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Volitional sex is central to the sexual health and well-being of women and girls globally. To date, few studies have examined women's empowerment and its application to sexual health outcomes, including volitional sex. The aim of this study was to explore the relevance of a sexual and reproductive empowerment framework to volitional sex across four geographically and culturally diverse contexts in sub-Saharan Africa. Qualitative data were collected between July and August 2017 in four sites: Ethiopia, Nigeria (Anambra and Kano states) and Uganda. A total of 352 women aged 15-49 and 88 men aged 18 and older were interviewed through 120 in-depth interviews and 38 focus group discussions (n = 440 total participants). Results describe the substantial barriers restraining women's sexual choices, particularly norms that stigmatise women's requests for sex, even within marriage. Results further highlight women's internal sexual motivations, particularly related to the enjoyment of sex and the role of sex in strengthening partner relationships. Future empowerment research and measurement should focus not only on sexual constraints, but also integrate internal motivations, in order to fully understand the factors that shape women's sexual health outcomes. [ABSTRACT FROM AUTHOR]

Economic and reproductive empowerment mutually reinforce each other. However, while many studies have examined the importance of economic empowerment for reproductive empowerment, few have investigated the reverse relationship, especially in Sub-Saharan Africa. This study uses retrospective contraceptive-use history and panel data from two time points from a peri-urban community in Ethiopia to explore the impact of quality of contraceptive use as measured by duration of use and type of method on a woman's ability to participate in the labor force, receive payment for work, and contribute to family income. Multivariate regression models were implemented based on the nature of the outcome variable. Women who reported more consistent use had statistically significant higher odds of working in the labor force and receiving cash payments. The findings illustrate the critical role of contraceptive use in enabling women to participate in the labor force and receive payment for their work. [ABSTRACT FROM AUTHOR]

The article talks about the use of contraceptive drugs in sub-Saharan Africa (SSA). It also discusses its impact on ethnic clustering, population diversity and growth. Topics include economic conditions of SSA, increase in the age of marriage for women, and the need to overcome strong cultural resistance to family planning.

Poor reproductive health constitutes one of the leading public health problems in the world, particularly in sub-Saharan Africa (SSA). We report here an academic partnership that commenced in 2003 between a US institution and six universities in SSA. The partnership addresses the human resources development challenge in Africa by strengthening public health education and research capacity to improve population and reproductive health (PRH) outcomes in low-resource settings. The partnership's core activities focused on increasing access to quality education, strengthening health research capacity and translating scholarship and science into policy and practices. Partnership programmes focused on the educational dimension of the human resources equation provide students with improved learning facilities and enhanced work environments and also provide faculty with opportunities for professional development and an enhanced capacity for curriculum delivery. By 2007, 48 faculty members from the six universities in SSA attended PRH courses at Johns Hopkins University, 93 PRH courses were offered across the six universities, 625 of their master's students elected PRH concentrations and 158 had graduated. With the graduation of these and future student cohorts, the universities in SSA will systematically be expanding the number of public health practitioners and strengthening programme effectiveness to resolve reproductive health needs. Some challenges facing the partnership are described in this article. [ABSTRACT FROM AUTHOR]

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Studies condom use for preventing HIV infection/AIDS in Sub-Saharan Africa. Heterogeneity in condom use among different clusters for both men and women; Changes in risky sexual behavior.

Background: Global monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates.Methods: Using woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country.Results: There is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4% (95% UI: 4.5-8.3) based on model estimates of 20.9% (19.6-22.2) in mid-2014 and 27.3% (26.0-28.8) in mid-2016, with change across 10 regions ranging from - 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation.Conclusions: Reliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods. [ABSTRACT FROM AUTHOR]

Objective To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. Methods The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. Findings The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Conclusion Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries. [ABSTRACT FROM AUTHOR]

Rationale: A renewed focus on women's and girls' empowerment in the era of Sustainable Development Goals reflects the belief that empowerment is central to health and development. Sexual and reproductive health (SRH) outcomes, including pregnancy and contraceptive use, may contribute to and result from empowerment. However, enhanced understanding of how women become empowered for SRH requires clear conceptualization of empowerment. Objective: We aimed to assess the applicability of a proposed framework for women's and girls' SRH empowerment (WGE-SRH) in sub-Saharan Africa. We sought to understand what shapes and motivates preferences for childbearing and contraception, exploring how women and girls navigate external pressures or rewards to exercise and achieve their reproductive goals. Methods: Grounded in the WGE-SRH framework, we conducted a qualitative study in four distinct contexts (Ethiopia, Kano and Anambra States in Nigeria, and Uganda). We implemented and analyzed 120 in-depth interviews and 38 focus group discussions with 440 women and men and translated results to refine the WGE-SRH framework. Results: Findings demonstrate the salience of women's internal motivations, including the social value and joys of motherhood, in shaping existence of reproductive choices. However, existence of choice was limited by couples' economic situations, pressures from providers, partners, and family members, and women's fears of contraceptive side effects or relationship dissolution. Despite these constraints, many found ways to exercise their reproductive choices through negotiation with partners, third party involvement in reproductive discussions, non-verbal communication, and covert use of contraception. Conclusions: The WGE-SRH framework is useful for exploring SRH empowerment, embracing the multilevel, dynamic nature of empowerment, as a process transitioning from existence of choice (autonomy) to exercise of choice (self-efficacy, decision-making, negotiation), and, ultimately, to achievement of choice. Future research and programs related to SRH empowerment should distinguish between existence and exercise of choices to promote the health and well-being of women and girls. • First cross-country study of women's and girls' sexual and reproductive health empowerment (WGE-SRH) in sub-Saharan Africa. • Internal and external factors, including economic contexts, pressures, and fear of consequences, shaped existence of choice. • Women exercise choices by negotiating, involving others, communicating non-verbally, and using contraception covertly. • Existence and exercise of choices are distinct elements of WGE-SRH that must be uniquely measured and addressed. • Findings highlight the WGE-SRH framework's utility for monitoring SRH empowerment and outcomes in research and programs. [ABSTRACT FROM AUTHOR]