Association between male absence and women's reproductive autonomy in sub-Saharan Africa: A cross-sectional analysis of Demographic and Health Survey Data.

Reproductive decision-making within partnered relationships in sub-Saharan Africa (SSA) is often shaped by patriarchal gender norms, with male partners commonly exerting substantial influence over family planning and contraception. These dynamics may shift when male partners migrate and are not physically present in the household. This study investigates the association between male absence and women's reproductive autonomy in SSA, using nationally representative Demographic and Health Survey (DHS) data from 30 SSA countries. A total of 269,171 women aged 15-49 in unions (married or having a partner) and with at least one child were included in the study. We used a modified Poisson regression model to examine three outcomes - women's desire for more children, use of modern contraceptives, and health autonomy - in relation to male absence as the primary explanatory variable, adjusting for sociodemographic and household characteristics. Overall, 29.35% of women reported using modern contraceptives, 61.04% desired more children, and 60.24% had autonomy in healthcare decision-making. Approximately 15.91% were not currently living with their husbands/partners. Women whose husbands/partners lived elsewhere had a lower likelihood of using modern contraceptives (PR = 0.80; 95% CI: 0.78 - 0.81) and a lower likelihood of desiring more children (PR = 0.95; 95% CI: 0.94 - 0.96), but higher likelihood of reporting health autonomy (PR = 1.10; 95% CI: 1.09 - 1.12). Furthermore, higher reproductive autonomy and contraceptive use were also associated with higher education levels, greater household wealth, urban residence, and employment. These findings highlight the complex ways in which male absence influence with women's reproductive decision-making in SSA. Strengthening women's reproductive autonomy will require addressing underlying structural inequalities, expanding educational and economic opportunities, and promoting awareness of reproductive rights. Targeted interventions that enhance equitable access to modern contraceptives are essential to reducing disparities within and across SSA countries.