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Child marriage has a variety of undesirable consequences at the peril of women’s health and autonomy. In this study, we examined the association between child marriage and sexual autonomy among women in sub-Saharan Africa. We utilised data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2019. A total of 218,578 women aged 20–49 were included in this study. Multivariable binary logistic regression models were used to show the association between child marriage and sexual autonomy. Crude odds ratio (cOR) and adjusted odds ratio (aOR) were used in presenting the results. The prevalence of child marriage and sexual autonomy was 44.51% and 83.35%, respectively. Compared to women who married at 18 years or above, those who married at less than 18 were less likely to have sexual autonomy, and this persisted after controlling for important covariates. In terms of the country-specific results, women who experienced child marriage were less likely to have sexual autonomy in Burundi, Congo DR, Nigeria, and Niger. With the covariates, lower odds of sexual autonomy were found among women with no formal education, those whose partners had no formal education, those who were not exposed to media, and non-working women. Child marriage was found to be associated with sexual autonomy. There is a need to strengthen policies and programmes such as compulsory basic education, poverty alleviation, and an increase in access to media that aim at reducing child marriage. These interventions will help to improve sexual autonomy among women, especially in this 21st century where individuals and organisations incessantly advocate for gender equality.
This study utilised data from the Demographic and Health Surveys (DHS) conducted in 31 countries in SSAs between 2010 and 2019. The DHS uses a repeated cross-sectional research design in carrying out nationally representative survey in over 85 low-and middle-income countries globally. It focuses on essential maternal and child health markers such as child marriage and sexual autonomy [26]. The data collection procedures for the surveys involve the use of a standard questionnaire comparable across countries for gathering data from women aged 15–49 and men aged 15–59 as well as data on their children. The questionnaire is often translated into the major local languages of the countries involved. To ensure the validity of the translated questionnaires, the DHS reports that the translated questionnaires, together with the version in English are pretested in English and the local dialect. After that, the pre-test field staff actively discussed the questionnaires and made suggestions to modify all versions. Following field practice, a debriefing session is held with the pre-test field staff, and modifications to the questionnaires are made based on lessons drawn from the exercise. Details of the sampling methods, procedures, and implementation can be found on the DHS website in each country’s final report [27]. The sampling procedure employed in the surveys involves a two-stage stratified sampling procedure, where countries are grouped into urban and rural areas. The first stage involves the selection of clusters usually called enumeration areas (EAs) and the second stage consists of the selection of a household for the survey. The study by Aliaga and Ruilin [27] provides details of the sampling process. In this study, a total of 218,578 women who had complete information on all the variables of interest were included in the study (Table 1). We relied on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement in writing the manuscript [28]. The dataset is freely available for download at https://dhsprogram.com/data/available-datasets.cfm (accessed on 17 February 2021) Description of the Study Sample. The outcome was sexual autonomy, which was a composite variable derived from “respondent can refuse sex,” “respondent can ask partner to use condom,” and “wife is justified in asking the husband to use condom.” The response categories of these variables were: “Yes” and “No”. The “Yes” responses were coded “1” and the “No” responses were coded “0”. An index was created with all the “Yes” and “No” answers with scores stretching from 0 to 3. The score 0 was labelled as “No” and 1 to 3 was labelled as “Yes”, where “No” represents females who did not have sexual autonomy and “Yes” if females had sexual autonomy [29]. The study used child marriage as the key independent variable. This variable was derived from the question, “at what age did [NAME] first enter marriage or cohabitation. The response to this question was in single years. For this study, the response was categorised into “married less than 18 years” = 1, where respondents stated they first entered marriage or cohabitation before the age of 18 years, and “married 18 years or more” = 2 for respondents who married or cohabited after 17 years. Data were analysed with Stata version 16.0 (StataCorp LLC, College Station, TX, USA). The analysis was done in four steps. The first step was a graphical representation of the prevalence of child marriage and the prevalence of sexual autonomy in SSA. The second step was a bivariate analysis that calculated the proportion of sexual autonomy across the explanatory variables with their p values which were derived from a chi-square of fitness. All the variables that showed statistical significance from the chi-square test were moved to the third step of the analysis. In the third step of the analysis, two hierarchical logistic regression models were built. The model I looked at a bivariate analysis between the independent variables and sexual autonomy. Model II controlled for the effect of all the independent variables in amultivariable logistic regression. In the fourth and final step of the analysis, a logistic was fitted to see the effect of child marriage on sexual autonomy, disaggregated by country. With this, two models were fitted where Model I was the crude odds ratio (cOR) and Model II was the adjusted odds ratio (aOR). The choice of the reference categories for the regression models was influenced by the sample sizes, with categories with the highest sample sizes chosen as reference categories. All frequency distributions were weighted, while the survey command (svy) in Stata was used to adjust for the complex sampling structure of the data in the regression analyses. The DHS reports that ethical clearances were obtained from the Ethics Committee of ORC Macro Inc. as well as Ethics Boards of partner organisations of the various countries such as the Ministries of Health. The DHS follows the standards for ensuring the protection of respondents’ privacy. Inner City Fund International ensures that the survey complies with the United States Department of Health and Human Services’ regulations for the respect of human subjects. Since this was a secondary analysis, no further ethical approval was required because the datasets are available for download in the public domain. Further information about the DHS data usage and ethical standards is available at http://goo.gl/ny8T6X (accessed on 17 February 2021)
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