A study conducted by the University of Johannesburg (UJ) has revealed that many women in sub-Saharan Africa still do not have the power to make decisions about their reproductive health.
“This lack of autonomy is closely linked to three linked factors – education, economic freedom and digital access,” said researchers from the university's sociology department.
The study, conducted in 16 African countries and surveying more than 67,000 women, found that interconnected factors such as education, economic freedom and digital access played a role in whether women accessed contraception, health care and family planning, as well as the extent to which they were able to participate in joint decision-making in their households.
The study looked at data from 67,437 married women living in 16 African countries, including South Africa, Nigeria, Uganda, Zimbabwe and Ethiopia.
It found that when women have higher levels of education, earn their own income and have access to digital devices such as mobile phones and mobile money, their decision-making power increases significantly.
The study was led by Professor Kammila Naidu and Dr Turnvet Otu Michael.
According to researchers, these three factors work together to strengthen a woman's ability to make informed choices about contraception, health care, and family planning.
Women who are educated, earn steady income and have access to digital tools are more likely to exercise real agency over their reproductive health
— Professor Kammila Naidu
“Women who are educated, earn stable incomes and have access to digital tools are more likely to exercise real agency over their reproductive health,” Naidu said.
These findings come against a backdrop of serious global and regional challenges.
According to the World Health Organization (WHO), 164 million women worldwide have unmet need for contraception.
In sub-Saharan Africa, only 37% of women aged 15 to 49 are able to make their own decisions about reproductive health care and contraceptive use. In Europe this figure is 87%.
Michael said the study found clear differences between countries.
Uganda and Madagascar ranked highest in terms of women's autonomous reproductive decision-making power, while Gambia, Guinea and Mali ranked lowest.
She said this pattern generally showed stronger results in parts of Eastern and Southern Africa than in many West African countries, where women with secondary or higher education were twice as likely to participate in joint reproductive health decisions with their spouses as women with no formal schooling, although there were some exceptions.
The study also found that economic freedom was a major turning point. Women who earned their own income were far more likely to be involved in decision-making about contraception and health care than women whose partners controlled household finances.
Digital access plays an important role, and women who have access to mobile phones, internet services and digital financial platforms are better able to access information, plan clinic visits and even conduct private financial transactions.
The researchers described this as a “capability chain”.
Michael said, “Education increases knowledge and confidence. Income strengthens negotiating power. Digital access provides information, privacy, and connection to services. When combined, these factors make it more likely that a woman can know her options, afford her choices, and act on them.”
Researchers warn that technology alone cannot fix deep-rooted gender inequality. The government should work on all three fronts at the same time. Keeping girls in school, expanding job opportunities for women, strengthening property and financial rights, and improving access to affordable digital services.
Michael said the long-term consequences of limited reproductive autonomy are serious.
“When women can't decide whether to have children, it impacts their health, economic prospects and the well-being of future generations.”
Times Live