Role of women’s empowerment in the relationship between women’s education and utilization of skilled birth attendants in Tach Gayint district, Northwest Ethiopia, mediation analysis, 2023

Abstract

<title>Abstract</title> <bold>Background</bold> : <bold/> newborn and maternal mortality remains unacceptably high in sub-Saharan Africa, where the use of skilled birth attendants at delivery has remained low, despite evidence of the effectiveness of trained birth attendants in reducing maternal deaths. However, examinations of the relationship between women’s empowerment and delivery care use are particularly limited, especially in sub-Saharan Africa. <bold>Objective</bold> : To assess the Role of women’s empowerment in the relationship between women’s education and utilization of Skilled Birth Attendants, mediation analysis, 2023. <bold>Methods</bold> : A community-based cross-sectional study was conducted from March 29 to April 28, 2023, in the Tach Gayint district. Systematic random sampling was used to select the study's 838 participants. Data was collected using a structured questionnaire and face-face interviews. A Generalized Structural Equation Model with mediation analysis was used to analyze the study. A statistically significant at a 95% Confidence interval and p-value of 0.05. <bold>Result</bold> : Overall, 53.58% of women in the sample gave birth by using skilled birth attendants. Women’s education (adjusted β= 0.021, 95% CI=.02,.03), age at 1 ^st marriage (adjusted β =.01, 95% CI =.001,.014), access to health care (adjusted β =0.05 (95% CI =.02,.07), and household decision-making (adjusted β = 0.02, 95% CI =.01,.05) were positively related with skilled birth attendant use. By using mediation analysis, Decision-making power (β = 0.002, 95% CI =0.001, 0.021), access to health care (β = 0.004, 95% CI =0.002, 0.01), and age at first marriage (β = 0.003, 95% CI =0.001, 0.02) had a significant indirect effect between the education and skilled birth attendants used. The proportion of the total indirect effect of education over the total effect was substantial (28.2%). <bold>Conclusion:</bold> The utilization of skilled birth attendants’ services among mothers in the study area was 53.58%. Higher education, paid employment, decision-making power, older age at first marriage, and access to health care had a positive direct effect on skilled birth attendants. Similarly, Women’s empowerment significantly mediated the relationship between the education of the mother and skilled birth attendant use.