Background: Women’s health decision-making autonomy is fundamental for the health and well-being of women and their children. Like most parts of Africa, women’s status in Tanzania remains contentious, with an estimated 19% prevalence of health decision-making autonomy in 2015. Given that women’s health decision-making autonomy is an ongoing process affected by technological and economic growth and social and cultural changes, understanding the sociodemographic correlates of women’s autonomy is imperative.  Objective: To examine the factors associated with health decision-making autonomy on their own health among Tanzanian women aged 15-49. Methods: A non-experimental cross-sectional study using secondary data from the current Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2022-2023.  The R statistical programming language was used to run the analysis. Chi-square and Ordinal Logistic Regression were fitted to identify the sociodemographic characteristics associated with women’s health decision-making autonomy on their own health. The odds ratio with its 95% confidence interval was used to determine the significance level at p-value <0.05. All estimates were adjusted for sample design (sample weight, strata, and sampling units) Results: A total of 9,249 women were included in the analysis. Only 1,908 (21%) had complete autonomy, 4,933 (53%) had joint autonomy, and 2,408 (26%) had no autonomy. Women's age, education level, household wealth index, and living in the South West Highlands zone were factors independently associated with higher odds of complete autonomy in their own healthcare. Rural residence was associated with decreased odds of complete autonomy. Conclusion: These results show that health decision-making autonomy among Tanzanian women remains very low. Efforts to empower women through better education and means to improve their economic status are needed to increase complete health decision-making autonomy on their health.  Recommendation: Accelerated and concerted efforts to increase health decision-making autonomy among married women will eventually improve their health and well-being and that of society. Future implication: The findings can serve as a basis for exploratory qualitative research to further understand the process of health decision-making autonomy among Tanzanian women.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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This is a study using a secondary data survey. The ethical approval for the DHS surveys was the Institutional Review Board (IRB) of ICF International and the I R B in the host country, Tanzania

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