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Healthcare utilisation and empowerment among women in Liberia
  1. Heather Sipsma1,
  2. Tamora A Callands2,
  3. Elizabeth Bradley3,
  4. Benjamin Harris4,
  5. Billy Johnson5,
  6. Nathan B Hansen2
  1. 1Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
  2. 2Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA
  4. 4Department of Psychiatry, A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
  5. 5John F. Kennedy Memorial Medical Center, Monrovia, Liberia
  1. Correspondence to Dr Heather Sipsma, Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue (MC 802), Chicago, IL 60612, USA; sipsmah{at}


Background Many efforts have been undertaken to improve access to healthcare services in low-income settings; nevertheless, underutilisation persists. Women's lack of empowerment may be a central reason for underutilisation, but empirical literature establishing this relationship is sparse.

Methods We conducted a cross-sectional study using data from the 2007 Liberia Demographic and Health Survey. Our sample included all non-pregnant women who were currently married or living with a partner (N=3925 unweighted). We used multivariate logistic regression to assess the associations between constructs derived from the Theory of Gender and Power (TGP) and healthcare utilisation.

Results Two-thirds of women (65.6%) had been to a healthcare facility for herself or her children in the past 12 months. Constructs from the three major theoretical structures were associated with healthcare utilisation. Women with no education, compared with women with some education, were less likely to have been to a healthcare facility (OR=0.76; 95% CI 0.62 to 0.93) as were women who had experienced sexual abuse (OR=0.65; 95% CI 0.45 to 0.95) and women who were married (OR=0.69, 95% CI 0.54 to 0.88). Women in higher wealth quintiles, compared with women in the next lower wealth quintile, and women with more decision-making power had greater odds of having been to a healthcare facility (OR=1.22; 95% CI 1.10 to 1.36 and OR=1.10; 95% CI 1.01 to 1.20; respectively).

Conclusions Strong associations exist between healthcare utilisation and empowerment among women in Liberia, and gender imbalances are prevalent. This fundamental issue likely needs to be addressed before large-scale improvement in health service utilisation can be expected.


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