Childhood illnesses are a leading cause of mortality among children under five, especially in low- and middle-income countries, where an estimated 4.9 million children die globally from preventable diseases. In Nigeria, a country with one of the highest child mortality rates, this issue intersects with deeply embedded patriarchal norms that may limit women's decision-making autonomy. However, the association between women’s decision-making autonomy and care-seeking for childhood illness remains understudied.

This cross-sectional study investigated whether women's decision-making autonomy is associated with care-seeking for diarrhoea, fever, cough, and short rapid breaths in children under five in Nigeria. Data from the 2024 Nigerian Demographic and Health Survey were analysed using descriptive statistics, bivariate associations, and binomial logistic regression to estimate odds ratios and adjust for sociodemographic confounders.

The prevalence of high decision-making autonomy among 6,031 Nigerian women aged 15-49 was 30%, and the prevalence of care-seeking for childhood illness symptoms was 65%. Results concluded that, after adjusting for confounders, high decision-making autonomy was no longer statistically associated with seeking care for symptoms of childhood illness (adjusted OR = 1.0, 95% CI: 0.8-1.1, p = 0.571).

These findings imply that structural and contextual factors, such as wealth, place of residence, and maternal education, may exert a stronger influence on care-seeking decisions than autonomy alone. Future research should examine how relational autonomy influences care-seeking for individual symptoms and differentiate between formal and informal healthcare providers. Understanding these interactions remains vital in contexts like Nigeria, where preventable mortality among children under five remains a pressing concern.