ORIGINAL RESEARCH article
Front. Glob. Women’s Health
Sec. Sex and Gender Differences in Disease
Socioeconomic inequality of low sexual autonomy among reproductive-age women in four selected Sub-Saharan African countries: A decomposition analysis by using Performance Monitoring for Action (PMA) data
Provisionally accepted
- 1Afya na Haki, department of evidence generation, Kampala, Uganda
- 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, Gondar, Ethiopia
- 3Deputy Director General, Afya na Haki Institute, Uganda, Kampala, Uganda
- 4Director General, Afya na Haki Institute, Uganda, Kampala, Uganda
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Abstract Background: Sexual health is a vital component of overall well-being and life happiness. The ability of women to make independent decisions regarding consensual sexual relationships is essential for their empowerment and the achievement of reproductive rights. Globally, only 55% of women can make their own decisions about sexual and reproductive health (SRH). Socioeconomic factors such as age, income, education, and early marriage significantly influence sexual autonomy. Therefore, this study aims to assess socioeconomic inequalities in sexual autonomy among women of reproductive age in four sub-Saharan African countries, using recent Performance Monitoring for Action (PMA) data. Methods: This study analyzed data from four sub-Saharan African countries—Burkina Faso, Ethiopia, Kenya, and Uganda—using the PMA project dataset. A weighted sample of 17,855 women of reproductive age was included. The dependent variable was sexual autonomy, defined as the presence of choice in sexual decision-making. Socioeconomic inequality was measured using the concentration curve and concentration index. Additionally, decomposition analysis was conducted to determine the contribution of explanatory variables to the overall inequality. Results: The weighted Erreygers normalized concentration index for low sexual autonomy was calculated as -0.184, with a standard error of 0.021 (P < 0.0001). Similarly, the corresponding concentration curve lies above the line of equality, showing that sexual autonomy is disproportionately distributed among the poor. Decomposition analysis revealed that rural residence (38.62%), followed by media access (16.52%), lower wealth quintile (13.71%), women’s education (8.87%), and husband’s education (7.24%) contribute to the overall inequality. Conclusion: Socioeconomic inequality was evident in low sexual autonomy across the four countries. According to the decomposition analysis of this inequality, the primary contributor was rural residence, followed by media access, wealth quintile, women's education, and husband's education.
Keywords: Africa, Equity, Reproductive-age women, sexual autonomy, socioeconomic inequity
Received: 05 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Angaw, Tsegaw, Muhumuza, Nakanwagi and Mulumba. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dessie Abebaw Angaw
Tigist Kifle Tsegaw
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