Women's Independent Household Decision Making Power and its influence on their Autonomy in relation to Child Vaccinations: a mixed-method study among Women of Reproductive Age in Northwest Ethiopia

Background: The importance of women's empowerment in influencing health outcomes has received attention globally, but there is limited information in Ethiopia on the relationship between women's household decision making power and the autonomy of decision making in relation to child vaccinations. Aim: The study aimed to assess the role of women's household decision making power on their autonomy in relation to child vaccinations. Methods: A community based mixed method study design was conducted among women who had 12-23-month-old children in Wogera district, Ethiopia. The sample size was determined using a single population proportion formula for the quantitative aspect of the study and the data collection for the qualitative study continued until saturation. The quantitative data was collected using a piloted questionnaire SPSS software was used for quantitative data analyses. X-2-square test was conducted to explore the association between women's household decision making power and their autonomy in relation to decision making around child vaccinations. Framework analysis was employed to analyse qualitative data using open code software. Results: A total of 584 women participated in the quantitative study and 13 In-depth interviews (IDI) with 13 key informants (KII)were conducted for the qualitative study. Majority, 88.2% (95% CI: 85.7, 90.6) of the respondents have autonomy to vaccinate children. This study showed that nearly two-thirds, 61.6% of the women had household decision making power. Respondents of the qualitative study noted that women had low household decision making power. Women's household decision making power is associated with women's autonomy to vaccinate children (x(2)=92.775(a), df=1, P<0.001). Conclusions: The overall level of women's household decision making power was relatively low compared to EDHS reports whereas women's autonomy to chid vaccination was high. There was a strong relationship between women's household decision making power and their autonomy in relation to child vaccinations. It is therefore important to implement activities, for example, provision of behavioural change communication (BCC) in the community, that can improve women's household decision making power which in turn will influence child vaccination coverage.