Effects of Gender Norms Regarding Violence against Women on the Use of Prenatal Care and Skilled Birth Attendance in Rural sub-Saharan Africa

Studies on the contextual determinants of maternal health services use have highlighted the importance of sociocultural norms that limit the role and place of women. In this study, we develop a measure for latent sociocultural norms related to violence against women and analyze their influence on the use of prenatal care and skilled birth attendance in rural Africa using DHS data from Ghana, Kenya, Uganda, and Tanzania. Measured from respondents’ perceptions of violence against women, our sociocultural contextual variable has good statistical reliability (Cronbach's alpha > 0.8). Moreover, it has a negative influence on women's autonomy in all countries, hence its utility for identifying sociocultural norms in these contexts. The results of multilevel structural equation models show that these sociocultural norms have a significant negative influence on the use of skilled birth attendance in Uganda and Ghana (results for prenatal care used are not yet available). In Ghana, we also note an indirect effect that involves reducing women's autonomy. These results have important implications for policymakers.