Spatial Pattern and Decomposition Analysis of the Educational Status Gap in Factors Associated with Risky Sexual Behavior Among Women with Disabilities in Ten African Countries.

Despite significant improvements in access to sexual and reproductive health services worldwide, many people with disabilities, particularly in low-income settings, remain vulnerable to risky sexual behaviors, predisposing them to sexual and reproductive health problems. This study examined the spatial patterns and performed a decomposition analysis of the educational status disparity in factors associated with risky sexual behavior among women with disabilities in 10 African countries. We utilized the latest secondary dataset with a disability module from demographic health surveys conducted in these countries between 2010 and 2022, including a sample size of 16,517 women with disabilities. Spatial analysis was employed to reveal the patterns of risky sexual behavior, while multivariable Blinder-Oaxaca decomposition regression analysis examined the disparity between educational status and risky sexual behavior. The analysis accounted for the complex survey design and results were presented using percentages and adjusted coefficients. The spatial pattern of risky sexual behavior among women with disabilities varied widely across the 10 African countries studied, with proportion ranging from 20 to 80%. Kenya leads with the highest prevalence at 94%, followed by Mali at 90%, while Mauritania reported no occurrence at 0%. Most of the disparity (81.93%) in risky sexual behavior related to educational status among women with disabilities was due to differences in coefficients, with the remaining 18.07% attributed to differences in characteristics. The findings indicate that women with disabilities, whether with formal or informal education, are highly exposed to risky sexual behavior in Africa. Therefore, targeted interventions are needed to minimize risky sexual behavior among women with disabilities in these countries.