Health literacy and institutional delivery among young Angolan women: a cross-sectional study in three provinces

A reduction in maternal mortality remains critical, particularly in sub-Saharan Africa, were significant disparities in access to healthcare affect outcomes. In Angola, almost half of women give birth outside the health system, highlighting the need to increase access to maternity services and information related to women’s sexual and reproductive health and rights (SRHR). The study comprehensively examines young Angolan women’s health literacy in SRHR and its role for institutional delivery. The data were derived from a cross-sectional survey involving 1139 women aged 18–24 years who had given birth, recruited from the provinces of Luanda, Huambo and Lunda Sul. The results included a univariate description of the participants’ socio-demographics and SRHR characteristics, and the barriers and facilitators to institutional delivery they identified. In addition, logistic regression models assessed associations between the participants health literacy levels and the odds for institutional delivery. Findings revealed that more than half of the women delivered in healthcare institutions. These women were comparably economically advantaged, often literate and resided in urban areas. Major barriers identified included lack of transportation and financial resources; facilitators also included companionship and trust in respectful treatment. Regardless of the delivery setting, many women lacked information on fundamental SRHR topics. There were significant associations between health literacy and the site of delivery in all areas considered, except in Lunda Sul. Women who had acquired SRHR information from healthcare professionals, had access to several sources of SRHR information and were acquainted with multiple SRHR topics exhibited higher odds of having had an institutional delivery. The study underscores the need to bolster young women’s access to essential SRHR information and knowledge. However, addressing socio-economic barriers and healthcare limitations concurrently is essential. Multisectoral approaches are vital to ensure widespread access to quality maternity services, thereby ensuring women can safely give birth in quality healthcare settings.