Women’s empowerment and under-five mortality in Cameroon Open Access

Ensuring a healthy start in life and promoting child health are essential for the well-being of future adults and subsequent generations (Besnier, 2023). Infant and child mortality remain significant global challenges and are key targets under the United Nations Sustainable Development Goals (SDGs). Despite concerted efforts to improve child health in the developing world, under-five death rates continue to be a critical concern in Africa. While worldwide rates of death among children, adolescents and young people continue to decline, children in sub-Saharan Africa remain disproportionately vulnerable to premature and preventable deaths (United Nations Inter-agency Group for Child Mortality Estimation [UN IGME], 2024). In 2022, sub-Saharan Africa accounted for 57% (2.8 million, range: 2.5–3.3 million) of all deaths among children under five (UN IGME, 2024).

In Cameroon, a lower-middle-income country, child mortality rates are alarmingly high. The World Bank reports that the mortality rate for children under five in Cameroon reached 69.23 deaths per 1,000 live births in 2022. This figure exceeds both the average for its income group (44 deaths per 1,000 live births) and even that of low-income countries (35 deaths per 1,000 live births). Although there has been a decline in the mortality rate for children under five during the previous decade—from 122 deaths per 1,000 live births in 2011 to 79 in 2018 and further to 69.23 in 2022—the pace of this reduction has slowed significantly. Specifically, the rate dropped by 43 deaths between 2011 and 2018 but by only 9.77 deaths between 2018 and 2022. This deceleration highlights structural barriers that impede faster progress. Black et al. (2017) underlined that, children under five are particularly vulnerable, as their health and development are closely tied to their caregivers. In this context, women’s empowerment emerges as a critical lever for improving child health outcomes.

Kabeer (1999) defines women’s empowerment as a process of challenging male-dominated social hierarchies, contesting power and gaining control over resources, decision-making and household management. Women, as primary caregivers, often face significant challenges when they lack resources and decision-making power, which can hinder their ability to make choices related to their children’s healthcare and nutrition. Such constraints exacerbate child health risks and mortality. Kellard et al. (2024) further emphasized the fact that promoting gender equality is a powerful mechanism for improving human development in low-income countries, suggesting that empowering women can result in increased investments in children.

The results of studies on the connection between women’s empowerment child health outcomes have been conflicting. Some research has revealed that certain dimensions empowerment of women has a favorable impact on children’s nutritional status (Cunningham et al., 2014; Yaya et al., 2020; Essilfie et al., 2020). However, other studies have failed to establish a causal relationship (Scantlan and Previdelli, 2013; Zereyesus et al., 2017; Deutsch and Silber, 2019). When examining child mortality, evidence consistently identifies women’s empowerment as a protective factor (Hossain, 2015; Stiyaningsih and Wicaksono, 2017; Doku et al., 2020; Ortigoza et al., 2023), although certain aspects, such as employment or entrepreneurial engagement, have been associated with higher child mortality rates in specific contexts (Hossain, 2015; Kellard et al., 2024).

Despite the prioritization of gender equality under Sustainable Development Goal (SDG) 5, Cameroon has made limited progress. Although legal frameworks recognize that women are still marginalized by gender equality, cultural norms and behaviors, especially in rural areas and socio-economically disadvantaged groups. Institut National de la Statistique [INS] (2022) revealed that women face disparities in employment participation (48.9% for women vs 60.1% for men), higher risks of underemployment (68.5% for women vs 55.8% for men) and more vulnerable employment conditions (74.3% for women vs 50.7% for men). Boys also benefit from greater educational access, with higher gross enrolment rates in both primary and secondary schools compared to girls.

Additionally, domestic violence is a pervasive issue in Cameroon, as highlighted by the fifth Demographic and Health Survey (Institut National de la Statistique [INS], 2020). Approximately 43.2% of women in unions experience domestic violence, with 39.8% affected by emotional violence and 14.5% by sexual violence. Entrenched gender norms and socio-cultural practices further restrict women’s empowerment, limiting their participation in household decision-making, access to healthcare and autonomy in matters affecting their children’s health. These challenges underscore the importance of understanding the connection between women’s empowerment and Cameroon’s under-five mortality rate as a means of enhancing child survival results.

This study addresses a critical research gap as it is to the best of our knowledge, the first to explore this relationship in French-speaking African countries, with a particular focus on Cameroon. While substantial literature examines the relationship between women’s empowerment and child health outcomes, such analyses remain scarce in this context. Furthermore, this study uses a multifaceted approach to assess women’s empowerment, emphasizing important aspects like perceptions of domestic abuse, participation in household decision-making and freedom of movement. By investigating how these dimensions impact child health outcomes, the study provides robust evidence on the role of women’s empowerment in reducing child mortality. The findings not only close a substantial gap in the literature but also offer policymakers valuable data to design targeted interventions aimed at improving public health.

This paper’s remaining sections are organized as follows: The literature review and methodology are presented in the following section. Subsequently, the results of the empirical estimates are discussed, and conclusions and policy implications are presented in the last section.

In order to address the issue of statistics of neonatal mortality in developing countries, Mosley and Chen (1984) proposed a framework that identifies five proximate determinants, including environmental factors, maternal characteristics, personal illness, nutritional deficiencies and injury. The literature also shows that socioeconomic factors such as household income, parents’ education and employment status significantly reduce child mortality (Kamal, 2012). However, it is observed that little focus has been placed on some factors, such as gender equality and women’s empowerment, which can be considered immediate causes within the household (Kamal, 2012).

Considering such an approach, Eswaran (2002) presented a theoretical model in which he demonstrated analytically that if women’s empowerment, which increases their bargaining power within households, increases, it results in a reduction in fertility and child mortality rates. According to this conceptual framework, the probability of a child’s death is not fixed and immutable; greater food expenditure and quality healthcare for children can reduce child mortality. Similarly Maitra (2004), developed a theoretical model showing that empowering women reduces the risk of child mortality through the utilization of maternal healthcare during pregnancy. In fact, women with weak agency and limited resources may be constrained in their decision-making ability regarding their own health and that of their children. Thus, these circumstances can affect their health and mortality, including that of their children (Maitra, 2004).

An overview of the empirical literature reveals that the methods used to measure women’s empowerment vary significantly. Some studies focus on resource-related aspects and measure women’s empowerment using socioeconomic indicators such as education and labor market participation (Grabowski and Self, 2013; Hossain, 2015; Shafiq et al., 2019). Additionally, several indicators used to measure women’s empowerment in the literature are taken from the Demographic and Health Survey Women’s Status Module, focusing on household decision-making, domestic violence, women’s mobility and socioeconomic status. On the one hand, some studies consider these indicators separately as measures of women’s empowerment (Kembo and Van Ginneken, 2009; Adhikari and Sawangdee, 2011; Grabowski and Self, 2013; Imai et al., 2014; Ibrahim et al., 2015; Shafiq et al., 2019; Essilfie et al., 2020; Yaya et al., 2020). On the other hand, there are studies that select variables considered as indicators of women’s empowerment and aggregate them to compute an index (Maitra, 2004; Hossain et al., 2007; Hossain, 2015; Alaofè et al., 2017; Zereyesus et al., 2017; Stiyaningsih and Wicaksono, 2017; Tsiboe et al., 2018; Deutsch and Silber, 2019; Heckert et al., 2019; Doku et al., 2020).

Numerous studies have examined the role of women’s empowerment in improving child health outcomes using different measures, yet their results remain inconclusive. Among these, the relationship between women’s empowerment and children’s nutritional status has been a focal point in attendant studies. Abreha et al. (2020) investigated the link between Ethiopian under-5 children’s growth faltering and women’s empowerment, utilizing data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Their findings revealed that greater women’s empowerment, particularly through improved socio-economic status and decision-making power, is associated with improved child health outcomes, including lower rates of stunting, wasting and a reduced incidence of pneumonia and anemia. Similarly, Essilfie et al. (2020) explored the impact of women’s empowerment on children’s nutritional status in Ghana using the 2014 Ghana Demographic and Health Survey. Their study highlights that maternal empowerment correlates with significant enhancements to the nutritional health of severely malnourished children. Hossain (2020) investigated the role of maternal empowerment in lowering Bangladesh’s child malnutrition rate. Maternal empowerment was measured using a composite index that included four proxy variables: age at first birth, the age difference between wife and husband, whether the woman has at least 10 years of schooling and whether the woman works for cash. The results of an ordered probit regression analysis indicated that maternal empowerment was the third most important indicator of malnutrition among Bangladeshi children.

Moreover, Tchakounté (2023) examined the effects of maternal empowerment on childhood stunting and wasting, using data from the 2018s Cameroon Demographic and Health Survey. The logistic regression analysis revealed that women’s financial autonomy and participation in decision-making significantly reduce the risk of stunting. Likewise, Diallo and Mbaye (2023) analyzed data from the 2019 Senegal Demographic and Health Survey to assess the impact of women’s literacy on children’s nutritional status. Their results showed that maternal literacy significantly decreases the likelihood of stunting and underweight in kids younger than five.

Several studies have adopted a multicounty approach to investigate how women’s empowerment and children’s nutritional status are related, offering insights into broader regional and cross-national dynamics. In this context, Ewerling et al. (2020) analyzed data from 26 African countries, encompassing 84,537 children aged 36–59 months, using the Early Childhood Development Index and developmental domains such as literacy-numeracy, physical, learning and socioemotional measures. Their findings highlighted that women’s empowerment, measured through the SWPER Worldwide index, positively impacts child development in Africa. Similarly, Bliznashka et al. (2021) explored the connections between the empowerment of women and various child outcomes, including development, growth, early learning and nutrition in sub-Saharan Africa. Their study revealed that women with higher empowerment levels are more likely to produce offspring with superior outcomes in these areas, underscoring the broad benefits of empowering mothers for child health and development. Specifically, children of mothers in the quintile with the highest levels of empowerment had higher height-for-age z-scores (HAZ) and a lower risk of stunting compared to those in the lowest quintile.

Christian et al. (2023) further examined the connection between childhood nutritional status and women’s empowerment in sub-Saharan Africa, utilizing data from 25,665 mother-child pairs in eight different nations. Their analysis demonstrated that greater women’s empowerment, especially when making decisions and owning assets, is associated with a reduced risk of anemia as well as the co-occurrence of stunting and anemia in children. However, the study also identified a nuanced dynamic: children of empowered women in male-headed households faced a higher risk of anemia and stunting compared to those in female-headed households.

The impact of female empowerment on child mortality has also been studied. Hossain (2015) investigated the effects of women’s empowerment on infant mortality in Bangladesh using the Bangladesh DHS data and a Weibull parametric survival model. The study considered four indicators to measure different aspects of women’s empowerment: education level, participation in household decision-making, freedom of movement and job status. The results showed that three dimensions of empowerment—freedom of movement, education level and participation in household decision-making—have a major impact on infant mortality. In contrast, employment among women was found to be linked to higher rates of newborn death.

Furthermore, using country-level Demographic and Health Survey (DHS) data, Doku et al. (2020) created individual-level (ILWEI) and population-level (PLWEI) women’s empowerment indices in order to evaluate this relationship in low- and middle-income countries (LMICs) through a two-stage individual participant data (IPD) meta-analysis. Their findings demonstrated that children of mothers with low empowerment are more likely to die in infancy or early childhood. Besnier (2023) investigated the association between women’s political empowerment and child health outcomes, including mortality, stunting and immunization. Using the Women’s Political Empowerment Index (WPEI) from the V-Dem project and Sustainable Development Goal (SDG) indicators, the study covered data from 161 countries between 1990 and 2016. The findings indicated that women’s political empowerment is associated with reduced child mortality, particularly in high-, low- and least-developed countries and improved immunization rates in low-income nations.

Ortigoza et al. (2023) carried out a cross-sectional multilevel study examining the relationship between women’s empowerment (WE) and infant mortality rates (IMRs) in 286 cities across seven Latin American countries. The findings revealed that higher women’s labour force participation consistently correlated with lower IMRs. Similarly, increased educational attainment among women was associated with reduced IMRs, but this effect was significant only in cities within nations with lower GDP. Additionally, weak national implementation of laws safeguarding women’s rights was linked to higher IMRs across all countries. Notably, the association between women’s educational attainment and IMRs was moderated by GDP per capita, with a significant negative relationship observed exclusively in countries where GDP per capita was below the median. Kellard et al. (2024) investigated the relationship between women’s empowerment, measured through the extension of rights and child mortality rates using a panel of 134 countries worldwide. According to the results, women’s empowerment generally lowers child mortality in high-income countries, but there are significant differences in low- and middle-income countries based on the specific aspects of empowerment. For example, women’s employment in the public sector or participation in public administration are linked to lower child mortality rates, but the opposite is true for their right to operate a business and their access to banking services.

This research is predicated on the theoretical model proposed by Maitra (2004) which examined the connection among women’s status in the home and child mortality in India. This framework assumes parents take decisions concerning the health of their siblings and they derived their utility from the consumption of goods that are brought from the market (X), leisure (h) and health of the child (Q). The derived production function for health of child is:

Here $C$ is health inputs and $Ω$ is a parameter capturing production efficiency. The mother’s $(m)$ and father's $(f)$ utilities are denoted $Um$ and $Uf$ and their individual utility can be written as follows:

The mother’s and father’s reservations utilities denoted $U¯m$ and $U¯f$ are considered as the external choice that each household member has access to. According to Maitra (2004), these parents’ reservation utilities are based on costs and attributes that influence a person’s capacity to express their preferences during domestic negotiations. Therefore, it is hypothesized that a vector of prices $p$⁠, unearned or asset incomes $Ai$ and a set of extra-family environmental characteristics $αi$ determine the level of reservation utility. Therefore,

The parents aim to choose the amount of $(X)$ , $hi(i=m,f)$ and $Q$ that maximise the following:

Subject to the constraint:

Here, $wi$ is the wage rate, $Ti$ is the time endowment of individual $i$⁠.

Maitra (2004) observed that solving this optimization problem yields reduced demand functions for children’s health. These functions depend on prices $(p)$⁠, individuals’ unearned income $(A)$⁠, the household’s production efficiency parameter $(Ω)$⁠, health inputs $(C)$ and variables reflecting the bargaining power of each household member.

The empirical version of this Eq. (6) is:

Here $ϕ$ represents a set of variables that reflect the relative authority and power of each member within the household influencing the demand for goods. These variables include both members’ unearned incomes $(Ai)$ and extra environmental parameters $(αi).$ From an empirical perspective, Maitra (2004) emphasized that any variable that represents relative autonomy or bargaining power within the home can be included in $ϕ$⁠. Therefore, in this study, variables capturing women’s empowerment will be incorporated into $ϕ$⁠.

This study makes use of information from the Cameroon Demographic and Health Survey (DHS) conducted in 2018. A representative sample of 13,160 homes participated in the study, which was conducted by the Ministry of Public Health and the National Institute of Statistics between June 16, 2018, and January 19, 2019. The sample was evenly distributed to ensure representativeness across urban and rural areas in 12 study regions. Except for Yaoundé and Douala, classified as entirely urban, each region was divided into urban and rural strata.

In the selected households, all women aged 15–49 who usually resided there were eligible to be surveyed. Questions on household relationships were administered to a randomly selected woman aged 15–49 from each household. Specifically, the 2018 DHS collected data on fertility levels, understanding and utilizing family planning techniques, as well as fertility preferences, maternal mortality, breastfeeding practices, child and maternal health, child mortality, possession and use of mosquito nets, nutritional status and feeding practices of mothers and children, among other topics.

Given the absence of a direct measure of women’s empowerment in the literature, we assess it using three indicators: justification of domestic violence (e.g., whether the wife refuses to have sex with her spouse, fights with her husband, ignores children or goes out without telling him), involvement in making decisions in the home (e.g., decisions about women’s financial resources, large household purchases or the spending of the husband’s money) and freedom of movement (e.g., visiting relatives, going to healthcare facilities with children or seeking healthcare for herself). These indicators are not only in line with the body of research on women’s empowerment but are also well-represented in the Cameroonian DHS data, enabling robust analysis.

While other potential indicators of empowerment exist, these were selected for their direct relevance to the lived experiences of women in Cameroon, their strong link to household dynamics, and the quality of the available data. Specifically, attitude towards domestic violence reflects societal norms regarding gender equality and women’s agency, involvement in decision-making captures women’s autonomy and influence in household matters and freedom of movement reflects women’s agency and access to opportunities outside the home, which are crucial for their empowerment in contexts like Cameroon.

To analyze the impact of women’s empowerment on under-five mortality, MCA is applied to the selected binary variables representing each indicator, such as attitude towards domestic abuse, engagement in family decision-making and freedom of movement. This method produces a composite index for each indicator, summarizing the multidimensional data into a single continuous variable. These indices, representing various domains of women’s empowerment, are then included as explanatory variables in the Logit model.

Multiple Component Analysis (MCA) is an appropriate method for constructing indices for each indicator of women’s empowerment because it effectively handles categorical variables, which are common among the selected indicators. MCA identifies underlying patterns and reduces dimensionality while preserving the multidimensional nature of each indicator. By assigning appropriate weights to the categories of each variable, it ensures that the resulting indices accurately reflect the relative contribution of each indicator to the overall concept of empowerment. Additionally, MCA has been used in similar studies (Deutsch and Silber, 2019; Buvinic et al., 2020), establishing it as a robust and reliable approach for generating composite indices from survey data, such as the DHS.

This approach differs from that proposed by Doku et al. (2020) because it focuses on indicators that address specific aspects of women’s empowerment, rather than constructing global indicators at the individual and population levels. The advantage of this approach is that it facilitates more targeted policy interventions aimed at the selected areas of women’s empowerment.

The outcome measure is Under-5 mortality. This refers to the death of a live-born child before reaching the age of five. The remaining variables relevant to child mortality-related health outcomes used in the study are described in Table 1.

This study employs a multivariate binary logistic regression model to assess the effect of women’s empowerment on under-five mortality. This analytical approach has been utilized in previous research investigating the determinants of child mortality (Adhikari and Sawangdee, 2011; Alemayehu et al., 2015; Stiyaningsih and Wicaksono, 2017; Doku et al., 2020). Binary logistic regression is a statistical approach adopted to analyze data where a binary dependent variable is influenced by one or more variables.

Table 2 highlights key demographic and socioeconomic characteristics of women and their children. It shows that 7.89% of women experienced at least one under-five death. The average age of women is 28 years, and they have an average of 6 years of education, mostly completing primary school. About 48.12% of women are employed, indicating a need for policies supporting women’s economic participation. The average birth order is 3.45, reflecting high fertility rates, while the average household size is 3.44 children, which may put a strain on resources and impact children’s well-being.

A significant 75.04% of births occur after an interval of more than 24 months, a positive indicator for maternal and child health, as longer birth intervals are associated with reduced health risks. Regarding wealth distribution, the largest proportions of households fall within the “Middle” (23.94%) and “Poorer” (23.48%) quintiles, while only 14.51% of households are in the richest quintile, reflecting socioeconomic disparities that may influence access to medical and educational resources.

Table 2 also presents descriptive statistics for 11 variables related to women’s empowerment, which were used to calculate the women’s empowerment index. In the domain of attitudes toward domestic violence, findings indicate that women are most likely to justify domestic violence if a woman goes out without permission (17.28%) or argues with her husband (16.93%). In the domain of household decision-making, nearly all women (92.21%) are empowered to make decisions about major household purchases, while fewer (43.58%) are involved in decision-making related to their husband’s earnings. For the domain of freedom of movement, only 33.64% of women reported being free to visit healthcare facilities for their own health, whereas a larger proportion (61.36%) indicated they were free to visit their relatives.

Table 3 presents the estimates of the effects of women’s empowerment indicators on under-five mortality, derived from a multivariate logistic regression model. The likelihood ratio (LR) chi-squared statistic is 486.94, with a corresponding p-value of 0.000, indicating strong evidence to reject the null hypothesis of simultaneous nullity of all coefficients. Thus, the overall model estimates are statistically significant.

Among the three variables used to capture women’s empowerment, only two are found to be statistically significant. Specifically, women’s attitudes towards domestic violence do not exhibit a significant effect on under-five mortality rates in Cameroon. These findings suggest that a woman’s favorable attitude towards domestic abuse has no effect on under-five mortality in the Cameroonian context.

Child mortality is significantly impacted negatively by the household decision-making index, according to an analysis of other facets of women’s empowerment. A decreased risk of under-five mortality is associated with women’s increased involvement in home decision-making. This emphasizes how crucial it is for women to participate in home decision-making in order to lower the number of child fatalities. Furthermore, for the variable that represents women’s freedom of movement, the odds ratio is significant. With an estimated value of 0.74069 (OR < 1). This indicates that the ability of women to move freely without requiring their partners’ permission acts as a protective factor against under-five mortality.

These results are attributable to the role of women as primary caregivers in Cameroonian society, where they oversee critical aspects of child welfare, including education, sanitation, health and nutrition. Increased decision-making power enables women to take timely and appropriate actions concerning their children’s health, thus reducing delays caused by consulting other family members. Women who have more control over decisions in the home, particularly those related to healthcare, are better positioned to mitigate risks and ensure improved child health outcomes (Desai and Johnson, 2005).

Another potential explanation for the positive impact of women’s participation in decision-making lies in its association with higher contraceptive use. Women with greater autonomy are more likely to use family planning techniques, which help lower fertility rates, extend birth intervals and reduce reproductive risks. These elements greatly lower the mortality rate for children under five (Dyson and Moore, 1983; Adhikari and Sawangdee, 2011). Furthermore, economic empowerment plays a pivotal role, as less economically empowered women often have restricted access to resources for education and money, negatively impacting child survival (Folaranmi, 2014). These findings corroborate earlier research demonstrating that enhancing women’s empowerment is a critical driver of improved child health outcomes (Dyson and Moore, 1983; Adhikari and Sawangdee, 2011; Folaranmi, 2014; Stiyaningsih and Wicaksono, 2017).

Higher levels of education achieved by women in Cameroon is associated with a significant decrease in the likelihood of death for children under five. Each additional year of education decreases these odds by 5%. Mothers who have greater education are more apt to use safe water, provide appropriate healthcare and make informed decisions about marriage, birth control, prenatal care and immunizations, all of which contribute to improved child survival rates. These findings align with previous studies in the field (Basu and Stephenson, 2005; Adhikari and Sawangdee, 2011; Kamal, 2012; Grépin and Bharadwaj, 2015; Hossain, 2015; Ortigoza et al., 2023).

Women’s employment status in Cameroon significantly increases the odds of under-five mortality. Specifically, children of employed mothers are 1.788 times more likely to die before reaching the age of five in contrast to kids whose moms do not have jobs. This finding is supported by existing literature, which suggests that maternal employment may reduce maternal attention and lead to less frequent breastfeeding, thereby potentially lowering child survival rates (Shrestha et al., 1987; Hossain, 2015). These results align with those found by Hossain (2015) in Bangladesh and Mekuriaw and Mohamed (2021) in Ethiopia.

The study finds that institutional delivery significantly reduces under-five mortality in Cameroon, with children born in healthcare facilities being less likely to die due to the ability of healthcare professionals to detect and prevent life-threatening complications during or after birth. This result aligns with previous studies showing that institutional delivery improves child health outcomes (Panis and Lillard, 1993; Maitra, 2004; Habibov and Fan, 2014; Hossain, 2015). However, the study reveals that an additional prenatal care visit does not have a significant effect on child mortality.

The estimates suggest that under-five mortality decreases with maternal age, as younger mothers, particularly teenage mothers, generally have higher infant mortality rates, a finding supported by previous studies (Hobcraft et al., 1985; Grépin and Bharadwaj, 2015; Stiyaningsih and Wicaksono, 2017). Additionally, the likelihood of under-five mortality decreases with household size, likely due to the increased care and support from extended family members in larger households. This result aligns with Hossain (2015) in Bangladesh. Moreover, this study finds a significant relationship between birth order and under-five mortality, showing that the odds of under-five mortality decrease as the birth order increases. This aligns with the findings of Hobcraft et al. (1985) and Grépin and Bharadwaj (2015), who highlight that first-born children face higher neonatal mortality rates and are consistently disadvantaged throughout infancy.

These results also indicate that child immunization acts as a protective factor. Specifically, immunization significantly and negatively influences the odds of under-five mortality. The findings presented in Table 3 show that under-five mortality is significantly lower among children who are fully immunized (OR = 0.708). Additionally, financial difficulties in accessing healthcare facilities are significantly linked to under-five mortality. Women who reported financial challenges in accessing healthcare facilities had a greater risk of under-five mortality compared to those without financial barriers to healthcare access.

This current research primarily investigated the connection between women’s empowerment and under-five mortality in Cameroon. To capture the multidimensional nature of women’s empowerment, three indicators were constructed using Multiple Component Analysis: (1) attitudes toward domestic violence, (2) participation in household decision-making and (3) freedom of movement. The results demonstrate that women who actively take part in decision-making within the home and those who do not require their husband’s permission to move freely are less likely to experience under-five mortality compared to their counterparts. Furthermore, the study reveals that women’s attitudes toward domestic violence do not have a significant impact on under-five mortality in Cameroon.

The implications of these results highlight the significance of governmental measures designed to reducing child mortality in Cameroon by prioritizing women’s empowerment. Specifically, consistent with the findings of the investigation on under-five death rate, practical actions should target the promotion of gender equality in making decisions for the home and the enhancement of women’s autonomy. Community-based programs can raise awareness of the benefits of shared decision-making within families, involving men as partners in these efforts. Initiatives to address restrictive socio-cultural norms could include legal measures, outreach campaigns and the provision of mobile health services to ensure women’s access to healthcare without restrictions. Maternal health education, peer support initiatives and conditional incentives can further encourage practices that improve child health. Policymakers should embed measures of women’s empowerment into health interventions, prioritize underserved areas and incorporate gender equality topics into school programs to drive long-term societal change. These measures collectively aim to advance child health outcomes and foster women’s empowerment.

Notwithstanding its merits, this research has a number of shortcomings. The concept of women’s empowerment is intricate and multidimensional, and it cannot be fully captured by the indicators used in this analysis. Notably, the communal and political dimensions of empowerment were not considered. Furthermore, caution should be exercised in generalizing these findings, as the data pertains only to mothers who became pregnant in the five years prior to the poll.

In conclusion, this study underlines the essential significance of women’s empowerment in reducing under-five mortality in Cameroon and provides actionable insights for policymakers. Future research should explore additional dimensions of empowerment and its interactions with other determinants of child health to develop more comprehensive policy frameworks. Additionally, the study reveals that women’s employment influences child mortality outcomes. A more detailed analysis of the types of employment that increase the risk of under-five mortality is needed. Identifying high-risk jobs would enable policymakers to raise awareness among women employed in these sectors, helping them understand and address the potential dangers to their children.

The authors are indebted to the editor and reviewers for constructive comments.