Determinants of pressure to conceive among reproductive age women in Sub-Saharan Africa: A multilevel analysis of recent Demographic and Health Surveys in five countries.

Globally, 40% of pregnancies are unplanned, with higher rates in Sub-Saharan Africa, often ending in abortion. Women face pressure from spouses/families to conceive, leading to unintended pregnancies and violations of reproductive rights, jeopardizing women's autonomy and well-being. Respecting individual decisions is crucial during this pivotal life stage. The study conducted a secondary data analysis using information from the latest Demographic and Health Surveys, encompassing five Sub-Saharan African nations from 2021 to 2023. The research focused on a weighted sample of 97,350 married women of reproductive age. Data analysis was performed using Stata 14, employing a multilevel mixed-effects logistic regression model to uncover the factors contributing to the pressure exerted by husbands and families on women to conceive. The study highlights that in Sub-Saharan Africa, approximately one in ten women experience pressure to conceive. Factors like age (20-35 years; AOR = 1.6, 95% CI: 1.46, 1.87), socioeconomic status (middle/affluent; AOR = 1.12, 95% CI: 1.04, 1.2 and AOR = 1.12, 95% CI: 1.03, 1.21), parity (childless; AOR = 4.65, 95% CI: 4.1, 5.2), and community literacy (low; AOR = 1.44, 95% CI: 1.25, 1.66) significantly influence this pressure. Notably, women in Tanzania have a 55% lower risk (AOR = 0.45, 95% CI: 0.41, 0.49), while those in Mozambique face a 1.88 times higher risk. The study highlights the substantial pressure faced by reproductive-age women to conceive in Sub-Saharan Africa. Addressing these challenges through targeted policies and interventions is crucial to empower women and promote their reproductive autonomy.