Role of women’s empowerment in the relationship between women’s education and utilization of skilled birth attendants in Tach Gayint district, Northwest Ethiopia, mediation analysis, 2023

Role of women’s empowerment in the relationship between women’s education and utilization of skilled birth attendants in Tach Gayint district, Northwest Ethiopia, mediation analysis, 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Role of women’s empowerment in the relationship between women’s education and utilization of skilled birth attendants in Tach Gayint district, Northwest Ethiopia, mediation analysis, 2023 Atirsaw Assefa Melikamu, Dr. Destaw Fetene Teshome, Tigabu Kidie Tesfie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5901644/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background : newborn and maternal mortality remains unacceptably high in sub-Saharan Africa, where the use of skilled birth attendants at delivery has remained low, despite evidence of the effectiveness of trained birth attendants in reducing maternal deaths. However, examinations of the relationship between women’s empowerment and delivery care use are particularly limited, especially in sub-Saharan Africa. Objective : To assess the Role of women’s empowerment in the relationship between women’s education and utilization of Skilled Birth Attendants, mediation analysis, 2023. Methods : A community-based cross-sectional study was conducted from March 29 to April 28, 2023, in the Tach Gayint district. Systematic random sampling was used to select the study's 838 participants. Data was collected using a structured questionnaire and face-face interviews. A Generalized Structural Equation Model with mediation analysis was used to analyze the study. A statistically significant at a 95% Confidence interval and p-value of 0.05. Result : Overall, 53.58% of women in the sample gave birth by using skilled birth attendants. Women’s education (adjusted β= 0.021, 95% CI=.02,.03), age at 1 st marriage (adjusted β =.01, 95% CI =.001,.014), access to health care (adjusted β =0.05 (95% CI =.02,.07), and household decision-making (adjusted β = 0.02, 95% CI =.01,.05) were positively related with skilled birth attendant use. By using mediation analysis, Decision-making power (β = 0.002, 95% CI =0.001, 0.021), access to health care (β = 0.004, 95% CI =0.002, 0.01), and age at first marriage (β = 0.003, 95% CI =0.001, 0.02) had a significant indirect effect between the education and skilled birth attendants used. The proportion of the total indirect effect of education over the total effect was substantial (28.2%). Conclusion: The utilization of skilled birth attendants’ services among mothers in the study area was 53.58%. Higher education, paid employment, decision-making power, older age at first marriage, and access to health care had a positive direct effect on skilled birth attendants. Similarly, Women’s empowerment significantly mediated the relationship between the education of the mother and skilled birth attendant use. skilled birth attendant women who gave childbirth women empowerment Tach Gayint District Full Text Additional Declarations No competing interests reported. Supplementary Files supplementaryfile.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Aug, 2025 Reviews received at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 05 Aug, 2025 Reviewers agreed at journal 30 Jun, 2025 Reviewers agreed at journal 08 Apr, 2025 Reviews received at journal 01 Apr, 2025 Reviewers agreed at journal 22 Mar, 2025 Reviewers agreed at journal 01 Mar, 2025 Reviewers invited by journal 01 Mar, 2025 Editor assigned by journal 01 Mar, 2025 Editor invited by journal 01 Mar, 2025 Submission checks completed at journal 28 Feb, 2025 First submitted to journal 28 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5901644","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581371892,"identity":"9429917a-fbbb-11f0-907b-06cc9d20a69f","order_by":0,"name":"Atirsaw Assefa Melikamu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYLCCCgYGHjDjAxCzsROj5QyDAVgL4wyQFmYitYBpZrBGQlr4+48/fHCg5o+Mef/hZ9I2v7bJ8zEzMH74mINbi8SNHGODA8cMeGRupJlJ5/bdNmxjZmCWnLkNjzU3eNikP7AZ8EhIMJjdzu25zQjUwsbMi0eL/Pnjz38c+AfUwn/8223Lntv2BLUYHEgwYzjYBtTCkGN2m+HH7USCWgyBfpE42GcMdFhO+c/ehtvJbcyMzXj9Inf++MMPB77J2QMdttngx5/btvPbmw9++IjP+yiAsQ1MNhCrHgT+kKJ4FIyCUTAKRgoAAP1pT615FzlkAAAAAElFTkSuQmCC","orcid":"","institution":"Injibara University","correspondingAuthor":true,"prefix":"","firstName":"Atirsaw","middleName":"Assefa","lastName":"Melikamu","suffix":""},{"id":581371961,"identity":"9b85df31-fbbb-11f0-907b-06cc9d20a69f","order_by":1,"name":"Dr. Destaw Fetene Teshome","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"Dr.","firstName":"Destaw","middleName":"Fetene","lastName":"Teshome","suffix":""},{"id":581372020,"identity":"a5108009-fbbb-11f0-907b-06cc9d20a69f","order_by":2,"name":"Tigabu Kidie Tesfie","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Tigabu","middleName":"Kidie","lastName":"Tesfie","suffix":""}],"badges":[],"createdAt":"2025-01-25 12:38:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5901644/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5901644/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101751638,"identity":"cad8409a-383f-44e6-881c-2fe8de3ae31b","added_by":"auto","created_at":"2026-02-03 10:21:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":840899,"visible":true,"origin":"","legend":"","description":"","filename":"revisedResearchSBAMunuscript16and29.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5901644/v1_covered_b992d958-f9c6-4640-9ef3-711feae40f2f.pdf"},{"id":101440024,"identity":"45d4a2de-d00c-4b7c-b73c-af279dae9dc9","added_by":"auto","created_at":"2026-01-29 16:52:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":208188,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-5901644/v1/cfe1f22b7c9078e7bb8fe264.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Role of women’s empowerment in the relationship between women’s education and utilization of skilled birth attendants in Tach Gayint district, Northwest Ethiopia, mediation analysis, 2023","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"skilled birth attendant, women who gave childbirth, women empowerment, Tach Gayint District","lastPublishedDoi":"10.21203/rs.3.rs-5901644/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5901644/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003cstrong\u003e \u003c/strong\u003enewborn and maternal mortality remains unacceptably high in sub-Saharan Africa, where the use of skilled birth attendants at delivery has remained low, despite evidence of the effectiveness of trained birth attendants in reducing maternal deaths. However, examinations of the relationship between women’s empowerment and delivery care use are particularly limited, especially in sub-Saharan Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To assess the Role of women’s empowerment in the relationship between women’s education and utilization of Skilled Birth Attendants, mediation analysis, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A community-based cross-sectional study was conducted from March 29 to April 28, 2023, in the Tach Gayint district. Systematic random sampling was used to select the study's 838 participants. Data was collected using a structured questionnaire and face-face interviews. A Generalized Structural Equation Model with mediation analysis was used to analyze the study. A statistically significant at a 95% Confidence interval and p-value of 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: Overall, 53.58% of women in the sample gave birth by using skilled birth attendants. Women’s education (adjusted\u0026nbsp;β= 0.021, 95% CI=.02,.03), age at 1\u003csup\u003est\u003c/sup\u003e marriage (adjusted\u0026nbsp;β =.01, 95% CI =.001,.014), access to health care (adjusted\u0026nbsp;β =0.05 (95% CI =.02,.07), and household decision-making (adjusted\u0026nbsp;β = 0.02, 95% CI =.01,.05) were positively related with skilled birth attendant use. By using mediation analysis, Decision-making power (β = 0.002, 95% CI =0.001, 0.021), access to health care (β = 0.004, 95% CI =0.002, 0.01), and age at first marriage (β = 0.003, 95% CI =0.001, 0.02) had a significant indirect effect between the education and skilled birth attendants used. The proportion of the total indirect effect of education over the total effect was substantial (28.2%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The utilization of skilled birth attendants’ services among mothers in the study area was 53.58%. Higher education, paid employment, decision-making power, older age at first marriage, and access to health care had a positive direct effect on skilled birth attendants. Similarly, Women’s empowerment significantly mediated the relationship between the education of the mother and skilled birth attendant use.\u003c/p\u003e","manuscriptTitle":"Role of women’s empowerment in the relationship between women’s education and utilization of skilled birth attendants in Tach Gayint district, Northwest Ethiopia, mediation analysis, 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 16:52:25","doi":"10.21203/rs.3.rs-5901644/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-14T08:15:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-11T05:40:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155770274437040257889515039845617588236","date":"2025-08-11T05:08:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240426369147159990951126307513600936335","date":"2025-08-06T11:45:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106701006028858177695908177755167954988","date":"2025-08-06T11:43:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329026206240674776636459161764762436137","date":"2025-08-05T23:02:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1442244109304769691146439330232099391","date":"2025-06-30T05:39:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204960711636046202796892582751355266180","date":"2025-04-08T08:13:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-01T07:49:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221868598488876372208791275407420678529","date":"2025-03-22T07:37:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3332274659279939758213249131232386541","date":"2025-03-01T14:23:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-01T14:01:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-01T13:41:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-01T08:58:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-28T09:33:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-02-28T09:31:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b77b990-2750-4682-97cc-b63b8e9c6b95","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T16:52:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 16:52:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5901644","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5901644","identity":"rs-5901644","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}