Association Between Women's Empowerment and Modern Family Planning Use

Empowerment enables women to articulate, assert, and claim their human rights, make decisions in their homes and wider society, and demonstrate power. It is a complex, multi-dimensional concept with variations in conceptualization and definition. The Sustainable Development Goals (SDGs) emphasize the importance of gender equality and the empowerment of all women and girls. Empowerment promotes equity and development outcomes, and it is a key strategy for reducing maternal and child mortality. The USAID's MOMENTUM Project aims to support improved health and well-being of individuals, families, and communities in more than 30 high-burden countries to accelerate the reduction of maternal, newborn, and child death, and disability. The project focuses on increasing access to quality voluntary family planning (FP) as a central strategy for reducing maternal and child mortality. Working with its partner countries, MOMENTUM tackles unique, country-specific challenges, while ensuring interventions have the best possible impact and reach. The project is implemented in more than 30 countries globally through its six global awards and associated local partners. Empowerment of women and girls is a meaningful goal in itself, and it promotes equity and development outcomes. It becomes possible when individuals and societies become conscious of gendered power dynamics and the need and mechanisms to change them in pursuit of equity. Girls and women can envision different dynamics and consider themselves entitled and able to pursue them. Measuring women's empowerment is challenging due to the concept's abstract nature. While empowerment is a process, it may also be considered a "state of being." Discussions have centered on whether empowerment should be externally defined and measured, or whether a woman herself should be the sole judge of the extent to which she feels empowered. The Demographic and Health Survey (DHS) includes questions on women's empowerment, and several studies use these to develop women's empowerment indices. The analysis leverages pooled cross-sectional DHS data from two timepoints across nine countries in Africa and Asia. Separate multivariate logistic regression models were run for each of the three empowerment domains included in a survey-based women's empowerment index (SWPER Global Index) to identify the association between women's level (low, medium, high) of empowerment in each domain and modern FP use, controlling for time and individual characteristics. Across the nine countries, prevalence of modern FP use ranges from 11.4% in Mali to 64.9% in Rwanda. Regionally, West Africa has lower levels of modern FP use than East Africa or Asia. West Africa also has the highest proportion of women with low levels of empowerment across all three domains. The percentage of women with high levels of empowerment generally trends upward over time. The relationship between women's empowerment and modern FP use varies by domain and empowerment level, within countries and across countries and regions. A statistically significant relationship between empowerment and FP use was found in less than half of all models. Of the three domains, decision-making is the one most frequently significant in its association with modern FP use, followed by social independence. Within countries, differences in predicted probability of modern FP use by empowerment level are small. Policymakers and program implementers seeking to increase use of FP may consider investing in women's empowerment, especially related to decision-making and social independence. It is essential to consider that empowerment in decision-making and social independence varies across time and context and that not all kinds of decision-making or social independence are of equal value or influence in FP use. The particularly strong effect sizes in West Africa, combined with the low prevalence of modern FP use, indicate both the need and potential for focusing on this geographic region.