Women's empowerment and barriers to healthcare access in Burkina Faso: an ordinal logistic regression analysis of the 2021 DHS.

backgroundAlthough free healthcare policies for women have been implemented in Burkina Faso, access to essential services remains severely hindered by insecurity, climate shocks, and widespread displacement. As one of the most affected countries in West Africa by internal conflict and fragility, Burkina Faso provides a critical context for examining gendered health disparities. Yet, studies that address the aspects of women's empowerment in this country remain rare, despite their importance for understanding healthcare access. Against this backdrop, the present study investigates how women's empowerment dimensions, such as decision making, information and communication technologies (ICT) access, bank account ownership, and perceptions of justified violence, shapes healthcare access in Burkina Faso.

methodsA nationally representative sample of 12,868 partnered women aged 15-49 years was analyzed. Healthcare access was measured using a composite score based on four barriers: needing permission, financial constraints, distance to health facilities, and reluctance to seek care alone. Each barrier was coded as 1 (present) or 0 (absent), generating a total score from 0 to 4, with higher scores indicating greater barriers. Key predictors included decision-making power, ICT access, bank account ownership, and acceptance of justified violence. To examine associations between healthcare access barriers and women's empowerment indicators, both unadjusted and adjusted ordinal logistic regression models were employed.

resultsAmong the sampled women, 29.6% reported no barriers to healthcare access, while 5.8% experienced all four. In adjusted ordinal logistic regression models, women with moderate autonomy in decisions had significantly lower odds of experiencing high healthcare barriers (OR = 0.78; 95% CI: 0.66-0.93), and those with high decision-making power had even lower odds (OR = 0.47; 95% CI: 0.28-0.78). Acceptance of justified violence was associated with increased odds of high barriers (OR = 2.14; 95% CI: 1.72-2.66). Women with the highest level of ICT access had markedly lower odds of facing high healthcare barriers (OR = 0.18; 95% CI: 0.14-0.22).

conclusionThis study shows that women's empowerment dimensions, especially decision-making power and ICT access, substantially reduce healthcare barriers, while acceptance of justified violence increases them. Financial inclusion and sociodemographic factors such as higher education, urban residency, and household headship also improve access. These findings underscore the need to address both structural inequalities and restrictive norms to expand women's healthcare access in Burkina Faso. Limitations include the cross-sectional design, reliance on self-reported data, and lack of qualitative insights. CLINICAL TRIAL NUMBER: Not applicable.