Peer-reviewed article
Leveraging women empowerment for better maternal health: using the SWPER index to identify key drivers of quality antenatal care in Southern Africa
Munawar Harun Koray, Evelina Ndapewa Johannes, Emmanuel Kwasi Afriyie, Alfred Pie Faabie ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study used Demographic and Health Survey data from 2015 to 2023 for 36,671 women in seven Southern African countries. It examined whether women's empowerment, measured with the SWPER Global Index, is linked to receiving quality antenatal care. Quality care meant receiving four services: blood pressure measurement, urine testing, blood testing and iron supplementation. Women with higher social independence and stronger rejection of gender-based violence were somewhat more likely to receive quality care. Quality care varied widely between countries.
Key points
- 45.1% of women received quality antenatal care overall.
- Coverage ranged from 27.4% in Malawi to 92.1% in South Africa.
- High social independence was linked to higher odds of quality care (aOR = 1.12, 95% CI: 1.01–1.24).
- Strong rejection of gender-based violence was linked to higher odds of quality care (aOR = 1.15, 95% CI: 1.05–1.26).
- Early ANC initiation, 8 or more visits and doctor-led care were the strongest predictors of quality care.
Limitations
The cross-sectional design shows associations, not cause and effect. The abstract does not measure child outcomes, and it names only two of the seven countries. The abstract also does not describe the full set of country-level findings.
Abstract
Background Quality antenatal care (ANC) is essential for reducing maternal and neonatal mortality; however, access remains inequitable in Southern Africa. Women's empowerment is increasingly recognized as a key determinant of health-seeking behavior; however, its role in shaping ANC quality has not been adequately examined in the region. Methods This study used cross-sectional Demographic and Health Survey (DHS) data from 2015 to 2023 across seven Southern African countries ( n = 36,671). Women's empowerment was measured using the SWPER Global Index, which covers the domains of attitude toward violence, social independence, and decision-making. Quality ANC was defined as the receipt of four essential services: blood pressure measurement, urine testing, blood testing, and iron supplementation. Hierarchical models were fitted, and the measures of variation and model fit were evaluated. The significance level was set at p < 0.05, with a 95% confidence interval. Results Overall, 45.1% of the women received quality ANC, with wide variation between countries (27.4% in Malawi vs. 92.1% in South Africa). A high level of empowerment against violence and decision-making was observed among the women in most of the countries. Women with high social independence (aOR = 1.12, 95% CI: 1.01–1.24) and strong rejection of gender-based violence (aOR = 1.15, 95% CI: 1.05–1.26) were significantly more likely to receive high-quality ANC. Early ANC initiation, ≥8 visits, and doctor-led care were the most powerful predictors of quality ANC care. Conclusion Women's empowerment, particularly social independence and autonomy from violence, plays a critical role in improving the quality of ANC in Southern Africa. However, persistent socioeconomic and geographic inequities highlight the need for context-specific strategies. Policies that integrate gender equality frameworks with strengthened ANC service delivery, especially in rural and low-performing countries, are essential for achieving maternal health targets.