Accelerating Progress in Women's Sexual and Reproductive Health and Rights Decision-Making: Trends in 32 Low- and Middle-Income Countries and Future Perspectives

Introduction: In 1994, the International Conference on Population and Development (ICPD) Programme of Action established the empowerment and autonomy of women as fundamental to achieving sustainable economic and social progress. Three decades later, significant strides have been made in enhancing sexual and reproductive health and rights (SRHR). However, deep-rooted gender inequality continues to impede substantial progress for many. We assess the advancements made under the Sustainable Development Goals, specifically through indicator 5.6.1, which measures women's SRHR decision-making.

Methods: Using data from 76 Demographic and Health Surveys and 1 Multiple Indicator Cluster Survey in 32 low- and middle-income countries from 2006 to 2022, the study analyzed trends in women's SRHR decision-making and its subcomponents of autonomy on reproductive health care, contraceptive use, and sexual relations-among married or in-union women aged 15-49 years currently using contraception. The analysis also examined trends in decision-making disparities related to household wealth quintiles, women's education levels, and area of residence, using disaggregated population-weighted percentages.

Results: Analysis revealed a generally positive trend in women's SRHR decision-making, with gains observed in Eastern and Southern Africa and notable declines in West and Central Africa. Subindicator disparities showed variations in autonomy across health care, contraception, and the ability to refuse sex. An inequality analysis highlighted that while some countries saw a narrowing wealth gap in decision-making, others faced growing disparities. Educational and urban-rural divides also shifted, reflecting a complex landscape of progress and challenges in improving women's SRHR decision-making.

Conclusion: The analysis underscores a patchwork of progress in women's SRHR decision-making while also exposing deep disparities. These data suggest a critical need for interventions tailored to cultural and socioeconomic contexts, particularly in countries and subnational areas lagging behind. Forward-thinking strategies must prioritize enhancing women's reproductive agency, ensuring interventions are informed by community-tailored priorities and global human rights standards.