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oai:figshare.com:article/34053531 2026-10-02T04:37:16Z category_7 portal_316 item_type_3 month_year_10_2026

Table 3_Leveraging women empowerment for better maternal health: using the SWPER index to identify key drivers of quality antenatal care in Southern Africa.docx Munawar Harun Koray (20347846) Evelina Ndapewa Johannes (25161393) Emmanuel Kwasi Afriyie (21555295) Alfred Pie Faabie (25161396) Medicine antenatal care maternal health multilevel analysis Southern Africa SWPER index women's empowerment Background<p>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.</p>Methods<p>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.</p>Results<p>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.</p>Conclusion<p>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.</p> 2026-10-02T04:37:16Z Dataset Dataset 10.3389/fgwh.2026.1886495.s004 https://figshare.com/articles/dataset/Table_3_Leveraging_women_empowerment_for_better_maternal_health_using_the_SWPER_index_to_identify_key_drivers_of_quality_antenatal_care_in_Southern_Africa_docx/34053531 CC BY 4.0