Women's autonomy in household decision-making and safer sex negotiation in sub-Saharan Africa: An analysis of data from 27 Demographic and Health Surveys

Abstract

Women's ability to negotiate the conditions and timing of sex is key to several reproductive health outcomes including family planning and prevention of sexually transmitted infections. We investigated the association between women's autonomy in household decision-making and safer sex negotiation (SSN) in sub-Saharan Africa (SSA). This was a cross-sectional analysis of data from the Demographic and Health Survey (DHS) of 27 countries in SSA. Data were analyzed using Stata version 16.0 using descriptive statistics, chi square test, and logistic regression models. Statistical significance was set at p < 0.05 at 95% confidence interval. The pooled prevalence of SSN in the 27 countries was 77.1%. Compared to women with low autonomy in household decision-making, those with medium (aOR = 1.30; CI = 1.23–1.37) and high levels of autonomy in household decision-making (aOR = 1.28; CI = 1.17–1.40) were more likely to have greater SSN. Those with primary (aOR = 1.35; CI = 1.28–1.41) and secondary/higher education level of education (aOR = 1.68; CI = 1.58–1.79) had higher odds of SSN, compared to those with no formal education. Women who were working had higher odds of SSN (aOR = 1.44; CI = 1.37–1.51) than those who were not working. Women in the middle (aOR = 0.93; CI = 0.87–0.99) and richer (aOR = 0.92; CI = 0.85–0.98) wealth status had lower odds of SSN, compared to those in the poorest wealth status. Women's autonomy in household decision-making is a significant predictor of SSN. Women autonomy in household decision-making programs and interventions should be intensified to achieve Sustainable Development Goals 3.7 and 5 which seek to achieve universal access to sexual and reproductive health services and ensure gender equality and empower all women and girls by 2030.

Mass Media Exposure and Safer Sex Negotiation among Women in Sexual Unions in Sub-Saharan Africa: Analysis of Demographic and Health Survey Data

“…We found a 71.6% prevalence of safer sex negotiation among women in sexual unions in SSA. The high prevalence of safer sex negotiation found in this study corroborates the findings of previous studies that found the prevalence of safer sex negotiation to be 77.1% [30] and 83.4% [31] respectively. There were country level variations in the prevalence of safer sex negotiation among women in sexual unions in SSA.…”

Safer sex negotiation and parity among women in sub-Saharan Africa

“…With regard to safer sex negotiation, 82.7% of the women surveyed had the capacity to negotiate for safer sex. Similar studies in SSA have reported a high prevalence of safer sex negotiation among women in SSA (Aboagye et al, 2021;Seidu et al, 2021). The increasing prevalence of safer sex negotiation among women in SSA could be due to factors such as improved access to education and mass media exposure (Aboagye et al, 2021;Seidu et al, 2021).…”

“…Women who responded 'yes' for at least one of the two variables were said to have safer sex negotiations, and those that responded 'no' for both variables were categorized as not having safer sex negotiation. This categorization was informed by previous studies that used the DHS dataset (Darteh et al, 2019;Tenkorang, 2012;Sano et al, 2018a;Putra et al, 2020;Budu et al, 2021;Seidu et al, 2021).…”

“…Improving sexual autonomy among women comes with various benefits, including better sexual and reproductive health outcomes such as the prevention of sexually transmitted and blood-borne infections and family planning (Fadumo, 2014;Seidu et al, 2021). Women, in particular, have been disproportionately affected by sexually transmitted and blood-borne infections, especially HIV/AIDS (UNAIDS, 2013), and this is as a result of low sexual autonomy resulting from gender inequalities (Seidu et al, 2021). Sexual autonomy among women is the control women have over their own lives and the extent to which they have an equal voice with their partners in matters affecting themselves (Seidu et al, 2021).…”

“…Women, in particular, have been disproportionately affected by sexually transmitted and blood-borne infections, especially HIV/AIDS (UNAIDS, 2013), and this is as a result of low sexual autonomy resulting from gender inequalities (Seidu et al, 2021). Sexual autonomy among women is the control women have over their own lives and the extent to which they have an equal voice with their partners in matters affecting themselves (Seidu et al, 2021). The Sustainable Development Goal (SDG) 5 focuses on women's empowerment to advance their rights in reproductive health decision-making, attitudes and overall ability to negotiate for safer sex with their male partners (United Nations, 2015).…”