Education, economic autonomy and digitalization as factors associated with married women’s ability to make sexual and reproductive health decisions in sub-Saharan Africa: a multi-level analysis of 16 countries

Background: Despite progress in various aspects of women’s rights and health, a significant gap persists in the area of reproductive health decisions among women in Sub-Saharan Africa. This study seeks to address this gap by investigating the interplay between educational access, economic autonomy, and digital systems on the sexual and reproductive health (SRH) outcomes of married women in the Sub-Saharan African context. Methods: Leveraging cross-sectional data obtained from the latest demographic and health surveys conducted across 16 Sub-Saharan African nations between January 2015 and December 2021, the study’s focus centred on 67,437 married women. Through the utilization of binary logistic regression, model-adjusted odds ratios accompanied by a 95% confidence interval were calculated. Results: Compared to their counterparts in Benin, married women in Madagascar (aOR = 4.95, 95% CI = 4.29–5.71) and Uganda (aOR = 3.42, 95% CI = 2.99–3.90) exhibited the highest levels of agency in making SRH decisions among the 16 countries studied. Factors like higher education (aOR = 2.37, 95% CI = 2.13–2.64), familiarity with modern contraception (aOR = 3.19, 95% CI = 1.99–5.13), utilization of mobile phones for financial transactions (aOR = 1.21, 95% CI = 1.14–1.28), possession of a bank account (aOR = 1.17, 95% CI = 1.10–1.25), current employment (aOR = 1.19, 95% CI = 1.08–1.32), and engagement with the internet (aOR = 1.16, 95% CI = 1.08–1.24) were found to significantly influence SRH decisions-making across all countries. Conclusions: Enhancing the sexual and reproductive health outcomes of married women in Sub-Saharan Africa necessitates targeted efforts, particularly among those without higher education, limited contraceptive knowledge, reliance on mobile phones for financial transactions, without bank accounts, lacking internet access, and currently unemployed. By addressing these specific areas, interventions can be more effective in bridging the existing gaps in SRH decision-making among married women in this region.