Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

Michele R Decker; Shannon N Wood; Meagan E Byrne; Nathalie Yao-N'dry; Mary Thiongo; Peter Gichangi; Funmilola M OlaOlorun; Alain K Koffi; Scott Radloff; Saifuddin Ahmed; Amy O Tsui

doi:10.1371/journal.pone.0257009

Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

PLoS One. 2021 Nov 29;16(11):e0257009. doi: 10.1371/journal.pone.0257009. eCollection 2021.

Authors

Michele R Decker^{1

2}, Shannon N Wood^{1

2}, Meagan E Byrne^{1

2}, Nathalie Yao-N'dry³, Mary Thiongo⁴, Peter Gichangi⁴, Funmilola M OlaOlorun⁵, Alain K Koffi^{2

6}, Scott Radloff^{1

2}, Saifuddin Ahmed^{1

2}, Amy O Tsui^{1

2}

Affiliations

¹ Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
² Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
³ Association Ivoirienne pour le Bien-Etre Familial (AIBEF), Abidjan, Côte d'Ivoire.
⁴ International Centre for Reproductive Health-Kenya, Nairobi, Kenya.
⁵ College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

Abstract

Background: Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence).

Methods: Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use.

Findings: Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing.

Interpretation: AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Coercion*
Cote d'Ivoire
Cross-Sectional Studies
Female
Humans
Intimate Partner Violence / psychology*
Kenya
Nigeria
Personal Autonomy*
Power, Psychological*
Reproductive Health*
Sexual Behavior*
Sexual Partners
Young Adult

Grants and funding

This work was supported by the Bill & Melinda Gates Foundation [010481]. Funders had no role in the study design, data collection, decision to publish nor preparation of the manuscript. Under the Foundation grant conditions, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.