Factors associated with married adolescent girls’ and young women’s participation in decision-making regarding sexual and reproductive health in Tanzania: a nationwide cross-sectional survey

Abstract

BACKGROUND: Married adolescent girls and young women's (AGYW) participation in sexual and reproductive health (SRH) decision-making is a critical factor for their overall health and well-being. High adolescent fertility rates and disparities in healthcare decision-making participation highlight a significant gap in understanding the dynamics that influence AGYW's involvement in SRH decisions. Therefore, this study aimed to address this gap by examining the factors associated with married AGYW's participation in decision-making regarding SRH in Tanzania. METHODS: A cross-sectional study design was employed. This study analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS), focusing on a weighted sample of 2,178 married AGYW. The data were weighted using the individual weight for women (v005/1,000,000). Multivariable modified Poisson regression was used to identify factors significantly associated with married AGYW's participation in decision-making regarding SRH. Statistical significance was determined at the 5% level. RESULTS: The study found that the participation of married AGYW in SRH decision-making was 41% (95% CI = 37.4, 44.0). Participation decision-making varied across zones, with the highest in the Southern highlands (72.3%) and the lowest in the Western zone (15.4%). The study found that having primary education (APR = 1.31, 95% CI = 1.05, 1.64), secondary education/higher (APR = 1.87, 95% CI = 1.45, 2.42), being employed (APR = 1.28, 95% CI = 1.12, 1.47), listening to radio (APR = 1.34, 95% CI = 1.15, 1.56), covered by health insurance (APR = 1.30, 95% CI = 1.04, 1.62), husband /partner with primary education (APR = 1.32, 95% CI = 1.02, 1.72) and secondary/higher education (APR = 1.35, 95% CI = 1.02, 1.80) had significantly associated with participation in decision-making regarding SRH among AGYW. CONCLUSION: The results indicate that AGYW participation in SRH decision-making remains low. To enhance the involvement of married AGYW in these decisions, it is essential to implement targeted educational programs that include workshops and community-based education, especially for those with limited educational backgrounds. Furthermore, empowering women through various economic activities is crucial. Stakeholders should intensify their efforts to achieve universal health coverage for AGYW, ensuring equitable access to SRH services.