Submit Manuscript | http://medcraveonline.com Abbreviations: DHS, demographic and health survey; MHS, maternal health services; ANC, ante natal care; WCBA, women of child bearing age; NDHS, Nigerian demographic and health survey; FCT, federal capital territory; LGAs, local government areas; EAs, enumeration areas; PSU, primary sampling unit; MCHCS, maternal and child health care services; IRB, institutional review board Introduction Autonomy is a combination of numerous subjects and domains that cuts across socioeconomic, political, local cultural norms, values, and beliefs system. Various published studies and reports have used different words to mean autonomy. For instance, empowerment, 1‒3 agency, 1,4 independent decision making 5 and volitional control 6 were commonly used in different settings to mean autonomy. In relation to the use of maternal health services (MHS), female autonomy simply means the ability of a woman to make independent decision regarding her reproductive desires and where to seek for MHS such as prenatal, natal, post natal care including family planning services. Ultimately, it is the degree to which a woman makes an independent decision and takes action on reproductive issues even if it is in variation to her partner, in laws or other people in her family. 3 The low proportion of women who made the recommended four ante natal care (ANC) visits before delivery was reported to be <50% among countries in sub-Saharan Africa, Middle east, North Africa and the far east particularly Pakistan, Afghanistan and India compared to the nearly 90% in Europe and Americas. 7 Plausible reason advanced for the poor use of MHS in Africa and Middle east is women in these areas have no or limited autonomy, lack cultural liberation and generally dominated by men unlike their counterparts in western countries. 8,9 The lack of capacity to take independent autonomous decision and action by women from these parts of the world might partially explain the poor utilization of MHS and poor pregnancy outcome in form of maternal and neonatal morbidity, mortality and disabilities. In sub Saharan Africa, less than half of all pregnant women between 2008-2012 had their frst ANC visit in the frst three months of being pregnant. 7 This regional average does not highlight the wide variation within the African region. For example, only a mere 10% of pregnant women in Senegal commenced their ANC visit before the third trimester. 10 Such behavior of late commencement of ANC will not facilitate the primary objective of ANC to identify high risk pregnancies and the institution of early management of these cases. 11,12 In Nigeria, it has been reported that nearly two thirds of all pregnant women had made the frst ANC visit towards the end of the second trimester. 12 The late commencement of ANC could be one of the reasons why Nigeria has made the list of 11 countries where a woman is likely to die due to pregnancy and its complication. 13 Furthermore, lack of autonomy may result in late decision making, delay to reach the nearest maternity hospital and getting the appropriate management which aptly explains the 3 Delays (3D) Model. 14 Literature review indicated that Sociologist and population scientist seem to use several variables in order to measure the autonomy of women depending on the objective of a study. Variables like education, income, employment, age at frst sexual intercourse, age of her spouse or partner, having fxed assets (land, house, farm), owning gold, pearls or silver, living in the MOJ Public Health. 2017;6(2):273‒277. 273 © 2017 Umar. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Women autonomy and the use of antenatal and delivery services in Nigeria Volume 6 Issue 2 - 2017 Abubakar Sadiq Umar School of Public Health, Walden University, USA Correspondence: Abubakar Sadiq Umar, School of Public Health, College of Health Sciences, USA, Tel +263785467172, Email abubakar.umar@waldenu.edu Received: May 10, 2017 | Published:June 16, 2017 Abstract The ability of a woman to make independent decision and appropriate action on her reproductive desires is dependent on her level of autonomy. This study was undertaken to determine whether the level of autonomy of Nigerian women influences the use of antenatal and delivery services. A quantitative cross-sectional study using the Demographic and Health Survey (DHS) to determine whether an association exists between women’s autonomy and the appropriate use of prenatal and delivery services. A total of 22,556 women aged 15-49 years were recruited using a stratified two stage proportionate to size cluster sampling from all parts of Nigeria. About 43% of respondents indicated that they do not independently take decision on health issues relating to their health, are not allowed to venture out of their matrimonial homes without seeking for permission and have no income and thus categorized as having no any form of autonomy. North East and South West zones had the lowest (18%) and highest (62%) proportion of women with full autonomy). Women with full autonomy are more likely to use prenatal (unadjusted odd ratio=2.229; CI 2.094–2.373) and delivery (Unadjusted Odd Ratio=3.795; CI 3.523–4.088)) services as recommended compared to women with no any form of autonomy (Adjusted Odd Ratio=1.129; CI 1.117– 1.146; p<.05). This study demonstrated that autonomy influences the use of Maternal Health Services (MHS) in Nigeria. There is the need for policy change on girl’s education and women employment as well as dialogue with relevant Sociocultural structure like religious and traditional leaders in order to improve the level of autonomy and ultimately high use of MHS. Keywords: autonomy, antenatal visit, place of delivery, Nigeria, socio cultural structure, ante natal care, ORC macro, ICF international, Calverton Maryland, enumeration MOJ Public Health Review Article Open Access