Investigating pathways linking women's status and empowerment to the use of skilled birth attendant at childbirth in Tanzania: Structural Equation Modeling approaches

Objective. Skilled birth attendance and women’s empowerment are considered to be critical factors in reducing maternal mortality in sub-Saharan Africa. Yet few studies have assessed the complex pathways linking women’s status and empowerment to Skilled Birth Attendant (SBA) use. This study examines these pathways and linkages using SEM.

Data and Methods. Data from married women participating in the 2010 Tanzania Demographic and Health Survey (weighted n=4,445) were analyzed. An SEM tested four equations simultaneously, using probit regression with the weighted least squares estimator. The analysis controlled for sociodemographic characteristics and perceived difficulties in accessing health care, and the path coefficients were standardized.

Results. Women with more education (standardized b=0.095, p<0.001) and higher decision-making power (b=0.067, p<0.01) are more likely to use SBA. However, the age at first marriage (b=0.005, p=0.84) and progressive perceptions of gender norms (b=0.020, p=0.36) are not significant predictors. The relationship between women’s education status and SBA use is significantly mediated by age at first marriage, power, and gender norms in the partially adjusted model (p<0.001). In the fully adjusted model, only the mediation effect of power remains significant (b=0.006, p<0.05), yet the other mediation effects have become not significant.

Conclusion. There is evidence that high women’s status positively affects empowerment, especially decision-making power, which in turn positively affects SBA use. Most of the sociodemographic characteristics are shown to be significant predictors for women’s power and SBA use. In an effort to accelerate maternal health and empowerment, it is essential to address women’s decision-making power and underlying sociodemographic status.