Is Reproductive Agency Associated With Subjective Well-being? A Population-based Cross-sectional Study Among Men and Women in Four Sub-saharan African Countries Using the World Values Survey

Abstract Background We investigated the association between reproductive agency and subjective well-being among respondents of reproductive age in four African countries. Methods We used nationally representative data from the World Values Survey (WVS) conducted in Ethiopia, Kenya, Nigeria, and Zimbabwe between 2017–2021 (N = 4,948). Subjective well-being was measured using four items on perceived: i) life satisfaction (range 1–10), overall life agency (range 1–10), health status (range 1–5), and happiness (range 1–4). Reproductive agency was measured by asking respondents to rank their freedom of choice and control over whether, when, and how many children to have (range 1–10). Pearson’s chi-squared test, bivariate, and multivariable logistic regression were used to compare subjective well-being between respondents of high vs low reproductive agency using the median as cutoff, stratified by country and sex, calculating adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results The analytical sample included 4,302 respondents. Half (55%) rated their reproductive agency as high (median 8; IQR = 5). Two-thirds (66%) rated their life satisfaction as high (median 5; IQR = 4), and half (51%) their overall life agency as high (8; IQR = 5). Most (75%) reported themselves as healthy (median 4; IQR = 2) and happy (median 3; IQR = 1). In adjusted analyses, high reproductive agency was associated with higher life satisfaction (aOR 1.28, 95% CI 1.11–1.46) and overall life agency (aOR 3.65 95% CI 3.20–4.17). When stratifying by sex and country, associations remained for respondents in Nigeria and Zimbabwe and women. Conclusions As fertility is increasingly politicized, we contribute with person-centered and human rights-based indicators that are necessary to inform rights-based policies.