When money, distance, and men decide: A cross-sectional analysis of multidimensional barriers to healthcare access among women in Liberia

Background Ensuring comprehensive healthcare access is essential for promoting good health, preventing and managing diseases, and reducing adverse outcomes such as disability and mortality. In Liberia, however, research has documented persistently low levels of healthcare utilisation among women. This underutilisation is closely linked to pronounced gender-based power imbalances and limited female participation in household financial decision-making. In light of these challenges, this study sought to examine the barriers to healthcare access encountered by women in Liberia. Methods We performed a secondary analysis of data from 8,064 women who participated in the 2019–2020 Liberia Demographic and Health Survey (LDHS). The outcome variables were measured using four healthcare access concerns: ‘getting permission to go for treatment’, ‘getting money for treatment’, ‘distance to health facilities’, and ‘not wanting to go alone’. We used frequencies and percentages to describe sample characteristics and prevalence. Bivariate and multivariable logistic regression analyses were used to evaluate factors associated with barriers to accessing healthcare among women. Results The weighted prevalence of women with at least one barrier was 44.7% (95% CI: 41.2–48.1%), while that of women with all barriers was 7.0% (95% CI: 5.6–8.9%). Women with secondary education (aOR 0.56, 95% CI 0.39–0.80), higher education (aOR 0.18, 95% CI 0.04–0.73), working employment status (aOR 0.58, 95% CI 0.42–0.79), and who used the internet less than once a week (aOR 0.15, 95% CI 0.05–0.46) had reduced odds of encountering barriers to accessing healthcare. In contrast, women from the poorest wealth quintile (aOR 3.11, 95% CI 1.28–7.57) and the South Eastern B region (aOR 1.84, 95% CI 1.16–2.90) had increased odds of experiencing barriers to healthcare access. Conclusion Almost half of Liberian women encountered at least one barrier to accessing healthcare, which reveals a gap in health system inclusivity and responsiveness. The study findings highlight the need for interventions and policies to expand women’s financial and decision-making autonomy, as well as enhance community outreach tailored to women’s health needs.