Introduction: Women’s household decision autonomy is a significant part of women’s empowerment and has, in previous studies, been shown to affect the possibility of negotiating for safe sex practices. Women in sub-Saharan Africa face difficulties in refusing sex from their partners due to stigmatization, which puts them at risk for both unwanted pregnancies and STIs. The aim of this thesis is to assess the association between participation in household decision-making and married women’s ability to refuse sex in Mali. Methods: It is a cross-sectional study using data from the 2018 Mali Demographic and Health Survey. The final study sample included 7681 married or women living in union, and the analysis used descriptive statistics and univariate- and multivariate logistic regression. Results: This study found that women who participate in household decisions are significantly more likely to be able to refuse sexual intercourse with their partners. Additionally, uneducated women and women living in rural areas were significantly less likely to be able to refuse sex, while women who have access to some sort of media on a weekly basis were more likely to be able to refuse. Age, sex of head of household, and partner’s education showed no impact on the ability to refuse sex. Conclusion: The results corroborate with existing literature and highlight the need for improved efforts to specifically address social and cultural barriers that may aid women’s ability to practice safe sex negotiations in their relationships.