Women’s reproductive health decision-making: A multi-country analysis of demographic and health surveys in sub-Saharan Africa

Abstract

IntroductionWomen’s ability to make decisions regarding their reproductive health has important implications for their health and well-being. We studied the socio-demographic factors affecting reproductive health decision-making among women in 27 sub-Sahara African countries.Materials and methodsThe study made use of pooled data from current Demographic and Health Survey (DHS) conducted from January 1, 2010 and December 31, 2016 in 27 countries in sub-Sahara African. Binary and multivariate logistic regression models were used to investigate the associations of women’s socio-demographic factors with decision-making regarding sexual reproductive health.ResultsThe proportion of women who can ask their partners to use a condom during sexual intercourse ranged from lowest in Mali (16.6%) to highest in Namibia (93.4%). Furthermore, the proportion of women who can refuse sex ranged from 18.3% in Mali to 92.4% in Namibia. Overall, approximately every five out of ten women can ask their partners to use a condom, six out ten women could refuse their partners sex and seven out of ten women could make at least 1 decision. Women from rural areas (OR = 0.51, CI = 0.48–0.54), those with no education (OR = 0.11, CI = 0.10–0.12), Muslim women (OR = 0.29, CI = 0.27–0.31), women not working (OR = 0.53, CI = 0.51–0.56) and women whose partners had no education (OR = 0.17, CI = 0.16–0.19) were less likely to make a decision on their reproductive health.ConclusionResidence, age, level of education, religion, occupation and partner’s education were found to be associated with women’s decision-making about sexual intercourse, condom use and reproductive health decision-making index. This study contributes to the discourse on reproductive health decision-making in Africa. Policies and intervention targeted at improving women’s autonomy and empowering them to take charge of their sexual and reproductive health issues should be focused on these factors.

Structural equation modeling of psychosocial determinants of health for the empowerment of Iranian women in reproductive decision making

“…In the decision-making process, demographic characteristics, women's education, spouse's education, occupation, and property present the potential to influence informed decision making. This process can also be affected by characteristics such as religion, place of origin, and cultural practices [14]. Because structural determinants refer to political, social, and economic issues, they also cover social and economic statuses [14,43], which influence the use of health facilities [44].…”

“…This process can also be affected by characteristics such as religion, place of origin, and cultural practices [14]. Because structural determinants refer to political, social, and economic issues, they also cover social and economic statuses [14,43], which influence the use of health facilities [44]. Employment status, education level, and income are the most important indicators [45], which were also introduced at the Cairo Conference as facilitators of empowering women in health issues [46].…”

“…Accordingly, the Cairo Conference emphasized the reduction of gender inequality fundamentally through the empowerment of vulnerable groups either at the individual or at the societal level [12]. With regard to women, in particular, this empowerment is enabled by their education, occupations, and economic conditions [13,14]. Improving their socioeconomic conditions, in turn, cultivates their capacity to insist on the right to engage in reproductive decision making [15].…”

“…In reviewing the literature, factors such as the education of women and their husbands' [14,19,20], the occupation of women and their husbands' [14,[20][21][22], asset index [3,4], self-confidence [4,23], marital satisfaction [14,24] and social support [17,25] have been associated with women's empowerment in reproductive decision making. On the other hand, the World Health Organization model has identified these factors as determinant Social health is divided into two groups: structural (occupation, education and asset index) and intermediate (self-confidence, marital satisfaction, social support).…”

Women’s Attitudes Towards Negotiating Safe Sexual Practices in Nigeria: Do Family Structure and Decision-making Autonomy Play a Role?

“…Though, studies have revealed the in uence of socio-demographic, marital and psychological factors, gender norms, and women's position within the household as well as community factors on women's ability to negotiate sex in many parts of the globe has been examined [35,[51][52][53]. Other studies considered condom use and sexual negotiation among young men and women [54]; women's household decision-making autonomy and safer sex negotiation [55]; women's decision-making about self-protection during sexual activity [56]; household decisionmaking among married women [57] and women's reproductive health decision-making [58]. Despite the governmental and non-governmental efforts to minimize new infections in most countries with generalized or high burden epidemics, including Nigeria, the comparison and measurement of the interaction in uence of family structure and decision-making autonomy on attitudes towards negotiating safe sexual practices has been quite limited.…”