Abstract
BACKGROUND: Anemia is one of the world's public health problem, especially in developing nations. The majority of women of childbearing age (15-49) are affected by anemia. Women's role in the decision-making process is significant for their health and related issues such as anemia. So far, there is no evidence of women's decision-making autonomy on anemia. Consequently, this study aimed to robustly examine both individual- and group-level women's decision-making autonomy and other determinants of anemia among married women in Ethiopia. METHODS: We examined data from an Ethiopian demographic and health survey conducted in 2016. Our analysis included 9220 married women of childbearing age (15-49 years). For bivariate analysis, we applied the chi-squared (X(2)) test. The relationship between individual and group-level women's decision-making autonomy and anemia was assessed using multilevel binary logistic regression models while adjusting other socio-demographic and economic characteristics. RESULTS: In this study the magnitude of anemia was 30.5% (95% CI; 29.5-31.4). According to our multilevel analysis, group-level women's autonomy was found to be negatively related with anemia than individual-level women's autonomy (AOR = 0.53, 95% CI = 0.41-0.69). In addition, the indicator of women's wealth index at group level was a protective factor (AOR = 0.68, 95% CI =0.51-0.90) to develop anemia. Among individual-level indicators women's age (AOR = 0.73, 95% CI = 0.60-0.89), use of contraceptive (AOR = 0.66, 95% CI = 0.55-0.81), BMI (AOR = 0.71, 95% CI = 0.59-0.86) and employment status (AOR = 0.88, 95% CI = 0.79-0.98) were negatively related with anemia. While women who follow Muslim religion (AOR = 1.62, 95% CI = 1.32-1.97,), women who had five and above number of children (AOR = 93, 95% CI = 1.53-2.46), and who were pregnant (AOR = 1.21, 95% CI = 1.04-1.40) were positively associated with anemia. Our final model showed that around 27% of the variability of having anemia was because of group-level differences (ICC = 0.27, P < 0.001). In addition, both individual and group-level factors account for 56.4% of the variance in the in the severity of anemia across communities (PCV = 56.4%). CONCLUSIONS: Our study showed that empowering women within households is not only an important mechanism to reduce anemia among married women but also serves as a way to improve the lives of other women within the society.