Abstract
BACKGROUND: Despite global efforts to improve maternal health outcomes, many regions, including Uganda, continue to face challenges in achieving optimal maternal healthcare utilization. This study aims to investigate how restricted autonomy in household decision-making by significant others affects inadequate use of maternal healthcare services among married women in Uganda. Inadequate use of maternal healthcare services refers to not meeting all four WHO-recommended standards for ANC timing, ANC visits, place of delivery, and PNC timing. METHODS: Secondary data from the latest 2016 Uganda Demographic and Health Survey (UDHS 2016) were used for this study. Data from 7906 married women of childbearing age were analyzed using a multilevel binary logistic regression approach. RESULTS: The inadequate use of maternal healthcare services was estimated to be 39.1%. The odds of inadequate use were 17% higher among women with moderate restricted autonomy in household decision-making by significant others compared to women with low restrictions [Adjusted Odds Ratio (AOR) = 1.17, 95% Confidence Interval (CI) = 1.02-1.34]. Inadequate use of MHCS decreases with an increase in the household wealth index. Women from the richest household [(AOR) = 0.52, 95% CI = 0.39,0.70] were less likely to report Inadequate use of maternal healthcare services compared to the poorest. Employed women were less likely [AOR = 0.73, 95% CI = 0.62-0.84] to report inadequate use of maternal healthcare services. Women who reside in the northern region of Uganda were significantly less likely [AOR = 0.72, 95% CI = 0.52-0.99] to report inadequate use of maternal healthcare services compared to those who reside in the central region. CONCLUSION: The study concluded that the restricted autonomy in household decision-making by significant others plays a crucial role in the use of maternal healthcare services among married women in Uganda. Factors such as maternal age, household wealth index, employment status, and region of residence were also associated with inadequate use of maternal healthcare services. Therefore, to achieve Sustainable Development Goal (SDG) 3.1, the government and policymakers should engage significant others in maternal health programs, promote regional equity, female labor force participation, education, and autonomy in health decision-making.