Association between male absence and women’s reproductive autonomy in sub-Saharan Africa: A cross-sectional analysis of Demographic and Health Survey Data
5 affiliations
- 1School of Global Studies, Faculty of Social Science, University of Sussex, Brighton, United Kingdom
- 2School of Health Sciences, Massey University, Auckland, New Zealand
- 3Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- 4School of Social Sciences, University of New South Wales, Sydney, Australia
- 5School of Population Health, University of New South Wales, Sydney, Australia
Abstract
Reproductive decision-making within partnered relationships in sub-Saharan Africa (SSA) is often shaped by patriarchal gender norms, with male partners commonly exerting substantial influence over family planning and contraception. These dynamics may shift when male partners migrate and are not physically present in the household. This study investigates the association between male absence and women’s reproductive autonomy in SSA, using nationally representative Demographic and Health Survey (DHS) data from 30 SSA countries. A total of 269,171 women aged 15–49 in unions (married or having a partner) and with at least one child were included in the study. We used a modified Poisson regression model to examine three outcomes - women’s desire for more children, use of modern contraceptives, and health autonomy - in relation to male absence as the primary explanatory variable, adjusting for sociodemographic and household characteristics. Overall, 29.35% of women reported using modern contraceptives, 61.04% desired more children, and 60.24% had autonomy in healthcare decision-making. Approximately 15.91% were not currently living with their husbands/partners. Women whose husbands/partners lived elsewhere had a lower likelihood of using modern contraceptives (PR = 0.80; 95% CI: 0.78 - 0.81) and a lower likelihood of desiring more children (PR = 0.95; 95% CI: 0.94 - 0.96), but higher likelihood of reporting health autonomy (PR = 1.10; 95% CI: 1.09 - 1.12). Furthermore, higher reproductive autonomy and contraceptive use were also associated with higher education levels, greater household wealth, urban residence, and employment. These findings highlight the complex ways in which male absence influence with women’s reproductive decision-making in SSA. Strengthening women’s reproductive autonomy will require addressing underlying structural inequalities, expanding educational and economic opportunities, and promoting awareness of reproductive rights. Targeted interventions that enhance equitable access to modern contraceptives are essential to reducing disparities within and across SSA countries.
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BibTeX
@article{bawuah2026association,
title = {{Association between male absence and women’s reproductive autonomy in sub-Saharan Africa: A cross-sectional analysis of Demographic and Health Survey Data}},
author = {Alex Bawuah and Ruth O. Ejiwale and Sylvester R. Okeke and Deborah O. Okeke-Obayemi and Sanni Yaya},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007255},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007255},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between male absence and women’s reproductive autonomy in sub-Saharan Africa: A cross-sectional analysis of Demographic and Health Survey Data
AU - Alex Bawuah
AU - Ruth O. Ejiwale
AU - Sylvester R. Okeke
AU - Deborah O. Okeke-Obayemi
AU - Sanni Yaya
PY - 2026
DA - 2026/09/15
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007255
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007255
AB - Reproductive decision-making within partnered relationships in sub-Saharan Africa (SSA) is often shaped by patriarchal gender norms, with male partners commonly exerting substantial influence over family planning and contraception. These dynamics may shift when male partners migrate and are not physically present in the household. This study investigates the association between male absence and women’s reproductive autonomy in SSA, using nationally representative Demographic and Health Survey (DHS) data from 30 SSA countries. A total of 269,171 women aged 15–49 in unions (married or having a partner) and with at least one child were included in the study. We used a modified Poisson regression model to examine three outcomes - women’s desire for more children, use of modern contraceptives, and health autonomy - in relation to male absence as the primary explanatory variable, adjusting for sociodemographic and household characteristics. Overall, 29.35% of women reported using modern contraceptives, 61.04% desired more children, and 60.24% had autonomy in healthcare decision-making. Approximately 15.91% were not currently living with their husbands/partners. Women whose husbands/partners lived elsewhere had a lower likelihood of using modern contraceptives (PR = 0.80; 95% CI: 0.78 - 0.81) and a lower likelihood of desiring more children (PR = 0.95; 95% CI: 0.94 - 0.96), but higher likelihood of reporting health autonomy (PR = 1.10; 95% CI: 1.09 - 1.12). Furthermore, higher reproductive autonomy and contraceptive use were also associated with higher education levels, greater household wealth, urban residence, and employment. These findings highlight the complex ways in which male absence influence with women’s reproductive decision-making in SSA. Strengthening women’s reproductive autonomy will require addressing underlying structural inequalities, expanding educational and economic opportunities, and promoting awareness of reproductive rights. Targeted interventions that enhance equitable access to modern contraceptives are essential to reducing disparities within and across SSA countries.
SN - 2767-3375
ER -