Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review

Abstract

Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004–2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.

“I feel like it is asking if he is a stalker … but I also feel like it is asking if he cares”: exploring young South African women and men’s perceptions of the Sexual Relationship Power Scale

“…Only with gender equity, the process of allocating resources, programs, and decision making fairly to all genders without any discrimination on the basis of gender and addressing any imbalances in the benefits to people of different genders, can gender equality be achieved. While gender inequity and the subsequent health impacts (e.g., experiences of violence, including intimate partner violence [IPV], and poor sexual and reproductive health [SRH] outcomes) disproportionately affect communities in the Global South, most measures of gender equity are developed and validated among samples in the Global North and used and applied in diverse global contexts, without continued investigation into their contextual applicability and validity [ 3 – 5 ]. Thus, in order for adequate global monitoring of SDG 5 and other markers of health and wellbeing for girls and young women across their life course, measures need to be grounded in population and context-specific understandings of gender equity [ 2 ].…”

“…A driving force of gender inequity and subsequent experiences of violence and negative SRH outcomes, is the unequal division of power held by women and other marginalized genders [ 6 , 7 ]. Given the importance of power, one widely used measure of gender inequity is the Sexual Relationship Power Scale (SRPS) [ 5 ]. The SRPS aims to measure the level of control a male partner has in the relationship, and was originally developed using two sub-scales assessing controlling behaviours and decision-making dominance within intimate relationships [ 3 ].…”

“…The SRPS was originally developed in 2000 among 388 women in heterosexual relationships, with a mean age of 27 in the United States, the majority of whom were married [ 3 ]. While the original scale had two sub-scales, the relationship control sub-scale has sound psychometric properties on its own [ 4 ], and many studies focused on youth have used adapted versions that include items assessing male dominance and controlling behaviours in a single scale [ 5 ]. Since its original development, the SRPS and several modified versions of the scale have been used in numerous global settings, as well as with men to measure controlling behaviours towards female partners in relationships.…”

“…Since its original development, the SRPS and several modified versions of the scale have been used in numerous global settings, as well as with men to measure controlling behaviours towards female partners in relationships. However, there is little published evidence detailing the contextual and contemporary considerations and relevance of the scale among younger unmarried groups in settings outside North America [ 4 , 5 ]. There exists vast cultural and contextual differences in relationship power dynamics and gender relations between North American and other global settings [ 9 ], thus researchers need to be more critical of the Western conceptualized scales they use in their global studies.…”

The Role of Gender Power Imbalances in the Spread of HIV among Women in Intimate Relationships: Guidelines for Social Work Practice

“…The USAIDS (2012) reports that gender inequality drives the HIV epidemic and devoted the issue to discussing the gender-related risk factors that influence HIV infection among women. Evidence from multiple settings across sub-Saharan Africa suggests several ways in which gender inequalities affect women's disproportionate exposure to the risk of HIV infection (Closson et al, 2020). First, women's unequal social, economic, and political status places them at an inherent disadvantage in many aspects of life.…”