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Spousal age differences and women’s contraceptive use in sub-Saharan Africa

Contraception and Reproductive Medicine volume 9, Article number: 45 (2024) Cite this article

Abstract

Background

This study examines the likelihood of contraceptive use among married women in sub-Saharan Africa, focusing on the influence of spousal age difference.

Methods

Binary logistic regressions predicting contraceptive use were estimated using a sample of 478,193 women in first union from 29 sub-Saharan African countries spanning two decades from 1999 to 2022. The data were sourced from the Demographic and Health Surveys (DHS).

Results

The regression results indicate that spousal age difference is negatively correlated with the likelihood of contraceptive use with each additional year reducing the odds of using contraception by 1.1 percent. The association between the two variables has remained largely consistent over time. The findings also show substantial variation in the influence of spousal age differences on contraceptive use ranging from statistically significant and negative odds in some countries to not statistically significant but positive odds in others. Measures of female autonomy, education and healthcare decision-making, had a modest influence on the size and significance of the association between spousal age difference and contraceptive use.

Conclusions

The relationship between spousal age difference and contraceptive use is of concern given the prevalence of age-disparate relationships in the context. These findings add to the literature on the potentially negative implications of age-disparate relationships, while highlighting that the association is not uniformly negative across countries.

Plain English Summary

This study examined the relationship between the age difference between a woman and her spouse and her likelihood of using contraception. The analysis used Demographic and Health Survey data from 29 sub-Saharan African countries. The surveys spanned a 24-year period from 1999 to 2022. The larger the age difference between a woman and her spouse, the less likely she is to use contraception. The findings add to the research on the potentially negative influence of relatively large differences between a woman’s age and that of her partner and highlight the need for additional research on understanding the pathways through which spousal age differences influences contraceptive use.

Introduction

Substantial literature has studied the determinants of contraceptive use in sub-Saharan Africa where contraceptive prevalence rates in the region remain lower than in other parts of the world [1]. Understanding the barriers to contraceptive use is of great academic and policy interest given the demographic, health, and economic benefits of contraception. The use of contraception is linked to improved maternal and infant outcomes, and reductions in unintended pregnancies, unsafe abortions, and maternal deaths [2,3,4]. Contraceptive use has also been linked to public sector health savings by preventing unintended pregnancies [5,6,7].

The individual determinants of contraceptive use are well-documented [8,9,10] as are partner characteristics such as partner education [9, 11, 12], and age relative to wife [12,13,14] on women’s contraceptive use. Age-disparate relationships are generally associated with negative outcomes among women. Age-disparate relationships have been defined as unions in which one partner is more than five years older [15, 16]. This definition considers women in age-disparate marriages as a homogenous group without adequate consideration of disparities within the group in terms of outcomes based on the size of the age difference. The age difference between partners is significantly associated with sexually transmitted infection risk [17,18,19] and an increased likelihood of risky sexual behaviors such as unprotected sex and multiple concurrent partners [17, 20, 21]. Women in age-disparate relationships are also at greater risk of intimate partner violence [22, 23].

The adverse consequences of age-disparate relationships are mainly attributed to the power dynamics at play where younger women have lower autonomy and decision-making power in unions with larger age differences [24,25,26]. Research has shown that decision-making around contraceptive use often involves negotiation between partners, with power differentials influencing the decision to use contraception or not [27,28,29]. Reduced female autonomy has implications for contraceptive use given the positive influence of female empowerment on contraceptive behavior [25, 26, 30,31,32]. Spousal age differences can thus be indicative of unequal power dynamics within marriages, with implications for women’s agency and autonomy in reproductive decision making.

This study aimed to investigate patterns and trends in the relationship between spousal age difference and women’s contraceptive use in 29 sub-Saharan African countries. The central hypothesis is that the size of the spousal age gap is inversely correlated with the likelihood of using contraception. The study further examines differences over time and across countries in the correlation between spousal age difference and contraceptive use. Finally, it explores whether women’s autonomy moderates the strength of the association between spousal age difference and contraceptive use.

This study contributes to a deeper understanding of marital dynamics and power structures within relationships in sub-Saharan Africa regarding contraception usage. By examining contraceptive use across 29 countries over a two-decade period, this study offers a comprehensive overview of the influence of spousal age differences on women’s reproductive choices in this sub-region. Second, by assessing trends in the relationship between contraceptive use and spousal age differences, the study sheds light on the extent to which reproductive autonomy for women in age-disparate marriages may have changed over time. Furthermore, the study also examines the potential influence of women’s autonomy, in this case, education and decision-making about healthcare, as these factors may play a role in shaping decision-making concerning contraceptive use.

Data and methods

This study used data pooled from 91 standard Demographic and Health Surveys (DHS) conducted in 29 countries in sub-Saharan Africa between 1999 and 2022 [33] (see Table 5 in Appendix). Countries with only one survey conducted during this period were excluded from the sample. The rationale for pooling the datasets across time and countries was to obtain data that would allow the analysis of both time trends and cross-national differences. In pooling the sample, each survey contributed equally to the analysis, while individual sampling weights within surveys were applied.

The sample was restricted to currently married women in first union aged 15 – 49 years as information on partner age is available only for the current partner. Women who reported being pregnant at the time of the survey, with missing partner information, who reported being infecund or menopausal, and who reported never having had sex were excluded from the sample.

Binary logistic regression analysis was used to predict current contraceptive use. The dependent variable for the analysis was whether the woman is currently using any method of contraception (modern, traditional, or folkloric). The main independent variable was the spousal age gap which is calculated by subtracting the age of the woman from the age of the husband reported by the woman. The age difference distribution was winsorized [34] to delete outliers that fell below the 0.5th percentile and above the 99.5th percentile of the sample. The original range for the spousal age difference was -34 to 76 years. After winsorization, the spousal age difference ranged from -17 to 39 years in the final analytic sample of 478,193 women.

Marriage cohorts based on the year of first marriage were constructed for the analysis of time trends. Women married before 1975 were excluded from the analysis due to the small sample sizes in those cohorts.

The analysis controlled for variables that we conceptualized might influence the likelihood of contraceptive usage based on prior literature: woman’s age, religion,Footnote 1 husband’s education, number of children alive, gender composition of children alive, type of place of residence (urban/rural), polygamous union, year of survey, country, co-residence with husband, heard about family planning in the media in the last few months, heard about family planning from a health worker (visited by a family planning worker in the past 12 months/ told about family planning at the health facility) and couple-level fertility preferences: a variable constructed by combining the questions asked in the DHS on whether a woman wants another child and husband’s desire for children. The purpose of including these variables in the analysis is to examine whether even after controlling for mediating effects of these variable the conceptualized expected relationship between spousal age difference and contraceptive use persists.

Women’s educational level and decision-making concerning women’s health were included as proxies for women’s reproductive autonomy with the assumption that they will moderate the influence of spousal age difference on contraceptive use.

The analysis comprises three models on the pooled sample. The first model includes the independent and control variables to estimate the association between spousal age difference and contraceptive use. The second model adds the two moderating variables to assess whether they influence the strength of the association. The third model introduces an interaction between spousal age difference and year of marriage to determine whether there have been changes over time in the association between spousal age difference and contraceptive use. A fourth set of regressions examine the relationship between spousal age and contraceptive use in various countries, providing estimates at the national level, to provide insight on the cross-national differences in this relationship.

Results

Table 1 presents summary statistics of the sample. Almost a third (31.8%) of the total sample was currently using contraceptives. The mean spousal age difference in the sample is 8.3 years. The spousal age difference for women not using contraception (9.1) is about two-and-a-half years more than for women using contraception (6.7). With respect to year of marriage, a higher share of the women using contraception belong to the youngest marriage cohorts.

Table 1 Descriptive statistics of sample
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A higher share of women using contraception reported that they usually make the decision on healthcare choices on their (24.1%) compared to those not using contraception (15.4%). Five in every 10 (52.6%) women not using contraception reported that their husband alone made decisions on their healthcare compared to three in every 10 (31.9%) women who was using contraception.

The share of women not using contraception that had no education (54.9%) was more than twice the share of women who were using contraception (20.4%). Conversely, the share of women with tertiary education was higher for those using contraception (7.4%) compared to those who were not using (2.9%).

Table 2 presents variation in spousal age differences for selected covariates. The age difference decreases successively for each marriage cohort suggesting that spousal age gaps in the sub-region has been narrowing over time. Women whose husbands alone usually decide on their healthcare have the largest spousal age difference (9.5) followed by women who have someone else making decisions on their healthcare (8.4). The largest spousal age difference is observed for women with no education (10.2), more than a three-year difference compared to women with all other levels of education (6.9 or less).

Table 2 Spousal age difference by selected covariates
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There is substantial variation by country in the mean spousal age difference – ranging from 4.1 in Rwanda to 13.1 in Guinea. Generally, the countries with the largest spousal age differences are in West Africa while countries in East Africa have smaller age gaps between spouses.

Figure 1 presents the correlation between spousal age difference and current contraceptive use at the country level, indicating that countries with larger spousal age gaps generally have lower contraceptive prevalence.

Fig. 1
figure 1

Scatterplot of spousal age difference and contraceptive use by country

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Table 3 presents results of the logistic regression. Model 1 indicates that a one-year increase in the spousal age gap is correlated with a 1.4 percent lower likelihood of contraceptive use which is statistically significant. The results also indicates that the likelihood of using contraception is positively correlated with the year of marriage.

Table 3 Results of logistic regression predicting contraception use
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Model 2 adds the measures of women’s autonomy which leads to a marginal reduction in the odds ratio for spousal age difference and reduction in the significance of the coefficient. This suggests that while these variables can be considered to have a moderating influence on the association between spousal age difference and contraceptive use, their influence is relatively minor.

In Model 3, none of the interaction terms are statistically significant suggesting that the relationship between spousal age difference and contraceptive use has largely remained unchanged over time. The odds ratios on the interaction terms also do not consistently increase over time, as observed for the coefficients for the marriage cohort. In this third model, there is a further reduction in the size and significance of the odds ratio for spousal age difference – each additional year is associated with a 1.1% lower likelihood of using contraception.

Table 4 presents country-level estimates of the association between spousal age difference and contraceptive use. The results indicate substantial variation across countries in this relationship. In 11 of the 29 countries, the association is not statistically significant. Within this group the odds were negative for seven (7) and positive for four (4). In the remaining 18 countries, spousal age difference had a statistically significant and negative relationship with contraceptive use ranging from odds ratio of 0.97 to 0.99. The largest odds are recorded in Namibia where an additional year was correlated with a 2.6 percent lower likelihood of using contraception, which is twice the size of that recorded for the pooled sample (1.1%).

Table 4 Cross-national differences in the association between spousal age difference and contraceptive use
Full size table

Discussion

This study examined contraceptive usage of women in 29 sub-Saharan African countries focusing on the influence of spousal age differences. The results indicate that the odds of contraceptive use are negatively correlated with the size of the spousal age difference, a finding that is consistent with previous studies on the subject [13, 14, 35, 36]. Large spousal age differences are often believed to confer gender imbalances in decision making in favour of males particularly in patriarchal settings in Africa [13].

However, the results show substantial variation across the countries in the association between spousal age difference and contraceptive use, indicating that spousal age differences may not be detrimental with respect to contraceptive use in all settings. Among the countries where there is a statistically significant negative relationship, there is diversity in terms of geographic sub-region, level of contraceptive use, and mean spousal age difference. While countries in West Africa with larger spousal age differences predominate the countries where the association between spousal age difference and contraceptive use is not statistically significant, the group also includes two countries with the lowest spousal age differences. This variation highlights the need for subsequent research to further investigate the possible socio-cultural beliefs and practices, gender norms, and macro-level factors that could influence the association between the two variables.

The findings further indicate that the strength of the association between spousal age difference and contraceptive use has not changed over time, although contraceptive use is higher for women in later marriage cohorts.

The findings of this study support existing research on the potentially negative implications of age-disparate relationships. The explanation for the relationship between spousal age difference and contraceptive usage is the power imbalance in age-disparate marriages [24,25,26]. The magnitude and significance of the difference in contraceptive use for women in age-disparate relationships are somewhat reduced with the inclusion of measures of education and healthcare decision-making suggesting that promoting female autonomy may mediate the influence of spousal age differences on women’s health outcomes.

The influence of individual-level factors correlated with larger spousal age differences such as lower educational attainment [24, 37], autonomy in healthcare decision-making [38], age at first marriage [24] and rural residence [24], on contraceptive use suggests that women in age-disparate relationships may be doubly disadvantaged highlighting the importance of continued study and development of targeted interventions. This is because the factors that are correlated with large spousal age differences are also determinants of contraceptive use, many of which have odds that are greater in both size and magnitude relative to that of spousal age difference.

The results also highlight other statistically significant predictors of contraceptive use which are consistent with previous literature such as employment [9, 39], parity [39,40,41] hearing about family planning [40], and partner education [39]. Consistent with previous literature, this study found substantial variation across countries [40, 41] in contraceptive prevalence with the lowest rates recorded in the Western and Central regions which also tend to have higher spousal age differences.

Although the literature indicates that patterns of contraceptive use differ by marital status [42, 43], this study’s sample was limited to married women. This is because the Demographic and Health Survey does not collect data on the current partner age of unmarried women.

To conclude, our major conceptualized hypotheses is that countries where there are large spousal age differences which is indicative of unequal power dynamics and likely to be detrimental contraceptive use, the results attest to that fact, because we noticed that countries with larger spousal age gaps generally tended to have lower contraceptive prevalence. This result might be due to fact that women this category may lack the autonomy to make independent decisions and may constrain their use contraception. It is also significant to highlight the fact that women of more recent marriage cohorts tend to have higher contraceptive use than earlier cohorts. This is result is expected and consistent with trends in contraceptive use in Africa where almost everywhere in the continent contraceptive use has been increasing over time.

Availability of data and materials

The datasets analyzed in the study are publicly available and can be accessed from the Demographic and Health Survey website at https://dhsprogram.com.

Notes

  1. Five surveys, Lesotho (2004), Niger (2012), Rwanda (2000), and Tanzania (2005; 2015/16), did not have data on religion. For the countries that have a predominant religion in the country based on their other DHS surveys i.e. 95% of the women belonged to one religion, the religion was imputed. For Niger, all women were recoded as Muslims, and for Lesotho all women are recoded as Christian. For the other countries, a category not available (N/A) was created. Women who had missing values for religion in surveys where religion was asked were also added to the religion N/A category.

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This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Regional Institute for Population Studies, University of Ghana, Post Office Box LG 96, Legon, Accra, Ghana

    Pearl S. Kyei & Ayaga A. Bawah

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Contributions

PK conceptualized the study, analyzed data, interpreted the data analysis and was a major contributor to writing the manuscript. AB conceptualized the study, interpreted the data analysis and was a major contributor to writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ayaga A. Bawah.

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Appendix

Appendix

Table 5 List of surveys included in analysis
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Kyei, P.S., Bawah, A.A. Spousal age differences and women’s contraceptive use in sub-Saharan Africa. Contracept Reprod Med 9, 45 (2024). https://doi.org/10.1186/s40834-024-00306-7

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Keywords

Contraception and Reproductive Medicine

ISSN: 2055-7426

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