Background
The degree of autonomy women experience affect maternal and child mortality as well as overall social well-being of women. How to measure women’s autonomy has remained problematic and controversial. In this paper we have estimated women’s autonomy by using a generalized approach of identifying a latent variable likely to be associated with “autonomy”. The purpose is to explore how the level of women’s autonomy affects utilization of obstetric care services in Bangladesh.

Methods

Data from the Bangladesh Demographic and Health Survey (BDHS) 2011 was used for the analysis. Inclusion criterion was women who gave birth in the last five years. Obstetric care variables examined are the recommended level of ante-natal care (ANC) utilization, institutional delivery and post-natal care (PNC) utilization. Women’s autonomy index was obtained through a principal component analysis of variables related to autonomy in decision making, financial autonomy and freedom of movement. Instrumental variable (IV) approach was employed due to the endogenous nature of autonomy construct.

Results

Study sample consisted of 8,753 women. Average age of the respondents was 25.6 years and their mean years of schooling was 5.5. Women in the sample had 2.3 children on an average. Recommended level of ANC utilization, institutional delivery and PNC utilization was lower among women with no formal education, of Islamic faith, from poorest wealth quintile, and who had lower autonomy scores. Marginal effect analysis after IV probit estimation showed that women’s autonomy (Mean: 0.0001; SE: 1.69) significantly increased ANC (0.20), institutional delivery (0.20) and PNC utilization (0.15) for unit increase of autonomy index.

Conclusions

Women with higher autonomy score showed higher obstetric care utilization. Thus women’s autonomy is an important driver of antenatal care, delivery care and postnatal care utilization. Policies should be directed to increase women’s education as well as enhancing women’s autonomy to improve obstetric care utilization.