Indicator 5.6.1 Proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care

Goal 5: Achieve gender equality and empower all women and girls

Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.

Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care.

December 2021

Indicator 5.6.2, Target 3.7

Uganda Bureau Of Statistics

Uganda Bureau Of Statistics

Sharon Apio

Labour Statistics Unit

Senior Statistician

+256 782 770851

P.O. Box 7186, Kampala

sharon.apio@ubos.org

Definition and concepts:

Proportion of women aged 15-49 years (married or in union) who make their own decision on all three selected areas i.e. decide on their own health care; decide on use of contraception; and can say no to sexual intercourse with their husband or partner if they do not want. Only women who provide a “yes” answer to all three components are considered as women who make their own decisions regarding sexual and reproductive health. A union involves a man and a woman regularly cohabiting in a marriage-like relationship. Women’s autonomy in decision-making and exercise of their reproductive rights is assessed from responses to the following three questions:

1. Who usually makes decisions about health care for yourself?

• Respondent

• Husband/Partner

• Respondent And Husband/Partner Jointly

• Someone Else

• Other Specify

1. Who usually makes the decision on whether or not you should use contraception?

• Respondent

• Husband/Partner

• Respondent And Husband/Partner Jointly

• Someone Else

• Other Specify

1. Can you say no to your husband/partner if you do not want to have sexual intercourse?

• Yes

• No

• Depends/Not Sure

A woman is considered to have autonomy in reproductive health decision making and to be empowered to exercise their reproductive rights if they

(1) decide on health care for themselves, either alone or jointly with their husbands or partners,

(2) decide on use or non-use of contraception, either alone or jointly with their husbands or partners; and

(3) can say no to sex with their husband/partner if they do not want to.

Percent

Non

The Uganda Demographic Health Surveys (UDHS).

Sample Design:

The sample design for the 2016 UDHS used the sampling frame from the Uganda National Population and Housing Census (NPHC 2014).The census frame is a complete list of all census Enumeration Areas (EAs) created for the 2014 NPHC. In Uganda, an EA is a geographic area that covers an average of about 130 households.

At the time of the NPHC, Uganda was divided administratively into 112 districts, which were grouped for this survey into 15 regions.

The sample for the 2016 UDHS was designed to provide estimates of key indicators for the country as a whole, for urban and rural areas separately, and for each of the 15 sub regions. Estimates are also presented for three special areas: the Lake Victoria islands, the mountainous districts, and greater Kampala.

The 2016 UDHS sample was stratified and selected in two stages. In the first stage, 697 EAs were selected from the 2014 NPHC, 162 EAs in urban areas and 535 in rural areas. Households constituted the second stage of sampling. A listing of households was compiled in each of the 696 accessible selected EAs from April to October 2016. To minimize the task of household listing, each large EA (that is to say more than 300 households) selected for the 2016 UDHS was segmented. Only one segment was selected for the survey with probability proportional to segment size, and the household listing was conducted only in the selected segment.

Out of the 20,880 selected households (30 households per EA), 18,506 women aged 15-49 were successfully interviewed. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In one-third of the sampled households, all men age 15-54, including both usual residents and visitors who stayed in the household the night before the interview, were eligible for individual interviews..

Training and field work:

UBOS recruited and trained field staff to serve as supervisors, CAPI managers, interviewers, health technicians, and reserve interviewers for the main fieldwork. Health technicians were trained separately from interviewers. A two day f ield practice was organized to provide trainees with additional hands on practice before the actual fieldwork. Prior to the main field work, a pre-test was conducted and best practices were adopted.

Questionnaires:

Four questionnaires were used for the 2016 UDHS: The Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s model questionnaires, were adapted to reflect the population and health issues relevant to Uganda.

Input was solicited from all stakeholders such as; Government Ministries and Agencies, Non-governmental Organizations, and Development partners. After the finalization of the questionnaires in English, they were then translated into eight major local languages. The Household, Woman’s, and Man’s Questionnaires were programmed into a computer-assisted personal interviewing (CAPI) application for data collection purposes.

Data collection:

Data collection was conducted by 21 field teams, each consisting of one team leader, one field data Manager, three female interviewers, one male interviewer, one health technician, and a driver. The health technicians were responsible for anthropometric measurements, blood sample collection for Hemoglobin and malaria testing, and DBS specimen collection for vitamin A testing.

The, interviewers used tablets to record all questionnaire responses during the interviews. The tablets were equipped with Bluetooth technology to enable remote electronic transfer of files, such as assignments from the team supervisor to the interviewers, individual questionnaires among survey team members, and completed questionnaires from interviewers to team supervisors.

The field supervisors transferred data to the central data processing office via IFSS. Senior staff from the Makerere University School of Public Health, the Ministry of Health, and UBOS and a survey technical specialist from the DHS Program coordinated and supervised fieldwork activities.

Data collection took place over a 6-month period from June 2016 through December 2016.

Every 5 years

Uganda Bureau of Statistics

Uganda Bureau of Statistics, ICF

The Uganda Bureau of Statistics (UBOS) Act, 1998 provides for the development and maintenance of National Statistical System (NSS) to ensure collection, analysis and publication of integrated, relevant, reliable and timely statistical information. It established the Bureau as a coordinating, monitoring and supervisory body for the NSS.

Women’s and girls’ autonomy in decision making about sexual and reproductive health services, contraceptive use and consensual sexual relations is key to their empowerment and the full exercise of their reproductive rights.

Women who make their own decision regarding seeking healthcare for themselves are considered empowered to exercise their reproductive rights.

Regarding decision-making on use of contraception, a clearer understanding of women empowerment is obtained by looking at the indicator from the perspective of decisions being made “mainly by the partner”, as opposed to decision being made “by the woman alone” or “by the woman jointly with the partner”. Depending in the type of contraceptive method being used, a decision by the woman “alone” or “jointly with the partner” does not always entail that the woman is empowered or has bargaining skills. Conversely, it is safe to assume that a woman that does not participate, at all, in making contraceptive choices is disempowered as far as sexual and reproductive decisions are concerned.

A woman’s ability to say no to her husband/partner if she does not want to have sexual intercourse is well aligned with the concept of sexual autonomy and women’s empowerment.

Until recently, the indicator captured results for married and in-union women and adolescent girls of reproductive age (15–49 years old) who are using any type of contraception. In the phase of the national Demographic and Health Survey (DHS–7) and later, the questionnaire was extended to respondents whether they were using contraception or not. The measure does not cover women and girls that are not married or in union, as they do not usually make “joint decisions” on their own health care with their partners

Numerator: Number of married or in union women and girls aged 15-49 years old:

1. For whom decision on health care for themselves is not usually made by the husband/partner or someone else; and
2. For whom the decision on contraception is not mainly made by the husband/partner; and.
3. Who can say no to sex? Only women who satisfy all three empowerment criteria are included in the numerator. Denominator: Total number of women and girls aged 15-49 years old, who are married or in union. Proportion = (Numerator/Denominator) * 100%

Pretest, Training of field staff, field supervision, and data processing were conducted. Data Processing: It included checking for inconsistences, incompleteness and outliers. Data editing and cleaning included structure and consistency checks to ensure completeness of work in the field.

Further guidelines on collecting data for SDG 5.6.1 in national household surveys is available

1. The survey implementation is overseen by a Steering Committee which is constituted using a multi sectorial approach.

2. The survey report is reviewed by an experienced team at Management level who are in most cases Directors or Heads of departments and key stakeholders from Makerere School of Public Health, Molecular Laboratory of Makerere University School of Health Sciences, Ministry of Health and later reviewed by consultants

The UDHS goes through several stages before production and sharing of the final findings. During the Survey implementation.

1. Consultative user needs assessment meetings are held with all key stakeholders.

2. ICF International provided consultants to oversee the UDHS

3. The survey and sampling design generated using scientific methods as recommended by the Census and Survey Rules and Regulations.

4. Comprehensive training sessions are organized for all survey staff before deployment on the field

5. The questionnaire development for different categories of the Target respondents was adapted to reflect the population and health issues relevant to Uganda. (Man’s Questionnaire, Woman’s questionnaire, Biomarker questionnaire and Field worker questionnaire. This follows a multi-stakeholder approach and pretesting helps to establish the relevancy and adequacy of the questions to be used.

Before dissemination, the report is reviewed and quality assured by a professional team of the National Statistical System.

Quality Control is addressed at all levels during Survey implementation

Data availability:

Data is available in 2016 UDHS, for 15 Sub-regions.

Data disaggregation:

15- sub-regions, age, income/wealth, Residence, education , employment and number of living children

Non

Uganda Demographic and Health Survey