The Social Paradox of Women's Autonomy and Child Mortality in Tanzania: A Multi-Level Analysis with Policy Implications

Abstract

Despite recent improvements in women's empowerment and educational attainment, and modest economic gains, Tanzania continues to experience notable under-five mortality rates within Sub-Saharan Africa. Drawing on Mosley and Chen's child survival framework and the Socio-ecological Model, this study examines how maternal empowerment and decision-making capabilities shape child mortality outcomes. Analysis of the 2022 Tanzania Demographic and Health Survey data for 6599 mothers reveals complex relationships between women's autonomy and child survival. Logistic regression models were used to assess three autonomy dimensions: access to economic resources, attitudes toward domestic violence, and decision-making power. Increased access to economic resources (OR: 1.28, 95% CI: 1.18–1.39) and greater decision-making power among partnered women (OR: 1.09, 95% CI: 1.02–1.17) were associated with higher odds of under-five mortality, while attitudes toward domestic violence showed no significant link. These findings suggest that advancing women's agency alone does not automatically improve child health; effective policy must embed women's empowerment within a broader institutional agenda that expands public care services, promotes shared caregiving responsibilities, builds community support networks, and shifts the gender norms that shape family health.