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The Programme of Action of the International Conference on Population and Development, held in 1994 in Cairo, focused on “the right of men and women to a better sexuality and reproductive health” and identified as a prerequisite the establishment of relationships of “mutual respect and equity between the sexes.” In sub-Saharan Africa, there is still much to do to achieve this objective. In particular, economic, social and identity problems add to the difficulty of encouraging equality in rural areas. To highlight these problems, this article reviews a quantitative and qualitative study carried out in the Sassandra région of Côte d’Ivoire, where cash crops dominate. Observations on the evolution of the status of men and women reveal a flagrant inequality between the sexes in the distribution of economic and social power. Patriarchal structures relating to economic questions are repeated in the domestic and personal spheres. The man, who controls crops production and sales is the main household cash provider and plays a key-role in undertaking expenses and in choices related to health and birth control. Such conditions make uncertain the emergence of a conjugal model where the mutual respect and equality of the sexes necessary for the exercise of free and conscious choice in questions of childbearing would prevail.