Married women’s decision-making autonomy on modern contraceptive use and its associated factors in high fertile sub-Saharan Africa countries: a multi-level analysis of Demographic and Health Surveys

BACKGROUND: For better maternal and child health, women’s independence on reproductive health issues is crucial; however, couples are restricted from discussing openly with their partner. Regarding this, information about women’s decision-making autonomy is low in the world, including Sub-Saharan Africa; therefore, this study was aimed to assess married women’s decision-making autonomy on modern contraceptive utilization in high fertility SSA countries. METHODS: Data for this study was obtained from the most recent (2010–2018) Demographic and Health Surveys. A total of weighted sample of 14,575 married reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of decision-making autonomy on modern contraceptive utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance. RESULTS: Overall prevalence of married women decision-making autonomy on modern contraceptive utilization in the high fertile SSA countries is 25.28% (95% CI:18.32%, 32.24%). The factors significantly associated with the decision-making autonomy on modern contraceptive utilization were women’s age 25–34 years (AOR = 1.88, 95% CI = 1.84–1.93) and 35–49 years (AOR = 1.90, 95% CI = 1.82–1.92), had media exposure (AOR = 1.13, 95% CI = 1.00- 1.28), Number of alive children, 1–2 (AOR = 2.35, 95% CI = 1.38–4.01), 3–4 (AOR = 2.98, 95% CI = 1.74–5.10), [Formula: see text] 5 (AOR = 2. 82, 95% CI = 1.63–4.86), educational status; primary education (AOR = 1.93, 95% CI = 1.77–2.83), Secondary and higher (AOR = 2.11, 95% CI = 1.78–2.89), Community media exposure (AOR = 1.80, 95% CI = 1.38–2.34), Community level poverty, (AOR = 1.43, 95% CI = 1.09–1.86) and resides in rural (AOR = 0.67, 95% CI = 0.64–0.71). CONCLUSION: Women’s decision-making autonomy on modern contraception utilization in this study was low. Therefore, the government should promote women’s autonomy on contraceptive use as an essential component of SRH rights through mass media, with particular attention for, women living in the poorest communities, and those residing in rural settings of the country. Moreover, health professionals should counsel the women about the benefits of using modern contraceptive to help them managing their number of children.