Determinants of sexual and reproductive empowerment: a cross-national analysis in five Sub-Saharan African countries

Abstract

Abstract Research has shown inconsistent associations between women’s empowerment and sexual and reproductive health (SRH) in sub-Saharan Africa (SSA), pointing to a lack of salient measures in this context. A novel measure provides an opportunity to explore different facets of SRH empowerment in SSA. Methods We used five national surveys among women 15-49 years conducted between 2019-2020 in Kenya (n=5,504), Uganda (n=2,273), Cote d’Ivoire (n=2,329), Burkina Faso (n=4,135), and Niger (n=2,228). Two measures of contraceptive and sexual empowerment were combined into a four-category SRH empowerment measure to identify the opportunity structures associated with SRH empowerment using multinomial logistic regression modeling. Results SRH empowerment was lowest in Niger and highest in Kenya. Between 15.0% and 21.7% of participants had more sexual but less contraceptive empowerment than their peers, while the opposite was true for 15.4% to 20.4% of participants. Education increased overall SRH empowerment or sexual empowerment alone in all sites and contraceptive empowerment alone in Kenya. Wealth increased overall SRH empowerment or sexual empowerment alone in three sites. Parity increased overall empowerment or contraceptive empowerment alone in all sites but decreased sexual empowerment alone in Uganda. Finally, healthcare provider contact increased overall and contraceptive empowerment in four sites while family planning media messages increased overall empowerment in two sites. Conclusion This study confirms the multidimensional nature of SRH empowerment, which varies by country, domain, and by women’s parity and social capital. Longitudinal research is needed to comprehend how women gain or lose SRH empowerment and how empowerment predicts SRH outcomes.