# 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.

## Key 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.