Influence of Women's Decision-Making Autonomy on Maternal Healthcare Utilisation Among Married Women in Rivers State, Nigeria

Despite high antenatal care (ANC) attendance in Rivers State, skilled birth attendance (SBA) remains low, with women's decision-making autonomy posited as a key determinant. This study examined the influence of women's decision-making autonomy on maternal healthcare utilisation. A cross-sectional study was conducted among 600 randomly selected married women who delivered at least one year preceding the survey using a semi-structured questionnaire. Descriptive, Bivariate and multivariate logistic regression analysis was carried out to identify the influence of women's decision-making autonomy on maternal healthcare utilisation. The findings revealed that women's decision-making autonomy significantly influenced maternal healthcare utilization, but autonomy was low. The deficit was most severe for place of delivery, the most male-controlled domain (38.0% husband-alone against 24.0% self-alone), indicating husband dominated decision making on place of delivery. The effect of autonomy was continuum-specific. For antenatal care [ANC] ≥4 visits, autonomy was not an independent driver after Adjustment (aOR=1.82, 0.88-3.78, p=0.106). For skilled birth attendance [SBA], self-led autonomy remained significant [aOR=1.94, 1.15-3.28, p=0.003] - women who decided alone were twice as likely to have skilled delivery against husband-alone - alongside tertiary education [aOR=2.74, 1.55-4.83] and high income [aOR=2.01, 1.16- 3.47]. Joint decision was not significant [aOR=1.31, 0.81-2.10]. For postnatal care (PNC), neither autonomy [aOR=1.31, 0.81-2.10] nor education was significant, reflecting generally low PNC across all strata. This study demonstrates that women's decision-making autonomy emerged as a critical yet continuum-dependent determinant of maternal healthcare utilization in Rivers State. Programs that enhance women’s autonomy in household decision-making, particularly in health-related matters should be implemented.