Autonomie décisionnelle des femmes et recours aux services de santé maternelle au Burkina Faso : Analyse des données de l’EDS 2021
DOI :
https://doi.org/10.64707/revstss.v49i1.2180Mots-clés :
Autonomisation des femmes ; Prise de décision ; Soins prénatals ; Accouchement assisté par un personnel qualifié ; Accessibilité des services de santé ; Burkina Faso.Résumé
Introduction : L’autonomie décisionnelle des femmes est souvent considérée comme un déterminant du recours aux soins maternels, mais son influence peut varier selon les étapes du continuum de soins. Cette étude examine son association avec la réalisation d’au moins quatre consultations prénatales (CPN ≥ 4) et l’accouchement assisté par un personnel qualifié au Burkina Faso.
Méthodes : Les données proviennent de l’Enquête Démographique et de Santé du Burkina Faso de 2021. L’analyse porte sur 6 048 femmes en union âgées de 15 à 49 ans ayant eu une naissance vivante au cours des trois années précédant l’enquête. Des régressions logistiques binaires hiérarchiques ont été estimées en contrôlant les facteurs organisationnels, environnementaux, individuels et liés au ménage.
Résultats : Au total, 72,96 % des femmes avaient réalisé au moins quatre CPN et 92,24 % avaient bénéficié d’un accouchement assisté. Après ajustement, comparativement aux femmes déclarant une autonomie complète, celles ayant une autonomie partielle (ORa = 1,47 ; p < 0,01) ou aucune autonomie (ORa = 1,43 ; p < 0,01) présentaient des chances plus élevées d’avoir réalisé au moins quatre CPN. Cette association est non monotone et distingue surtout les femmes déclarant décider seules. En revanche, l’autonomie décisionnelle n’était pas significativement associée à l’accouchement assisté. La distance et les disparités régionales, particulièrement au Sahel, demeuraient déterminantes.
Conclusion : Les résultats ne montrent pas de gradient simple entre autonomie décisionnelle et recours aux soins maternels. Ils soulignent l’importance des dynamiques relationnelles et contraintes structurelles. Les interventions devraient associer autonomisation des femmes et réduction des inégalités territoriales d’accès aux soins.
Références
Kurjak A, Stanojević M, Dudenhausen J. Why maternal mortality in the world remains tragedy in low-income countries and shame for high-income ones: will sustainable development goals (SDG) help? Journal of Perinatal Medicine [Internet]. 2023 Feb 23;51(2):170–81. Available from: http://dx.doi.org/10.1515/jpm-2022-0061
Institut National de la Statistique et de la Démographie, The DHS Program. Burkina Faso Enquete Démographique et de Santé 2021 [Internet]. Burkina Faso et Rockville, Maryland, USA: INSD et ICF; 2023. Available from: https://www.dhsprogram.com/pubs/pdf/FR378/FR378.pdf
Cresswell JA, Alexander M, Chong MYC, Link HM, Pejchinovska M, Gazeley U, et al. Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis. Lancet Glob Health [Internet]. 2025 Apr;13(4):e626–34. Available from: http://dx.doi.org/10.1016/S2214-109X(24)00560-6
Organisation mondiale de la santé, editor. Recommandations de l’OMS concernant les soins prénatals pour que la grossesse soit une expérience positive. Genève: Organisation mondiale de la santé; 2017.
Aboagye RG, Osborne A, Anyasodor AE, Yikindi SV, Adnani QES, Ahinkorah BO. Utilisation of eight or more antenatal care visits and its associated socio-economic-related inequalities in sub-Saharan Africa: A decomposition analysis. PLoS One [Internet]. 2025 Mar 25;20(3):e0312412. Available from: http://dx.doi.org/10.1371/journal.pone.0312412
Kabakyenga JK, Östergren P-O, Turyakira E, Pettersson KO. Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. Reprod Health [Internet]. 2011 Dec;8(1):33. Available from: http://dx.doi.org/10.1186/1742-4755-8-33
Graham Y, Hayes C, Cox J, Mahawar K, Fox A, Yemm H. A systematic review of obesity as a barrier to accessing cancer screening services. Obes Sci Pract [Internet]. 12/2022 [cited 2025 July 7];8(6):715–27. Available from: http://dx.doi.org/10.1002/osp4.606
Ilboudo P, Siri A. La Politique de Gratuité des Soins de Santé Maternelle et Infantile au Burkina Faso: Effets et Pérennité de l’Intervention. 2022; Available from: https://publication.aercafricalibrary.org/handle/123456789/3389
Offosse M-J, Avoka C, Yameogo P, Manli AR, Goumbri A, Eboreime E, et al. Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis. Confl Health [Internet]. 2023 July 6 [cited 2025 Feb 21];17(1):33. Available from: http://dx.doi.org/10.1186/s13031-023-00530-z
Badolo H, Bado AR, Bazié H, Bacyé YF, Konseiga R, Hien H. Factors associated with adequate antenatal care use among women of childbearing age in Burkina Faso: finding from the 2010 and 2021 demographic and health surveys. Front Public Health [Internet]. 2025 Apr 16;13:1526255. Available from: http://dx.doi.org/10.3389/fpubh.2025.1526255
Some TD, Sombie I, Meda N. Women’s perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study. Reprod Health [Internet]. 2011 Jan 28;8(1):3. Available from: http://dx.doi.org/10.1186/1742-4755-8-3
Shimamoto K, Gipson JD. Examining the mechanisms by which women’s status and empowerment affect skilled birth attendant use in Senegal: a structural equation modeling approach. BMC Pregnancy Childbirth [Internet]. 2017 Nov 8;17(Suppl 2):341. Available from: http://dx.doi.org/10.1186/s12884-017-1499-x
Kabeer N. Resources, Agency, Achievements: Reflections on the Measurement of Women’s Empowerment. Dev Change [Internet]. 1999 [cited 2025 May 14];30(3):435–64. Available from: https://onlinelibrary.wiley.com/doi/10.1111/1467-7660.00125
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med [Internet]. 1994 Apr;38(8):1091–110. Available from: https://www.sciencedirect.com/science/article/pii/0277953694902267
Sombié I, Méda ZC, Savadogo LBG, Somé DT. La lutte contre la mortalité maternelle au Burkina Faso est-elle adaptée pour réduire les trois retards? Sante Publique [Internet]. 2018; Available from: https://shs.cairn.info/article/SPUB_182_0273
Somé DT, Sombie I, Meda N. What prevent women for a sustainable use of maternal care in two medical districts of Burkina Faso? A qualitative study. Pan Afr Med J [Internet]. 2014 May 12;18(43):43. Available from: https://www.ajol.info/index.php/pamj/article/view/131549
Somé DT, Sombié I, Meda N. How decision for seeking maternal care is made--a qualitative study in two rural medical districts of Burkina Faso. Reprod Health [Internet]. 2013 Feb 7;10(1):8. Available from: http://dx.doi.org/10.1186/1742-4755-10-8
Solar O, Irwin A. A conceptual framework for action on the social determinants of health. 2010; Available from: https://drum.lib.umd.edu/items/df328dec-ef67-4171-bbfd-45271d5f0635
Duysburgh E, Ye M, Williams A, Massawe S, Sié A, Williams J, et al. Counselling on and women’s awareness of pregnancy danger signs in selected rural health facilities in Burkina Faso, Ghana and Tanzania. Trop Med Int Health [Internet]. 2013 Dec;18(12):1498–509. Available from: http://dx.doi.org/10.1111/tmi.12214
Duysburgh E, Zhang W, Ye M, Williams A, Massawe S, Sié A, et al. Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding. Trop Med Int Health [Internet]. 05/2013 [cited 2025 Feb 18];18(5):534–47. Available from: http://dx.doi.org/10.1111/tmi.12076
Hounton S, Menten J, Ouédraogo M, Dubourg D, Meda N, Ronsmans C, et al. Effects of a Skilled Care Initiative on pregnancy-related mortality in rural Burkina Faso: Cost effectiveness of a Skilled Care Initiative in rural Burkina Faso. Trop Med Int Health [Internet]. 2008 July;13 Suppl 1:53–60. Available from: http://dx.doi.org/10.1111/j.1365-3156.2008.02087.x
Ngaba EA. Dimensions of women’s decision-making power and the influence on quality early prenatal care in Burkina Faso. Soc Sci Med [Internet]. 2025 Sept;380(118235):118235. Available from: http://dx.doi.org/10.1016/j.socscimed.2025.118235
Mumtaz Z, Salway S. Understanding gendered influences on women’s reproductive health in Pakistan: moving beyond the autonomy paradigm. Soc Sci Med [Internet]. 2009 Apr;68(7):1349–56. Available from: http://dx.doi.org/10.1016/j.socscimed.2009.01.025
Upadhyay UD, Gipson JD, Withers M, Lewis S, Ciaraldi EJ, Fraser A, et al. Women’s empowerment and fertility: a review of the literature. Social science & medicine [Internet]. 2014 [cited 2025 May 29];115:111–20. Available from: https://www.sciencedirect.com/science/article/pii/S0277953614003736
Fotso J-C, Ezeh AC, Essendi H. Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services? Reprod Health [Internet]. 2009 June 16;6(1):9. Available from: http://dx.doi.org/10.1186/1742-4755-6-9
Gabrysch S, Campbell OMR. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth [Internet]. 2009 Aug 11;9(1):34. Available from: http://dx.doi.org/10.1186/1471-2393-9-34
Tanou M, Kamiya Y. Assessing the impact of geographical access to health facilities on maternal healthcare utilization: evidence from the Burkina Faso demographic and health survey 2010. BMC Public Health [Internet]. 2019 June 27;19(1):838. Available from: https://link.springer.com/article/10.1186/s12889-019-7150-1
Beaujoin C, Bila A, Bicaba F, Plouffe V, Bicaba A, Druetz T. Women’s decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso. BMC Womens Health [Internet]. 12/2021 [cited 2025 May 11];21(1):272. Available from: http://dx.doi.org/10.1186/s12905-021-01411-4
Beegle K, Christiaensen L. Accelerating poverty reduction in Africa. Washington, D.C., DC: World Bank Publications; 2019.
Chol C, Negin J, Agho KE, Cumming RG. Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010-2016. BMJ Open [Internet]. 2019 Mar 13;9(3):e023128. Available from: http://dx.doi.org/10.1136/bmjopen-2018-023128
Adde KS, Ameyaw EK, Dickson KS, Paintsil JA, Oladimeji O, Yaya S. Women’s empowerment indicators and short- and long-acting contraceptive method use: evidence from DHS from 11 countries. Reprod Health [Internet]. 2022 Dec 6 [cited 2025 Apr 22];19(1):222. Available from: http://dx.doi.org/10.1186/s12978-022-01532-5
Pambè MW, Gnoumou/thiombiano B, Kaboré I. Relationship between women’s socioeconomic status and empowerment in Burkina Faso: A focus on participation in decision-making and experience of domestic violence. Etude Popul Afr [Internet]. 2014 Aug 6;28(0):1146. Available from: http://dx.doi.org/10.11564/28-0-563
Pratley P. Associations between quantitative measures of women’s empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world. Soc Sci Med [Internet]. 2016 Nov;169:119–31. Available from: https://www.sciencedirect.com/science/article/pii/S0277953616304087
Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet [Internet]. 2019 June 15;393(10189):2440–54. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30652-X/abstract
Banke-Thomas A, Offosse M-J, Yameogo P, Manli AR, Goumbri A, Avoka C, et al. Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: a qualitative study. Health Res Policy Syst [Internet]. 2023 June 6;21(1):46. Available from: http://dx.doi.org/10.1186/s12961-023-01008-3
Téléchargements
Publiée
Comment citer
Licence
(c) Tous droits réservés Sciences de la Santé 2026
Ce travail est disponible sous la licence Creative Commons Attribution 4.0 International .
