Attitudes toward sexual and reproductive health and rights and their associations with reproductive agency: a population-based cross-sectional study in Ethiopia, Kenya, and Zimbabwe.
Båge K, Kågesten A, et al. • Sexual and reproductive health matters • 2025
Findings suggest an association between SRHR and gender equality values and attitudes and the level of reproductive agency, and underscore the importance of addressing values and attitudes in context-specific interventions.
Key Findings
Results
Country, education, subjective social class, and religion were associated with reproductive agency across Ethiopia, Kenya, and Zimbabwe.
Data came from the 2020-21 World Values Survey (WVS) with n=3,096 respondents across three countries.
Reproductive agency was measured as perceived level of freedom of choice and control over whether, when, and how many children to have.
Respondents were categorized into high vs. low reproductive agency groups using the median as a cut-off.
Analyses were stratified by country and sex.
Results
Supportive attitudes toward equitable masculinity norms were associated with high reproductive agency in adjusted analyses.
The SRHR Support Index included five subindices to gauge SRHR attitudes.
Equitable masculinity norms was one of the subindices showing association with high reproductive agency.
Associations were identified through multivariable logistic regression analyses.
The association held after adjustment for country, education, subjective social class, and religion.
Results
Supportive attitudes toward SRHR interventions (such as safe abortion) were associated with high reproductive agency in adjusted analyses.
SRHR interventions constituted one of the five subindices of the SRHR Support Index.
The association between support for SRHR interventions and high reproductive agency was identified in adjusted multivariable logistic regression.
Safe abortion was cited as an example of the SRHR interventions captured by this subindex.
The WVS Equality Index was used separately to measure gender equality values.
Results
Supportive values toward gender equality were associated with high reproductive agency in adjusted analyses.
Gender equality values were measured using the WVS Equality Index.
This association was identified in adjusted multivariable logistic regression analyses.
The association held alongside the SRHR-specific subindices.
Analyses were stratified by both country and sex.
Results
Associations between SRHR/gender equality values and reproductive agency varied more between countries than by sex.
The three countries studied were Ethiopia, Kenya, and Zimbabwe.
Analyses were stratified by country and sex to examine this variation.
This finding suggests that national or cultural context plays a larger role than sex differences in shaping the relationship between attitudes and reproductive agency.
This result underscores the importance of context-specific interventions.
Discussion
The authors conclude that measures of SRHR progress should be critically reviewed and complemented with self-assessed items rather than solely researcher-ascribed items.
Reproductive agency was assessed using self-reported perceived freedom of choice and control over childbearing.
The authors argue that self-assessed measures better align with global SRHR agenda goals.
This recommendation is framed as necessary to support the successful implementation of global SRHR agendas.
The critique targets the common use of researcher-ascribed measures for tracking SRHR progress.
What This Means
This research suggests that people's values and attitudes about sexual and reproductive health and rights (SRHR) — including views on gender equality and norms around masculinity — are linked to how much freedom and control they feel they have over their own reproductive choices. Using survey data from over 3,000 people in Ethiopia, Kenya, and Zimbabwe collected in 2020-2021, the study found that those who held more supportive attitudes toward gender equality, equitable masculinity norms, and SRHR interventions like safe abortion were somewhat more likely to report having high reproductive agency (meaning they felt free to decide if, when, and how many children to have). Factors like country of residence, education level, social class, and religion were also associated with reproductive agency.
One of the most notable findings was that the associations between these values and reproductive agency differed more depending on which country a person lived in than whether they were male or female. This suggests that broader societal and cultural context — rather than gender alone — may shape how attitudes translate into reproductive agency. The study highlights the importance of designing interventions that are tailored to specific local contexts rather than applying a one-size-fits-all approach.
The authors also raise a methodological concern relevant to global health policy: that standard measures used to track progress on SRHR goals often rely on categories defined by researchers rather than how people describe their own experiences. This research suggests that adding self-assessed questions to surveys — where people report their own sense of freedom and control — could provide a more accurate picture of reproductive agency and help better align measurement tools with the goals of global SRHR agendas.
Båge K, Kågesten A, Uthman O, Salazar M, Puranen B, Svallfors S, et al.. (2025). Attitudes toward sexual and reproductive health and rights and their associations with reproductive agency: a population-based cross-sectional study in Ethiopia, Kenya, and Zimbabwe.. Sexual and reproductive health matters. https://doi.org/10.1080/26410397.2024.2444725