Married Women Decision-Making Autonomy on Contraceptive Use in East Africa: A Multilevel Analysis of Recent Demographic and Health Survey

The utilization of contraceptives depends on women's autonomy in making decisions. Limited and inconclusive information is available on women's decision-making autonomy to use contraceptives in East Africa. Therefore, the main objective of this study was to assess married women's decision-making autonomy on contraceptive use and associated factors in East African countries. The most recent Demographic and Health Surveys were used for this study. The study included a total weighted sample of 41,893 married reproductive-age women. A multilevel mixed-effect binary logistic regression model was fitted. The prevalence of married women's decision-making autonomy on contraceptive use was 18.91% (95% CI: 18.54, 19.29). Respondents who are employed (AOR = 1.24; 95% CI: 1.03, 1.44), having more than two alive children (AOR = 1.38; 95% CI: 1.13, 1.67), and visited a health facility in the last 12 months (AOR = 1.22; 95% CI: 1.05, 1.45), urban residency (AOR = 1.39; 95% CI: 1.27, 1.50), lower middle-income level 1.37 (AOR = 1.37; 95% CI: 1.17, 1.60), and community media exposure to family planning message (AOR = 1.25; 95% CI: 1.04, 1.45) were significantly associated with women's decision making autonomy on contraceptive use. Despite the fact that every woman has the right to participate in her own healthcare decisions, less than one-fifth of married women in East Africa have contraceptive decision-making autonomy. Hence, Women's decision-making autonomy on contraceptives should be promoted through mass media as an essential part of sexual and reproductive rights, with particular attention paid to rural women, women with no children, and women living in low-income households.