The population of sub-Saharan Africa (SSA) is expected to double by the next four decades [1]. This has made the ever-increasing population growth a major concern in SSA since the fertility rate ranges from 2.9 in Botswana to 7.2 in Niger [2]. The variations in fertility rates across the countries in SSA as a result of low utilization of contraceptives and high unmet needs for contraceptive [3, 4]. This has made contraceptive use a critical tool due to weakened maternal and child health care services [5]. The use of contraceptives contributes positively to the socioeconomic and health outcomes of couples and their families [6]. That is, contraceptive allows women, men and couples to either voluntarily or otherwise decide on birth delaying, spacing and child limiting [7]. Studies show that contraceptive use has at least reduced pregnancies and unsafe abortions whilst increasing birth spacing and pregnancy delay prospects [5, 8].
Despite considerable investments and funding of contraceptive programs, usage is still low in most countries in SSA [5, 9]. However, in 2017, more than two-thirds of married women in their reproductive ages and their partners used any modern or traditional methods of contraceptives [10]. It is believed that about 225 million people in low-and-middle-income countries who are in their reproductive ages are not using any method of contraceptive [11]. Evidence shows that socio-economic and demographic factors including place of residence, household head, educational level, age, marital status, religion and other factors have been linked to the utilization of contraceptives in SSA [5]. The varied nature of SSA countries has affected their sexual and reproductive health outcomes leading to a considerably high number of unsafe abortions [12, 13]. It is on record that most women in low-and-middle-income countries (LMICs) have an unmet need for contraceptives [14, 15].
Mali, one of the countries in SSA, is the third highest in the world with a fertility rate of 6.3 compared with 7.1 births per woman about three decades [16, 17]. The population of Mali which is around 20 million is estimated to double in the next one and a half decade [16]. This has been attributed to the estimated low prevalence of modern contraceptive utilization and their traditional practice of early marriage which has initiated a lot of females to early childbearing [17, 18]. Contraceptive use remains far from ideal as current estimates reveal that less than a quarter of married adolescents and married women in their reproductive age use modern contraceptives [17].
This has compelled the government of Mali and development partners to initiate programs that will reposition contraceptives as an essential public health and development intervention [17]. These initiatives have subsequently led to cost reduction of contraceptives, and made contraceptives more accessible with strengthened reproductive health education of religious leaders and parliamentarians [19]. However, these interventions are not likely to see the light of day due to the traditional norms which uphold high fertility and gender inequality that restricts women’s ability to make decisions in contraceptive [20]. That is, the sociocultural variations which are still in force have deprived women of contraceptive usage [2].
Although access to economic resources, the political, social and health status of women have seen some improvement, globally, women’s empowerment is essential in contraceptive utilization [5, 21]. Empirical evidence reveals that household decision-making does not favour women unlike their men counterpart [22]. It has also been noted that the modernization of many subcultures which has allowed women to receive higher education, engagement in the labour force, marry at an older age, choose their partner and live apart from their extended families have been associated with a greater women’s household decision-making [23].
A couple of researches on SSA have revealed that the status of women at the household level hurts their reproductive desires or contraceptive use [24]. In SSA, women’s low self-esteem status at the household level has placed them at a weaker level which has negatively undermined their achievement of desired reproductive and contraceptive use because men or their spouses are the decision-making authority [24,25,26,27]. The patriarchal ideology in most SSA societies, including Mali, has often seen women relegated to the backstage has led to unplanned pregnancies and unsafe abortion [28, 29].
Also, there is an impressive body of literature that has examined the role of decision-making power in contraceptive use and inadequate resource-constraint settings [23]. Some studies have shown that women’s household decision-making influences their ability to make decisions about contraceptive use [5, 21, 30]. However, studies have not focused on the role of women’s household decision-making power and contraceptive use in Mali. Hence, we examined the association between the household decision-making power of women and contraceptives in Mali. This study aside from addressing the gap in literature will not only provide the basis for policymakers to design appropriate policies and programs but will make recommendations that will help increase contraceptive use in Mali.
