Maternal health care utilization still remains crucial in ensuring good pregnancy outcomes and a reduction in maternal and child mortality especially in developing countries. Although several studies have been conducted to investigate determinants of maternal health care utilization, the innfluence of gender relations and women empowerment on maternal healthcare in cross-national context has received little attention. This paper sought out to examine the influence of gender relations and women empowerment on maternal healthcare utilization in sub-Saharan Africa. The analysis pools sample data of 245,955 respondents from the most recent Demographic and Health Surveys (DHS) and World Development Indicators of 35 sub-Saharan African countries. Separate Bayesian multilevel logistic regression models are fitted for adequate antenatal care and institutional delivery in relation to several factors indicating gender relations and women empowerment at three levels. Several components of gender relations and women empowerment were significantly associated with maternal health care after adjusting for covariates. In addition, significant between country and between community variations in the odds of maternal health care utilisation were observed. These results underscore the importance of prioritising contextual gender equity and women empowerment to achieve better utilisation of maternal healthcare services and subsequently, a reduction in maternal mortality in sub-Saharan Africa.

There are no competing interests associated with this manuscript

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

https://dhsprogram.com/data/available-datasets.cfm

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

All data produced are available online at: //dhsprogram.com/data/available-datasets.cfm