Socioeconomic and Generational Inequities in Shared Household Decision-Making Agency in Nigeria: An Age-Period-Cohort Analysis, 2008–2024
1
Strategic Information, Centre for Integrated Health Programs, Abuja, Nigeria
2
Clinical Service Unit, Centre for Integrated Health Programs, Abuja, Nigeria
3
Big Data Health Science Center, University of South Carolina, Columbia, United States
4
Department of Community and Behavioral Health, University of Iowa, Iowa City, United States
5
Leadership & Management, Centre for Integrated Health Programs, Abuja, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A1229
ABSTRACT
INTRODUCTION:
Shared household decision‑making (SDM) among couples—joint agency in healthcare and resource allocation—is a key determinant of women’s reproductive autonomy and maternal health service utilization.¹,² Few studies employ longitudinal frameworks to disaggregate age, period, and cohort (APC) contributions to generational shifts in shared agency.³ We examined temporal and structural determinants of SDM in Nigeria using an APC framework.²,⁴
METHODS:
We pooled four waves of Nigeria Demographic and Health Survey data for women in union (2008–2024; N=99323). The outcome, SDM, was operationalized via polychoric principal component factor analysis (α=0.79) of joint decisions regarding health, purchases, and social visits. SDM was defined as the top tertile of the composite score. An APC model was fitted using the intrinsic estimator approach⁴ to disentangle husband’s age (25–65 years), period (2008–2024), and husband’s birth cohort (1943–1998) effects, adjusting for geographical, socioeconomic, and marital factors.
RESULTS:
Socioeconomic drivers exhibited a dose-response relationship, with SDM rising progressively across wealth quintiles (peaking at β=0.54 [0.46, 0.61]) and education levels (peaking at β=0.50 [0.44, 0.56]). Conversely, polygyny (β=-0.56 [-0.60, -0.52]) and large spousal age gaps (β=-0.33 [-0.38, -0.28]) were significant structural barriers (p<0.001). Geographically, SDM was lowest in the north‑west (β=-0.47, p<0.001) and highest in the south‑east (β=0.62, p<0.001), with a slight rural advantage (β=0.05, p=0.018). Husband’s age effects followed a positive linear progression, rising from β=-0.27 at age 25 to β=0.19 at age 65 (p=0.001). Period effects peaked in 2018 (β=0.03, p=0.014), with a plateau in 2024. Cohort analysis identified a non‑linear trend reaching its nadir in the 1988 birth cohort (β=-0.15 [-0.20, -0.10], p<0.001).
CONCLUSIONS:
Socioeconomic inequities, polygyny, and spousal age gaps hinder Nigerian women’s SDM, notably in the north‑west. APC analysis reveals heightened risks among younger husbands and specific birth cohorts. Addressing these structural barriers requires prioritizing household agency and regional empowerment alongside reproductive health services.
Shared household decision‑making (SDM) among couples—joint agency in healthcare and resource allocation—is a key determinant of women’s reproductive autonomy and maternal health service utilization.¹,² Few studies employ longitudinal frameworks to disaggregate age, period, and cohort (APC) contributions to generational shifts in shared agency.³ We examined temporal and structural determinants of SDM in Nigeria using an APC framework.²,⁴
METHODS:
We pooled four waves of Nigeria Demographic and Health Survey data for women in union (2008–2024; N=99323). The outcome, SDM, was operationalized via polychoric principal component factor analysis (α=0.79) of joint decisions regarding health, purchases, and social visits. SDM was defined as the top tertile of the composite score. An APC model was fitted using the intrinsic estimator approach⁴ to disentangle husband’s age (25–65 years), period (2008–2024), and husband’s birth cohort (1943–1998) effects, adjusting for geographical, socioeconomic, and marital factors.
RESULTS:
Socioeconomic drivers exhibited a dose-response relationship, with SDM rising progressively across wealth quintiles (peaking at β=0.54 [0.46, 0.61]) and education levels (peaking at β=0.50 [0.44, 0.56]). Conversely, polygyny (β=-0.56 [-0.60, -0.52]) and large spousal age gaps (β=-0.33 [-0.38, -0.28]) were significant structural barriers (p<0.001). Geographically, SDM was lowest in the north‑west (β=-0.47, p<0.001) and highest in the south‑east (β=0.62, p<0.001), with a slight rural advantage (β=0.05, p=0.018). Husband’s age effects followed a positive linear progression, rising from β=-0.27 at age 25 to β=0.19 at age 65 (p=0.001). Period effects peaked in 2018 (β=0.03, p=0.014), with a plateau in 2024. Cohort analysis identified a non‑linear trend reaching its nadir in the 1988 birth cohort (β=-0.15 [-0.20, -0.10], p<0.001).
CONCLUSIONS:
Socioeconomic inequities, polygyny, and spousal age gaps hinder Nigerian women’s SDM, notably in the north‑west. APC analysis reveals heightened risks among younger husbands and specific birth cohorts. Addressing these structural barriers requires prioritizing household agency and regional empowerment alongside reproductive health services.
| eISSN: | 2654-1459 |
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