Determinant of women's autonomy in sexual and reproductive health decision-making in Tanzania: a multilevel analysis of 2022 demographic and health survey

TL;DR

This study explores factors affecting Tanzanian women's autonomy in sexual and reproductive health decisions, finding that education, wealth, and media exposure are key influences.

Contribution

The study provides a nuanced multilevel analysis of specific socio-economic and demographic factors influencing women's SRH autonomy in Tanzania.

Findings

Women with higher education levels had significantly higher odds of SRH autonomy.

Media exposure and wealth were positively associated with autonomy in SRH decision-making.

Rural women were less likely to have SRH autonomy compared to urban women.

Abstract

The critical importance of women's autonomy in sexual and reproductive health (SRH) decision-making overall well-being is widely recognized. Existing research often provides only a generic understanding without specifically identifying the nuanced socio-economic, cultural, and demographic factors that truly enable or hinder women's autonomous SRH in Tanzania. High adolescent fertility and ongoing disparities in healthcare decision-making autonomy highlight a significant gap between policy intentions and lived realities. Therefore, this study aimed to close this gap by assessing the determinants of women's autonomy in sexual and reproductive health decision-making.

This study employed an analytical cross-sectional design, utilizing secondary data from the 2022 Tanzania Demographics and Health Survey. Women's autonomy in SRH decision-making was an outcome variable derived from three questions assessing autonomy over: (1) sexual relations, (2) contraceptive use, and (3) reproductive health care. This study's analysis included 9,252 women in sexual unions. The data were analyzed using multilevel mixed-effects logistic regression, employing four models to identify determinants of women's autonomy in SRH.

The prevalence of women's autonomy in SRH was 49.6% (95%CI: 47.5–51.8). The individual factors influencing SRH decision making autonomy were, women aged 35–49 years (AOR = 1.33, 95%CI: 1.09–1.61), women with primary education (AOR = 1.49, 95%CI: 1.31–1.70) and secondary or higher education (AOR = 2.16, 95%CI: 1.83–2.55) were more likely to have autonomy in SRH decision making. Women in rich households (AOR = 1.19, 95%CI: 1.02–1.40) and those with media exposure (AOR = 1.49, 95%CI: 1.33–1.67) had higher odds of autonomy in SRH than their counterparts. At the community level, women in rural settings (AOR = 0.73, 95%CI: 0.61-0.87) were less likely to have autonomy in SRH compared to women in urban settings.

This study found that nearly half of Tanzanian women lacked autonomy in SRH decision-making, significantly influenced by factors such as age, education, media exposure, current employment status, parity, wealth index, and geographic region. To address these disparities, comprehensive and context-specific interventions are necessary to overcome the cultural and socio-economic challenges faced by underserved populations.

Figures