Support for Sexual and Reproductive Health and Rights in Sub-Saharan Africa: A New Index Based on World Values Survey Data

Abstract

IntroductionAddressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) as per the 2030 Agenda. We aimed to develop a comprehensive index to measure individual’s support for SRHR, expanding opportunities for global trend analyses and tailored interventions. MethodsWe used nationally representative data on attitudes towards different dimensions of SRHR, collected via a new module integrated into the World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020–2021 (N=3,711). Exploratory factor analysis of 58 items was used to identify sub-scales, combined into an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex.ResultsA 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive “SRHR Support Index”, standardized on a 1–100 scale (mean=39.19, SD=15.27, Cronbach’s alpha=0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD=16.78) followed by Ethiopia (40.2, SD=13.63) and lowest in Zimbabwe (32.65, SD=13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urbanicity were also associated with more support among males only.ConclusionThe SRHR Support Index has potential to broaden SRHR attitude research from a comprehensive perspective – addressing the need for a common measure to track progress over time in contexts where such data are limited, including sub-Saharan Africa.While the index performed well, further validation is needed to assess its applicability in different settings and populations.