Background Malaria in pregnancy remains a major public health problem in endemic areas of the sub-Saharan African (SSA) region. However, there is limited understanding of the role of women empowerment in using Sulfadoxine-Pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp-SP) in the SSA region. This study examines the association between women empowerment indicators and optimal uptake of IPTp-SP (3 or more doses) in the Lake endemic region of Kenya.

Methods We used data from a cross-sectional baseline survey of 3154 women aged 15–49 years in Kisumu and Migori Counties who had a live birth in the last two years prior to the study. Data were collected between June to August 2021. We conducted a descriptive analysis to show the distribution of respondents by key background characteristics, and bivariate and multivariate logistic regression to examine statistically significant associations between women empowerment measures (decision-making power, control of assets, education, and employment status) and optimal uptake of IPTp-SP.

Results Of the 3154 surveyed women, 1505 (47.7%) received optimal IPTp-SP dose during their last pregnancy. The Odds for optimal use of IPTp-SP increased among women who had: high decision-making autonomy (AOR=1.31; CI=1.10 – 1.58); 4 or more ANC visits (AOR=3.18; CI=2.64 – 3.84); interacted with a healthcare provider about IPTp (AOR=1.47; CI=1.27 – 1.71); and high knowledge of approaches to prevent malaria in pregnancy (AOR=1.99; CI=1.62 – 2.45).

Conclusion The study findings suggest that maternal health interventions should focus on less empowered women (i.e. women with less decision-making autonomy), women with limited ANC visits and interaction with a healthcare provider, and those with limited knowledge of approaches to prevent malaria in pregnancy because they are less likely to achieve optimal use of IPTp-SP dose during pregnancy.