Health literacy and maternal decision-making autonomy in Austria: insights from a postpartum survey

Background

Despite increasing attention to woman-centred care, evidence on how health literacy (HL) shapes women’s decision-making during pregnancy and childbirth remains limited. This study examined the association between HL and mothers’ decision-making autonomy (MADM).

Methods

A cross-sectional online survey was conducted among 544 mothers (mean age 31.0 ± 4.3 years) with children aged 0–2 years in Styria, Austria. HL was assessed using the HLS-EU-Q12 adapted to maternity care. Decision-making autonomy was measured using the MADM scale. Hierarchical regression analyses assessed the association between HL and MADM scores, adjusting for age, education, and mode of delivery.

Results

Limited HL was found in 34% of mothers, with higher proportions among women <35 years (37%) and those with secondary education (40%). The most challenging domains were finding information on mental health (33%), evaluating treatment options (22%), and assessing media-based health information (21%). Most women reported moderate to high autonomy (75%), while 25% reported low or very low autonomy. MADM scores were significantly lower among women with caesarean section compared to spontaneous birth (p = .010). Overall, 62% reported being actively asked about their desired involvement, with higher proportions among women with spontaneous birth (66% vs. 57%). HL was significantly associated with MADM scores (β = .376, p < .001), R² = .141, p < .001. After adjustment for age, education, and mode of delivery, this association remained significant (β = .371, p < .001), R² = .174, p < .001, with a significant model improvement, p < .001. No moderation effects of age, education, or mode of delivery were observed.

Conclusions

HL was positively associated with decision-making autonomy in maternity care. Despite generally high perceived autonomy, findings indicate gaps in active involvement. Strengthening HL may support shared decision-making and contribute to advancing woman-centred care.

Key messages

• HL is positively associated with MADM and represents a relevant factor for woman-centred maternity care.

• Findings indicate the need to strengthen participatory care in maternity services, given lower autonomy among women with caesarean section and gaps in active involvement.