Turnwait Otu Michael, University of Johannesburg and Kammila Naidoo, University of Johannesburg

Many married women in sub-Saharan Africa don’t have the freedom to make decisions about their sexual and reproductive health. Global data show that only 37% of women in the region aged 15-49 can make their own informed decisions about sexual relations, contraceptive use and reproductive healthcare in the region. In Europe, 87% of women have this freedom.

These decisions shape whether women survive pregnancy, avoid unsafe abortions, stay in school, participate in paid work and plan the size of their families. Yet in many homes, decisions about engaging in sex, using contraception or seeking healthcare are strictly determined by husbands, in-laws or powerful social norms rather than by women themselves.

Researchers and policymakers have examined factors that could improve how women make such decisions independently or with their spouses. Findings from previous studies have produced mixed and sometimes contradictory results. Some showed that variables such as education, income or technology had a positive influence on women’s sexual autonomy. Others found no significant effect.

A possible reason could be that these factors have been investigated singly on different occasions, focusing on individual countries each time. The question then is what happens when these three forces – education, economic autonomy and digital access – are examined together across several countries.

We are population health researchers focusing on population dynamics, social determinants of health, and reproductive and maternal health. We conducted research in a bid to answer this question.

Our findings show how these three variables interact to influence women’s decisions. We developed a model to assess their interactive effects, using data collected from 67,437 married women across 16 sub-Saharan African countries.

Our findings showed that a combination of the three variables had a strong influence on women’s reproductive autonomy. Educated women with regular income and access to digital tools could, to a large extent, make independent choices about their sexual and reproductive health. They could also genuinely make choices with their spouses than those without the three variables.

The results show that investing in education, digital innovation and women’s economic empowerment influences how women are involved in the decision-making process with spouses regarding their sexual and reproductive health.

Identifying the problem

The World Health Organization reports that 164 million women globally have an unmet need for contraception and one in three women have experienced physical or sexual violence in their lifetime.

Records show that 257 million women globally are forced by their partners to have sex without negotiating the use of a condom or making decisions about their reproductive healthcare.

This affects the women’s health, body, safety and rights.

We asked three questions in our research. First, do women with secondary school education but no income have the same decision-making power as those with both education and a bank account?

Second, does having access to the internet or mobile money make a difference when women want to negotiate contraceptive use?

Third, how do these factors differ across sub-Saharan African countries?

We then analysed the demographic and health survey data collected in 16 African countries. Some of the countries were Nigeria, Uganda, Rwanda, Malawi, Madagascar and South Africa.

The analysis focused on four key questions asked of married women:

• • Can you refuse sex if you do not want it?

• • Can you ask your partner to use a condom?

• • Who usually decides on contraception?

• • Who usually decides on your healthcare?

Women who could say “yes” to these questions or make decisions on their own or jointly with their husband were counted as having decision-making power over their sexual and reproductive health.

What we found

Education: Well-educated women were twice as likely to decide their reproductive health together with their spouses than women with no education. Education gives women the opportunity to have access to information regarding contraceptives. This in turn helps them to develop confidence in their use.

Economic independence: Economically strong women have more freedom to make reproductive decisions than women whose husbands have total control of household spending.

Digital access: Women with access to digital tools, such as mobile phones for financial transactions, access to the internet, or digital banking accounts, had more freedom to make decisions regarding sex, use of contraceptives and reproductive health with spouses than women who did not. These improvements were generally significant, particularly in countries where mobile money is widely used.

Most importantly, our models showed that the combination of education, financial autonomy and digital access had more influence on women’s decisions than when these factors were examined in isolation.

Looking ahead

Educational, digital and financial initiatives should work in an interconnected manner. Giving girls formal education without developing their ability to earn income may not translate into decision-making power.

Exposure of women to digital literacy skills needed for financial digital services and health information is important.

This should be linked to policies that enable married women to work, save, borrow and own property.

Improving access to digital tools without addressing gender norms doesn’t change women’s ability to make substantial decisions at home. Programmes to help communities and couples discuss these issues could help lift old barriers.

Turnwait Otu Michael, Postdoctoral Research Fellow, University of Johannesburg and Kammila Naidoo, Professor of Sociology, University of Johannesburg

This article is republished from The Conversation under a Creative Commons license. Read the original article.