Women empowerment and Health insurance utilisation in Rwanda: a nationwide cross-sectional survey

Background: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among the vulnerable groups. Moreover, women empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women tackle the barriers to accessing healthcare. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment among Rwandan women. Methods: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and health insurance utilisation using SPSS version 25. Results: Out of the 14,634 women, 12095 (82.6%) (95% CI: 82.0-83.2) were using or had subscribed to health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators significantly associated with health insurance utilisation were; exposure to mass media, decision making and economic empowerment. Low decision making (AOR=1.195, 95% CI: 0.897-1.592), and low economic empowerment (AOR=1.128, 95% CI: 0.986-1.290) had a positive association with health insurance coverage, while high exposure to media had a negative association (AOR=0.664, 95% CI: 0.522-0.845). Other factors that were significant include; educational level, wealth index, residence, region, household size, and household head. Conclusions: Improving women's access to health facilities as well as media material tailored to the specific knowledge gaps could significantly increase enrolment rates of Rwandan women to health insurance.