciences version 27.0 for analysis. Bivariate and multivariable logistic regression analyses were used to assess factors related to women’s decision-making autonomy. A p-value < 0.05 with a 95% confidence level was used to establish statistical significance in multivariable analysis. The overall women’s decision-making autonomy was found to be 71.5% (95% CI, 67.0% − 76.0%). Age ≥ 35 years [AOR = 4.24 (1.85, 9.71)] and between 24 and 35 years [AOR = 2.78 (1.31, 5.91)], husband primary educated [AOR = 2.56 (1.33, 4.94)] and secondary and above educated [AOR = 3.66 (1.79, 7.47)], higher wealth index [AOR = 0.47 (0.24, 0.91)] and medium wealth index [AOR = 0.38 (0.19,0.76)], husband involvement [AOR = 6.19 (3.56, 10.74)], Women’s knowledge of neonatal danger signs [AOR = 2.07 (1.22, 3.49)], Women who were knowledgeable [AOR = 2.726 (1.33,5.56)] and moderately knowledgeable about maternal healthcare services [AOR = 2.81 (1.32,5.97)] were identified as significant factors. Although all women have the right to participate in decisions regarding their own and neonatal healthcare, more than one-quarter (28.5%) had no role. These findings highlight the need to strengthen health education to improve women’s knowledge on neonatal danger signs and maternal healthcare services, which is essential to empower women to participate in decisions about their healthcare. Lastly, encouraging husbands’ education and involvement in maternal and neonatal healthcare services will enhance women’s decision-making autonomy.