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Women’s ability to make decisions regarding their reproductive health has important implications for their health and well-being. We studied the socio-demographic factors affecting reproductive health decision-making among women in 27 sub-Sahara African countries.    Materials and methods  The study made use of pooled data from current Demographic and Health Survey (DHS) conducted from January 1, 2010 and December 31, 2016 in 27 countries in sub-Sahara African. Binary and multivariate logistic regression models were used to investigate the associations of women’s socio-demographic factors with decision-making regarding sexual reproductive health.    Results  The proportion of women who can ask their partners to use a condom during sexual intercourse ranged from lowest in Mali (16.6%) to highest in Namibia (93.4%). Furthermore, the proportion of women who can refuse sex ranged from 18.3% in Mali to 92.4% in Namibia. Overall, approximately every five out of ten women can ask their partners to use a condom, six out ten women could refuse their partners sex and seven out of ten women could make at least 1 decision. Women from rural areas (OR = 0.51, CI = 0.48–0.54), those with no education (OR = 0.11, CI = 0.10–0.12), Muslim women (OR = 0.29, CI = 0.27–0.31), women not working (OR = 0.53, CI = 0.51–0.56) and women whose partners had no education (OR = 0.17, CI = 0.16–0.19) were less likely to make a decision on their reproductive health.    Conclusion  Residence, age, level of education, religion, occupation and partner’s education were found to be associated with women’s decision-making about sexual intercourse, condom use and reproductive health decision-making index. This study contributes to the discourse on reproductive health decision-making in Africa. Policies and intervention targeted at improving women’s autonomy and empowering them to take charge of their sexual and reproductive health issues should be focused on these factors.

Women’s reproductive health decision-making: A multi-country analysis of demographic and health surveys in sub-Saharan Africa