Sexual autonomy among married young women in Ghana: a multivariable modified Poisson and multivariate Poisson decomposition analysis of a large population-based survey

Abstract

Sexual autonomy is a vital aspect of women’s reproductive rights and empowerment. However, limited evidence exists on its determinants and rural–urban disparities among young married women in Ghana. This study examined the predictors of sexual autonomy and decomposed the observed urban–rural gap using nationally representative data. Data were drawn from the 2022 Ghana Demographic and Health Survey, comprising a weighted sample of 1,426 married women aged 15–24 years. Multi-variable modified Poisson regression models were used to identify predictors of sexual autonomy, accounting for sampling design and clustering. A multivariate Poisson decomposition analysis was performed to partition the urban–rural gap into components due to differences in endowments and coefficients. Compared with women with no education, those with primary, secondary, and higher education had greater autonomy. Watching television less than weekly and daily internet use were positively associated. Decomposition analysis showed that differences in the distribution of women’s characteristics (education, media exposure, and contraceptive use) accounted for more than the entire rural–urban gap, with a negative but non-significant coefficient component suggesting slightly lower returns to these characteristics in rural areas. Educational attainment and access to information strongly shape young women’s sexual autonomy in Ghana. Targeted interventions promoting girls’ education and digital inclusion could reduce rural–urban inequalities in reproductive empowerment.