{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:56:04Z","timestamp":1790916964948,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Women\u2019s Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Quality antenatal care (ANC) is essential for reducing maternal and neonatal mortality; however, access remains inequitable in Southern Africa. Women's empowerment is increasingly recognized as a key determinant of health-seeking behavior; however, its role in shaping ANC quality has not been adequately examined in the region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study used cross-sectional Demographic and Health Survey (DHS) data from 2015 to 2023 across seven Southern African countries (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936,671). Women's empowerment was measured using the SWPER Global Index, which covers the domains of attitude toward violence, social independence, and decision-making. Quality ANC was defined as the receipt of four essential services: blood pressure measurement, urine testing, blood testing, and iron supplementation. Hierarchical models were fitted, and the measures of variation and model fit were evaluated. The significance level was set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05, with a 95% confidence interval.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 45.1% of the women received quality ANC, with wide variation between countries (27.4% in Malawi vs. 92.1% in South Africa). A high level of empowerment against violence and decision-making was observed among the women in most of the countries. Women with high social independence (aOR\u2009=\u20091.12, 95% CI: 1.01\u20131.24) and strong rejection of gender-based violence (aOR\u2009=\u20091.15, 95% CI: 1.05\u20131.26) were significantly more likely to receive high-quality ANC. Early ANC initiation, \u22658 visits, and doctor-led care were the most powerful predictors of quality ANC care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women's empowerment, particularly social independence and autonomy from violence, plays a critical role in improving the quality of ANC in Southern Africa. However, persistent socioeconomic and geographic inequities highlight the need for context-specific strategies. Policies that integrate gender equality frameworks with strengthened ANC service delivery, especially in rural and low-performing countries, are essential for achieving maternal health targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgwh.2026.1886495","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:40:42Z","timestamp":1790916042000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Leveraging women empowerment for better maternal health: using the SWPER index to identify key drivers of quality antenatal care in Southern Africa"],"prefix":"10.3389","volume":"7","author":[{"given":"Munawar Harun","family":"Koray","sequence":"first","affiliation":[{"name":"Upper West Regional Health Directorate, Ghana Health Service .","place":["Wa, Ghana"]},{"name":"Southern Medical University","place":["Guangzhou, 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