title: Women's empowerment and male involvement in antenatal care: analyses of Demographic and Health Surveys (DHS) in selected African countries.
abstract: BACKGROUND
  Increasing women's status and male involvement are important strategies in reducing preventable maternal morbidity and mortality. While efforts to both empower women and engage men in maternal health care-seeking can work synergistically, in practice they may result in opposing processes and outcomes. This study examines whether a woman's empowerment status, in sum and across economic, socio-familial, and legal dimensions, is associated with male partner accompaniment to antenatal care (ANC).
  
  
  METHODS
  Women's empowerment was measured based on the sum of nine empowerment items in the 2010-2011 Demographic and Health Surveys in eight sub-Saharan African countries: Burkina Faso (n = 2,490), Burundi (n = 1,042), Malawi (n = 1,353), Mozambique (n = 414), Rwanda (n = 1,211), Senegal (n = 505), Uganda (n = 428) and Zimbabwe (n = 459). In cross-sectional analyses, bivariate and multivariable logistic regressions models were used to examine the odds of male partner accompaniment to ANC between women with above-average versus below-average composite and dimensional empowerment scores.
  
  
  RESULTS
  In the majority of countries, male accompaniment to ANC was not uncommon. However, findings were mixed. Positive associations in women's composite empowerment and male involvement were observed in Burkina Faso (OR = 1.27, 95% CI: 1.08, 1.50) and Uganda (OR = 1.53, 95% CI: 1.00-2.35), and in the economic empowerment dimension in Burkina Faso (OR = 1.24, 95% CI: 1.05-1.47). In Malawi, significant negative associations were observed in the odds of male accompaniment to ANC and women's composite (OR = 0.77, 95% CI: 0.62-0.97) and economic empowerment scores (OR = 0.75, 95% CI: 0.59-0.94). No significant differences were observed in Burundi, Mozambique, Rwanda, Senegal, or Zimbabwe.
  
  
  CONCLUSIONS
  Women's empowerment can be positively or negatively associated with male antenatal accompaniment. Male involvement efforts may benefit from empowerment initiatives that promote women's participation in social and economic spheres, provided that antenatal participation does not undermine women's preferences or autonomy. The observation of mixed and null findings suggests that additional qualitative and longitudinal research may enhance understanding of women's empowerment in sub-Saharan African settings.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe St,, E5038, Baltimore, MD 21205, USA. ljennin6@jhu.edu.
authors.forename: Larissa
authors.initials: L
authors.lastname: Jennings
authors.forename: Muzi
authors.initials: M
authors.lastname: Na
authors.forename: Megan
authors.initials: M
authors.lastname: Cherewick
authors.forename: Michelle
authors.initials: M
authors.lastname: Hindin
authors.forename: Britta
authors.initials: B
authors.lastname: Mullany
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D003710:Demography; D003906:Developing Countries; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007182:Income; D008297:Male; D011209:Power, Psychological; D011295:Prenatal Care; D018454:Spouses / Q000523:psychology*; D014930:Women / Q000523:psychology*