Prevalence, Timing, Socioeconomic Inequalities and Determinants of Sexual and Reproductive Health Indicators among Reproductive-aged Women in Sub-Saharan African Countries

  • Michael Joshua Ekholuenetale

Student thesis: Doctoral Thesis


With a maternal mortality ratio (MMR) of 536 deaths per 100,000 live births, sub-Saharan Africa (SSA) had the highest rate of maternal deaths in 2020. This rate is 50 times higher than the MMR for high-income countries. Evidence suggests that underprivileged women, particularly those from resource-poor settings, have less access and use for sexual and reproductive health (SRH) services, which could explain the poor maternal health indices prevalent in the region.
In this thesis, I synthesized 32 peer-reviewed articles from my research conducted between 2016 and 2022 covering SRH indicators, which were explored and contextualize the thesis evidence base. Across my research designs, methods included descriptive and analytical studies.
From my studies on pregnancy care, there is low prevalence of early antenatal care (ANC) initiation and it is worrisome that the WHO new guideline for eight or more ANC contacts has not been implemented by several SSA countries. The low coverage in the utilization of maternal health services when compared with the WHO target, was found in early ANC initiation, ANC visits, institutional deliveries and post-natal care services use. The interactions between early ANC booking and improved socioeconomic status, show greater positive effect on eight ANC contacts.
In addition, my research conducted in Nigeria, showed exclusive breastfeeding (31.8%) and early initiation of breastfeeding (44.2%) had low prevalence rates, compared with the WHO target. In another study conducted across SSA countries, the prevalence of women who started breastfeeding within the first hour of giving birth ranged from 85.0% in Burundi to 23.0% in Chad. The average length of breastfeeding was 12 months. From my research, mother and newborn skin-to-skin contact (SSC) coverage was about 12% in Nigeria and approximately one- third in The Gambia.
Unintended pregnancy was largely reported in Nigeria and The Gambia, from my research. It was found that 60% of pregnancies which are terminated in Congo-Brazzaville are as a result of induced abortion. While Nigerian women reported about 11% of pregnancy termination respectively. The use of modern contraceptive method was found to be generally low across SSA countries, when compared with the national and WHO targets. Depot medroxyprogesterone acetate (DMPA) had upward trend in uptake among clients who received the contraceptive method through providers’ administration and self-injection.
Only about one-fourth (25.0%) of women had knowledge of HIV self-testing (HIVST) in South Africa as found in my research. In Nigeria, the knowledge of HIV was found to be low, when compared with the WHO target. From my research on HIV sero-prevalence, approximately one- tenth of reproductive-aged women are HIV positive in Namibia and Mozambique.
Several factors were identified to be associated with SRH indicators. Women with higher levels of socioeconomic status, decision-making power, enlightenment, urban dwellers, exposed to media use, had higher odds of pregnancy care, optimal breastfeeding practices, SSC, contraceptive use amongst others. Prominently, socio-demographic factors were found to be associated with SRH indicators.
My research findings demonstrate contributions to key SRH indicators that resulted in generating new knowledge, providing evidence and insights that inform policy decisions, programme implementation, health planning and fosters intellectual growth, as well as cross- cultural validation of existing knowledge through open science practices.
Date of Award6 Feb 2024
Original languageEnglish
SupervisorNgianga Ii Kandala (Supervisor) & Sasee Pallikadavath (Supervisor)

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