Assessing the Role of Married Women Healthcare Decision-Making Autonomy on Healthcare Utilization Among Left-Behind Wives of Migrants in Rural India

Despite significant improvements, maternal healthcare utilization among mothers in India remains suboptimal, particularly among marginalized socioeconomic groups. This study explores how married women’s autonomy in healthcare decision-making is associated with improved maternal healthcare in both migrant and non-migrant settings.

The study is conducted from October 2022 to February 2023 in rural Koch Bihar, West Bengal; this study utilized a mixed-methods approach, including surveys, interviews, and focus group discussions with left-behind women. The study involved 384 women aged 15–49 who had given birth to a live baby within the past five years, equally divided between those with migrant and resident husbands. Logistic regression was applied to estimate the effect of various predictors on the utilization of improved maternal healthcare facilities.

The findings show that 32.82% of women from non-migrant households and 27.69% of women from migrant households accessed improved maternal healthcare facilities. The migration status of husbands, young age of mothers, lower education levels, poor household wealth status, and marginalized caste backgrounds were associated with lower access to healthcare facilities. Multivariate regression analysis revealed that mothers from migrant households who made healthcare decisions jointly with their husbands (AOR, 0.13; 95% CI, 0.077–0.584) were less likely to access improved maternal healthcare compared to those who made decisions independently. Conversely, women from non-migrant households who shared healthcare decision-making with their husbands (AOR, 2.08; 95% CI, 0.748–5.883) were almost twice as likely to utilize improved maternal healthcare compared to those who made decisions alone.

The study concludes that households with better socioeconomic status and greater decision-making autonomy are more likely to access improved maternal healthcare. Therefore, it suggests that inclusive strategies are needed to reduce socioeconomic inequalities, alongside focused interventions that support women at the household level. These efforts should be targeted at the micro-level and aimed at strengthening ongoing policies to ensure equitable healthcare access for all women and to achieve global goals of reducing maternal mortality, advancing child health equity, and promoting social inclusion, regardless of their husbands’ migration status.