Across sub-Saharan Africa, many married women still lack the power to determine key aspects of their reproductive health and family planning. Research led by the University of Johannesburg (UJ) found that this limited autonomy is closely linked to three interconnected factors, namely education, economic independence and digital access.
Drawing on data from 67,437 married women across 16 African countries, the multi-country study found that when education, regular income and digital access come together, women’s decision-making power increases markedly. Those who enjoy higher levels of education, earn their own income, and have access to digital tools are significantly more likely to make informed and independent decisions about contraception, healthcare, and family planning, as well as to participate meaningfully in joint decision-making within their households.
The study was led by Professor Kammila Naidoo, Executive Dean of the Faculty of Humanities and a Professor of Sociology, UJ, in collaboration with Turnwait Otu Michael, Postdoctoral Research Fellow. Their work provides cross-country evidence on how education, economic independence and digital access intersect to shape women’s reproductive decision-making across Africa.
“Women who are educated, earn a stable income and have access to digital tools are far more likely to exercise real agency over their reproductive health,” said Prof Naidoo. “Importantly, these advantages not only strengthen independent decision-making. They also enable more balanced and meaningful joint decision-making within households, compared to women who lack these combined resources.”
According to the World Health Organization, 164 million women worldwide have an unmet need for contraception, and one in three women has experienced physical or sexual violence in her lifetime. The disparity in decision-making power is especially severe in sub-Saharan Africa, where only 37% of women aged 15 to 49 can make their own informed decisions about reproductive healthcare and contraceptive use. In Europe, the figure stands at 87%, exposing a profound global imbalance in autonomy, protection and access to care.
The consequences extend far beyond statistics. The ability to decide whether and when to have children directly affects a woman’s health and survival, her educational attainment, her economic participation and her long-term wellbeing. Limited decision-making power can entrench cycles of poverty and inequality across generations.
“Many married women in sub-Saharan Africa do not have the freedom to make decisions about their reproductive health. In numerous households, these decisions are shaped primarily by partners, extended family members or deeply rooted social norms, rather than by the women whose lives are most directly affected,” said Dr Michael.
Dr Michael added that the study found that women with secondary or higher education were twice as likely to participate in joint reproductive health decision-making with their spouses compared to women with no formal schooling.
“Education not only expands access to accurate information about contraception and healthcare options, but also strengthens confidence, communication skills and bargaining power within households. In effect, schooling translates into measurable influence over decisions that shape women’s health and futures.”
Prof Naidoo cautions that education alone does not automatically translate into authority at home. While schooling expands access to information and builds confidence in navigating contraceptive options, it is economic independence that shifts the balance of power within households.
“Women who earned their own income were far more likely to take part in decisions about contraception and healthcare than those whose partners controlled all household finances,” she said. Financial contribution strengthens negotiating power and reduces dependence in decisions that directly shape women’s health and futures.
Digital access further reinforces this momentum. Women with access to mobile phones, internet services and digital financial platforms such as mobile money were more able to initiate and sustain discussions around family planning and reproductive healthcare. In countries where mobile money is widely adopted, the gains in decision-making power were even more substantial.
“Most importantly, our models showed that the combination of education, financial autonomy and digital access had a far greater impact on women’s decision-making than any one of these factors on its own.”
The researchers contend that policy responses must match the complexity of the challenge. Isolated interventions are unlikely to deliver lasting change. “Giving girls formal education without developing their ability to earn income may not translate into decision-making power,” they caution. Education, economic empowerment and digital inclusion must be pursued in tandem, supported by digital literacy training, access to financial services and policies that enable women to work, save, borrow and own property.
The researchers stress that simply widening access to technology will not, on its own, dismantle deeply rooted power imbalances within households. Without confronting entrenched social expectations and gender norms, digital tools cannot translate into genuine authority. Community and couple-focused initiatives that promote open dialogue and shared decision-making are essential to breaking long-standing barriers.
“By analysing data from multiple African countries rather than a single national context, the study offers strong comparative evidence to inform regional policy and intervention strategies. It reinforces the growing contribution of the University to research on population health, social determinants of wellbeing and gender dynamics across the continent,” says Dr Michael.
At a time when reproductive health rights remain contested globally, the findings deliver a decisive message. Expanding women’s agency requires more than policy statements. It calls for sustained and coordinated investment in education, economic opportunity and digital inclusion, combined with intentional efforts to reshape norms within households and communities.
Prof Naidoo concludes, “If we are serious about advancing women’s autonomy, we must move beyond fragmented interventions. When education, economic empowerment and digital access converge, they create the conditions for real and lasting change in how women participate in decisions that shape their health, their families and their futures.”
