Women’s autonomy in refusing risky sex in sub-Saharan Africa

Evidence from 30 countries

Bibliographic Data

ID19594847
AuthorsEugene Budu (0000-0002-8484-9225, Korle Bu Teaching Hospital), Bright Opoku Ahinkorah (0000-0001-7415-895X, University of Technology Sydney), Joshua Okyere (0000-0003-4080-7522, University of Cape Coast), Abdul-Aziz Seidu (0000-0001-9734-9054, Takoradi Technical University), Richard Gyan Aboagye (0000-0002-3498-2909, University of Health and Allied Sciences), Sanni Yaya (0000-0002-4876-6043, Global Affairs Canada, corresponding author)
EditorsAdriana Andrea Ewurabena Biney
Year2023
Volume3
Issue9
Pagese0002350
Publication date2023-09-14
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002350
PMID37708097
OpenAlexW4386738564
LanguageEN
References cited24

Understanding the factors associated with women’s autonomy to refuse risky sex is imperative to inform the development of policies and interventions to reduce the risk of unintended pregnancies, sexually transmitted infections, unsafe abortion, and maternal mortality. This study sought to examine the prevalence and factors associated with women’s autonomy to refuse risky sex in sub-Saharan Africa (SSA). Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of thirty countries in SSA conducted from 2010 to 2020. We included a weighted sample of 260,025 women who were married or cohabiting in the final analysis. Percentages were used to present the results of the prevalence of women’s ability to refuse risky sex. We used a multilevel logistic regression analysis to examine the factors associated with women’s ability to refuse risky sex. Stata software version 16.0 was used for the analysis. We found that 61.69% (95% confidence interval [CI]: 56.22–67.15) of the women were autonomous to refuse sex if their partners have other women, and this was highest in Namibia (91.44% [95% CI: 90.77–92.18]) and lowest in Mali (22.25% [95% CI: 21.24–23.26]). The odds of autonomy in refusing risky sex was higher among women with higher education (adjusted odds ratio [aOR] = 1.88; 95% CI = 1.78–1.46) compared to those with no formal education. Employment status was also a significant predictor, with working women having higher odds of sex refusal compared to non-working women (aOR = 1.16; 95% CI = 1.13–1.18). Advocacy to improve women’s autonomy to refuse risky sex must leverage the mass media as it emerged as a significant factor. Policies and intervention to enhance women’s autonomy must also target high-risk sub-populations which constitutes adolescent girls, those with no formal education, and those without employment

Abortion · Autonomy · Confidence interval · Family planning · Logistic regression · Odds · Odds ratio · Political science · Population · Pregnancy · Psychiatry · Psychological intervention · Reproductive health · Sex ratio · Sociology · Unintended pregnancy · Adolescent Sexual and Reproductive Health · Demography · HIV/AIDS Research and Interventions · Medicine · Sex work and related issues

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