Demand for reproductive health services in selected West Africa countries: inter-relationships, women’s decision-making autonomy and parents’ education association for sustainable recovery

Introduction Improving reproductive health (RH) remains a central priority in health policy agendas and sustainable development goals, particularly in sub-Saharan Africa. Despite growing policy interest, the interrelationships among RH service utilization, household-level determinants, and child health outcomes remain insufficiently understood in the West African context.Objectives This study examines the demand for reproductive health services in selected West African countries, with a specific focus on the complementarity hypothesis. It analyses the associations between a mother’s demand for tetanus immunization, her child’s birth weight, parental education, and women’s decision-making autonomy.Methodology Drawing on pooled data from the 2018 Demographic and Health Survey (DHS), the study employs a control function model to address potential econometric issues, including endogeneity. The empirical strategy allows for a causal examination of the relationship between antenatal care uptake and birth outcomes, with subgroup analyses conducted to uncover heterogeneous effects.Results Findings indicate a positive and statistically significant association between maternal tetanus immunization during pregnancy and child birth weight, supporting the complementarity of antenatal care services with broader reproductive health outcomes. Subgroup analyses reveal distinct effects across specific population groups. Healthcare service demand is found to be significantly enhanced by empowering social factors such as parental education and women’s decision-making autonomy, while access-related constraints and persistent patriarchal norms exert adverse effects. Urban-rural disparities in service utilization are rooted in cultural, behavioral, and psychosocial dimensions.Practical implications These findings underscore the need for integrated reproductive health strategies that are equity-focused and behaviorally informed. Policies should prioritize women’s empowerment, address structural access barriers, and tailor interventions to account for urban-rural and sociocultural heterogeneity in order to sustainably improve maternal and child health outcomes.