Husbands' Dominance in Decision-Making About Women's Health: A Spatial Diffusion Perspective in Sub-Saharan Africa

This article maps spatial and temporal variation in husbands' dominance in deci sion-mak ing about their wives' health using pooled Demographic and Health Surveys from 28 countries in sub-Saharan Africa in an ear lier (i.e., 2001-2005) and later (i.e., 2010-2014) period. First, we use adap tive band width ker nel den sity estima tion to show how aggre gate coun try-level esti ma tes of hus bands' deci sion-mak ing dom i nance mask enor mous spa tial het ero ge ne ity within countries. Our maps also reveal a geo graphic clus ter ing of cells with sim i lar levels of hus band's deci sion-mak ing dominance both within and between countries. Next, we use panel fixed-effects spatial regres sion meth ods to show that decreases in hus bands' deci sion-mak ing dom i nance in neigh bor ing cells are asso ci ated with decreases in hus bands' deci sion-mak ing dominance in the reference cell. These findings support a diffusion explanation for declines in hus bands' deci sion-mak ing dom i nance over time. Our ana ly ses also indi cate that school ing and urban i za tion may be impor tant chan nels through which dif fu sion occurs, which we spec u late is because these are places where peo ple are exposed to new ideas and gen der norms.