Women empowerment and health insurance utilisation in Rwanda: a nationwide cross-sectional survey

Abstract

Background Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among vulnerable groups. Although women’s empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women to tackle the barriers to accessing healthcare, its association with health insurance usage has been barely investigated. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment as well as other socio-demographic factors among Rwandan women. Methods We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15–49 years, who were selected using multistage sampling. Health insurance utilisation, the outcome variable was a binary response (yes/no), while women empowerment was assessed by four composite indicators; exposure to mass media, decision making, economic and sexual empowerment. We conducted multivariable logistic regression to explore its association with socio-demographic factors, using SPSS (version 25). Results Out of the 14,634 women, 12,095 (82.6%) (95% CI 82.0–83.2) had health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators had a negative association with health insurance utilisation; low (AOR = 0.85, 95% CI 0.73–0.98) and high (AOR = 0.66, 95% CI 0.52–0.85) exposure to mass media, high decision making (AOR = 0.78, 95% CI 0.68–0.91) and high economic empowerment (AOR = 0.63, 95% CI 0.51–0.78). Other socio-demographic factors found significant include; educational level, wealth index, and household size which had a negative association, but residence and region with a positive association. Conclusions A high proportion of Rwandan women had health insurance, but it was negatively associated with women’s empowerment. Therefore, tailoring mass-media material considering the specific knowledge gaps to addressing misinformation, as well as addressing regional imbalance by improving women’s access to health facilities/services are key in increasing coverage of health insurance among women in Rwanda.

Maternal Mortality in Africa: Regional Trends (2000–2017)

“…In Africa, mobile phones are displacing radio and television as a means of social communication [ 118 ]. Mass media and educational interventions based on SMS and voice message reminders should be used to increase pregnant women’s prenatal visits [ 119 , 120 ].…”

“…In East Africa, among the factors associated with maternal mortality were non-membership in social movements intended to improve maternal and child health, low involvement of partners, medical illness, and no utilization of family planning services [ 131 ]. Women’s empowerment is associated with a reduction in maternal mortality but with low utilization of health services [ 119 ].…”

Maternal Mortality in Africa, Regional Trends (2000-2017)

“…In East Africa, among the factors associated with maternal mortality were non-membership in social movements intended to improve maternal and child health, low husbands' involvement, medical illness, and no utilization of family planning services [137]. Women empowerment is associated with a reduction in maternal mortality but with low utilization of health services [121].…”

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019–2020 Rwanda demographic health survey

“…Women with health insurance had higher odds of CoC utilization a finding that has been shown in other studies [ 60 – 63 ]. Rwanda’s community-based health insurance (CBHI) program is locally coordinated at the district level with enrollment being promoted by the village mobilization committees at the village level [ 61 , 64 , 65 ]. The program is funded by donor and development partners, the government, and individual contributions with prenatal and postnatal care being covered in the minimum package [ 29 , 61 ].…”