# Prevalence, Determinants, and Barriers to Reproductive Health Decision‐Making Autonomy Among Married Women in Rural Parts of Seden Sodo District, Southwest Ethiopia: A Mixed‐Methods Study

## TL;DR

This study examines how often married women in rural Ethiopia can make their own reproductive health decisions and what factors influence this.

## Contribution

The study provides new data on reproductive health decision-making autonomy in rural Southwest Ethiopia using mixed methods.

## Key findings

- Only 53.2% of women showed reproductive health decision-making autonomy.
- Factors like merchant occupation, later marriage age, and education were linked to greater autonomy.
- Barriers included male dominance, economic marginalization, and mobility restrictions.

## Abstract

In rural Ethiopia, where patriarchal norms prevail, women's limited decision‐making autonomy significantly restricts their reproductive health (RH) service utilization. However, scarcity of data persists. Hence, this study assesses the prevalence, determinants, and barriers to RH decision‐making autonomy among married women in rural parts of Seden Sodo district, Southwest Ethiopia.

A community‐based mixed‐methods study was conducted from December 2022 to January 2023 among 594 systematically selected married women in the Seden Sodo district, Southwest Ethiopia. The quantitative data were collected using structured interviewer‐administered questionnaires and analyzed by SPSS version 27. Women's decision‐making autonomy was assessed across four key reproductive health areas including family planning, antenatal care, place of delivery, and postnatal care using a weighted scoring system: 2 for sole decision‐maker, 1 for joint decisions, and 0 if the husband decided alone. Women who scored above the mean were considered autonomous. Sixteen key informants participated in qualitative interviews analysed thematically to explore contextual barriers with triangulation of the findings.

Only 53.2% (95% CI: 49–57) of women demonstrated autonomous RH decision‐making. Merchant occupation (AOR = 6.88, 95% CI: 3.12–15.14), age at marriage age > 18 years (AOR = 5.49, 95% CI: 3.20–9.43), husband's education (AOR = 3.51, 95% CI: 2.10–5.90), favourable RH perceptions (AOR = 2.08, 95% CI:1.05–4.12) and women's education (AOR = 0.47, 95% CI: 0.30–0.76) were significantly associated with RH decision‐making autonomy. Qualitative analysis revealed three key barriers: entrenched male dominance in health decisions, female economic marginalization, and mobility restrictions impeding service access.

While approximately half of rural women demonstrate some RH decision‐making autonomy, significant barriers persist. Therefore, programs promoting women's economic participation, challenging patriarchal norms, and engaging male partners are critical to enhancing autonomous RH decisions and improving maternal health outcomes.