Many women in sub-Saharan Africa still do not have the power to make decisions about their own reproductive health, a study conducted by the University of Johannesburg (UJ) has revealed.
“This lack of autonomy is closely linked to three connected factors — education, economic independence and digital access,” researchers at the university’s department of sociology said.
The study, conducted among 16 African countries and which surveyed more than 67,000 women, found that interconnected factors such as education, economic independence and digital access played a role in how women access contraception, healthcare and family planning, as well as the extent to which they are able to participate in joint decision-making within their households.
The study looked at data from 67,437 married women living in 16 African countries, including South Africa, Nigeria, Uganda, Zimbabwe and Ethiopia.
It found that when women have higher levels of education, earn their own income and have access to digital tools such as mobile phones and mobile money, their decision-making power increases significantly.
The study was led by Prof Kammila Naidoo and Dr Turnwait Otu Michael.
According to the researchers, these three factors work together to strengthen a woman’s ability to make informed choices about contraception, healthcare and family planning.
Women who are educated, earn a stable income and have access to digital tools are far more likely to exercise real agency over their reproductive health
— Prof Kammila Naidoo
“Women who are educated, earn a stable income and have access to digital tools are far more likely to exercise real agency over their reproductive health,” Naidoo said.
The findings come against the backdrop of serious global and regional challenges.
According to the world health organisation (WHO), 164-million women worldwide have an unmet need for contraception.
In sub-Saharan Africa, only 37% of women aged 15 to 49 are able to make their own informed decisions about reproductive healthcare and contraceptive use. In Europe, the figure is 87%.
Michael said the study found clear differences between countries.
Uganda and Madagascar ranked among the highest for women’s autonomous reproductive decision-making power, while Gambia, Guinea and Mali ranked among the lowest.
He said the pattern generally showed stronger outcomes in parts of East and Southern Africa compared with several West African countries, where women with secondary or higher education were twice as likely to take part in joint reproductive health decisions with their spouses compared to women with no formal schooling, although there were exceptions.
The study also found that economic independence was a major turning point. Women who earned their own income were far more likely to be involved in making decisions about contraception and healthcare when compared with those whose partners controlled household finances.
Digital access plays an important role, and women who have access to mobile phones, internet services and digital financial platforms are better able to access information, plan clinic visits and even make private financial transactions.
The researchers described this as a “capability chain”.
“Education increases knowledge and confidence. Income strengthens negotiating power. Digital access provides information, privacy and connection to services. When combined, these factors make it more likely that a woman can know her options, afford her choices and act on them,” Michael said.
The researchers warn that technology alone cannot fix deep-rooted gender inequality. The government must act on all three fronts at the same time. Keeping girls in school, expanding job opportunities for women, strengthening property and financial rights, and improving access to affordable digital services.
Michael said the long-term consequences of limited reproductive autonomy are serious.
“When women cannot decide if and when to have children, it affects their health, economic prospects and the well-being of future generations.”
TimesLIVE
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.