Abstract
BACKGROUND: Women's ability to refuse unwanted sex is a fundamental dimension of gender equality and a key determinant of overall well-being. Despite its importance, there is limited evidence on the prevalence and factors influencing this ability in Tanzania. This study therefore aimed to investigate the prevalence and determinants of women's ability to refuse sex among reproductive-age women in the country. METHOD: This study analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS), using a weighted sample of 9,090 women aged 15-49. Descriptive statistics summarized socio-demographic characteristics, while binary logistic regression identified factors associated with women's ability to refuse sex. Both unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals were reported, with statistical significance set at p < 0.05. RESULTS: The study found that 69.6% of Tanzanian women of reproductive age had the ability to refuse sex (95% CI: 68.5%-70.4%). After adjusting for confounders, women's ability to refuse sex was associated with their education, primary (aOR = 1.354, p < 0.001), secondary (aOR = 1.74, p < 0.001), higher (aOR = 2.253, p = 0.024), and their partners' education, secondary (aOR = 1.269, p = 0.015), higher (aOR = 1.756, p = 0.009). Wealth (aOR = 1.241, p = 0.017), awareness of sexually transmitted infections (aOR = 1.368, p < 0.001), prior HIV testing (aOR = 1.714, p < 0.001), media access, low (aOR = 1.273, p < 0.001), medium (aOR = 1.612, p < 0.001), high (aOR = 1.954, p < 0.001), and contraceptive use, calendar-based (aOR = 1.311, p < 0.001) or other methods (aOR = 1.525, p < 0.001), were also positively associated. Women from Unguja (aOR = 0.425, p < 0.001) and Pemba (aOR = 0.376, p = 0.004) were less likely to refuse sex. CONCLUSION: The study found that a majority of Tanzanian women have the ability to refuse sex and that the ability to refuse sex is significantly linked to education, economic status, partner's education, access to media, STI awareness, HIV testing, and contraceptive use. However, women in Unguja and Pemba had lower ability to refuse sex compared to those in mainland urban areas. The findings highlight the need for targeted interventions to address regional disparities and promote equitable access to resources that support women's ability to refuse sex.