Abstract
AbstractObjectiveThis study examines how women's chances of having an unintended birth is related to gender inequalities in education, employment, intra‐household decision‐making, and norms at individual, household, and community levels in sub‐Saharan Africa (SSA).BackgroundWomen in SSA have the highest rates of unintended births in the world, often with severe implications for the health and well‐being of families. A comprehensive understanding of how gender dynamics are associated with their chances of unintended birth is however lacking.MethodMultilevel binomial logistic regression models of unintended birth were estimated with harmonized data from 123 Demographic and Health Surveys including 534,533 married women living in 43,136 communities within 39 SSA countries over the period 1992–2019.ResultsThe odds of unintended birth are higher among higher‐educated women, women with a small age difference with their husband, and women living in communities with more higher‐educated women, and better (reproductive) health facilities. These women are more willing to acknowledge a birth as unintended. In communities where women are relatively more educated than their husband and in households where husbands and wives are equal in terms of education, higher occupational status, and fertility preferences, odds of unintended birth are lower.ConclusionUnintended birth is a complex reproductive experience related to local gender systems, women's relative position in intra‐household power relations, and their willingness to acknowledge a birth as unintended.ImplicationsImproving gender equality at household level may result in women's improved reproductive health. However, outcomes are also strongly shaped by the local gender system.
Highlights
Women in sub-Saharan Africa (SSA) have the highest pregnancy rates in the world
A first important observation that can be made is that at the individual and household level, and at the community level a substantial number of variables were significantly related to unintended birth
Women with a higher educational level had higher odds of unintended birth. Women who had their first marriage at an older age, who ever used contraceptives, or who experienced the death of a child had higher odds of reporting an unintended birth
Summary
Women in sub-Saharan Africa (SSA) have the highest pregnancy rates in the world. Each year, 218 of every 1000 women in the region become pregnant (Bankole et al, 2020). Whereas previous studies have identified a range of potential related factors, among others, urban/rural residence, region, ethnicity, maternal education, household decisionmaking, and family planning practices (Faye et al, 2013; Hall et al, 2016; Magadi, 2003), a comprehensive understanding of how gender dynamics are associated with women’s likelihood of experiencing this common and adverse reproductive outcome is lacking Examining this relation is all the more important since a growing number of scholars argues that reproductive health outcomes in SSA may be strongly connected to gender inequality and the position of women and men in African societies (DeRose et al, 2010; Dodoo & Frost, 2008; Zuberi et al, 2003). In the discussion we evaluate how our findings advance the literature on reproduction and reproductive health in SSA, and what the implications are for policy and practice
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