ABSTRACT:
Age-disparate sexual relationships, which typically involve older men and younger women, remain prevalent across Sub-Saharan Africa and are widespread within contexts of gender inequality, economic dependence, and unequal power relations. Such relationships influence women’s sexual and reproductive health by limiting contraceptive use, increasing the risk of unintended pregnancies, and influencing reproductive decision-making, including pregnancy termination. Despite global declines in fertility, Sub-Saharan Africa continues to experience high levels of unintended pregnancies and abortion among young women, with a substantial proportion of unintended pregnancies terminated. Although abortion laws and access to services vary widely across regions, persistent barriers such as stigma, limited health services, and socio-cultural norms continue to affect women’s reproductive choices. While existing literature has examined age-disparate relationships in relation to HIV risk, contraceptive use, and gender-based violence, comparative regional evidence on the association of age-disparate relationships and pregnancy termination remains limited. This quantitative cross-sectional study design will use pooled representative Demographic and Health Survey (DHS) data from Sub-Saharan African countries. The analytical sample comprises women aged 15–34 years. Age-disparate relationships are operationalized as sexual partnerships involving an age gap of five years or more between partners. The primary outcome is self-reported pregnancy termination. Descriptive analyses will assess prevalence patterns across countries. Multivariate logistic regression models will be adjusted for survey design and be used to estimate the association between age-disparate relationships and pregnancy termination, controlling for relevant demographic, socio-economic, and reproductive health factors. Potential underreporting of abortion due to stigma and social desirability bias is acknowledged as a limitation. Guided by the Social Determinants of Health and Socio-Ecological Model frameworks, this study will examine how demographic, socio-economic, partner-related, and health-related factors shape reproductive decision-making and pregnancy termination among women in age-disparate relationships across Sub-Saharan Africa, informing health-related policies across countries.