Academic journal article International Perspectives on Sexual and Reproductive Health

Women's Empowerment and Choice of Contraceptive Methods in Selected African Countries

Academic journal article International Perspectives on Sexual and Reproductive Health

Women's Empowerment and Choice of Contraceptive Methods in Selected African Countries

Article excerpt

CONTEXT: It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in African countries.

METHODS: Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15-49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use.

RESULTS: Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-7.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3-1.6) and the ability to negotiate sexual activity (1.1-1.2). In Namibia, women's negative attitudes toward domestic violence were correlated with the use of couple methods (7.1).

CONCLUSIONS: Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence.

International Perspectives on Sexual and Reproductive Health, 2012, 38 (1): 23-33, doi: 10 1363/3802312

Since the 1994 International Conference on Population and Development, women's empowerment has been recognized as important to their access to reproductive health services, including family planning. Women's lack of power restricts their ability to make decisions about family planning practice, as well as to have an open discussion with their partners about it. (1), (2)

The purpose of this study was to identify associations between women's empowerment and the use of contraceptives in selected African countries. Specifically, we examined whether women's empowerment was associated with the likelihood that a couple used either a female or a couple method of contraception. In this study, female-only methods included the pill, IUD, injectable and implant; couple methods included male and female condoms, the diaphragm, foam, jelly, withdrawal, the lactational amenorrhea method and periodic abstinence--that is, methods that require at least the awareness of and a certain degree of support and cooperation from husbands. We hypothesized that women who are more empowered would be more likely to use any method, as well as female-only methods, compared with women who are not empowered. We also hypothesized that some empowered women may be more likely to involve their husband in family planning and, therefore, be more likely to use couple methods. In addition, we explored the influence of different dimensions of women's empowerment on contraceptive use, which generally has not been explicitly examined.


Definitions and Measurements

To date, there is considerable variation in the definition and conceptualization of women's empowerment. (3-5) The World Bank defines empowerment as the "expansion of freedom of choice and action to shape one's life." (6) This definition encompasses two features of women's empowerment: process of change (through which a woman gains power in making decisions) and agency (7), (8) Kabeer defines women's empowerment as a "process by which those who have been denied the ability to make strategic life choices acquire such an ability." (9) (p.435) This definition involves resources and achievements, in addition to process of change and agency, all of which are interrelated. A common underlying feature of these definitions is the recognition that household and interfamilial relations are central aspects of women's empowerment. …

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