Association Between Women’s Empowerment and Unmet Family Planning Needs in Low- and Middle-Income Countries in Southeast Asia: A Cross-Sectional Study

Htay, Zin Wai; Kiriya, Junko; Sakamoto, Jennifer Lisa; Jimba, Masamine

doi:10.1080/23293691.2023.2174822

Cited by 3 publications

(3 citation statements)

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“…Secondly, due to small grants given to female refugees as a start-up kit for nancial support, they can support themselves and con dently go for contraceptive services without waiting for spousal consent. This study concurs with a nding by (Htay et al, 2023) in their study of unmet need for FP in East Asia which revealed that women can control their contraceptive need if empowered with better decision making opportunities.…”

Section: Dynamics Of Contraceptive Usesupporting

confidence: 90%

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda.

Orach

Nabiwemba

Atuyambe

2023

Preprint

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Introduction Contraceptive use is known to have a positive impact on maternal and child health outcomes, but it is still low especially in low-income countries. Contraceptive use is even lower among people in humanitarian situations. This study explored the decision-making processes towards use or non-use of contraceptives by people in humanitarian situations to inform program design for uptake. Methods A qualitative exploratory study was conducted among women of reproductive age (15-49 years) living in any of the three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14. Results This study found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. While following the linear pathway, participants reported starting with 1) idea inception, then followed through to 2) cognitive processing, 3) consultation, and 4) decision-making to either use or not use contraception. Complex linear pathway happened when participants did not go through consultation but straight to decision making. However, participants who followed non-linear pathway continuously went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who started off not using contraceptives ended up using, while some who started off using contraception ended up dropping out. There were also events that defied established pathway where women were forced to get off contraception by their spouses. Conclusions This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision for use particularly among refugees.

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Section: Dynamics Of Contraceptive Usesupporting

confidence: 90%

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda.

Orach

Nabiwemba

Atuyambe

2023

Preprint

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“…Women empowerment has the potential to increase contraceptive use [19,20]. Low WE status, on the other hand, is a known contributing factor to unmet needs for contraceptives by limiting access to health service delivery points through negative cultural beliefs and practices [21,22]. In some parts of the SSA, patriarchal rule impairs women's ability to exercise their fundamental reproductive health rights [23].…”

Section: Introductionmentioning

confidence: 99%

Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework

Habte,

Tamene,

Bogale

2023

PLoS ONE

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Background Low women empowerment, is a known contributing factor to unmet needs for contraception by limiting access to health services through negative cultural beliefs and practices. However, little is known about the association between unmet needs and domains of women empowerment in Sub-Saharan African (SSA) countries. Hence, this study aimed at assessing the influence of women empowerment domains on the unmet need for contraception in the region using the most recent Demographic and Health Survey (DHS) data (2016–2021). Methods The data for the study was derived from the appended women’s (IR) file of eighteen SSA countries. A weighted sample of 128,939 married women was analyzed by STATA version 16. The Harvard Institute’s Gender Roles Framework, which comprised of influencer, resource, and decision-making domains was employed to identify and categorize the covariates across three levels. The effects of each predictor on the unmet need for spacing and limiting were examined using a multivariable multilevel mixed-effect multinomial logistic regression analysis. Adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. Results The pooled prevalence of unmet needs for contraception was 26.36% (95% CI: 24.83–30.40) in the region, with unmet needs for spacing and limiting being 16.74% (95% CI: 16.55, 17.02) and 9.62% (95% CI: 9.45, 12.78), respectively. Among variables in the influencer domain, educational level, family size of more than five, parity, number of children, attitude towards wife beating, and media exposure were substantially linked with an unmet need for spacing and limiting. Being in the poorest wealth quintile and enrollment in health insurance schemes, on the other hand, were the two variables in the resource domain that had a significant influence on unmet needs. The overall decision-making capacity of women was found to be the sole significant predictor of unmet needs among the covariates in the decision-making domain. Conclusion Unmet needs for contraception in SSA countries were found to be high. Reproductive health program planners and contraceptive service providers should place due emphasis on women who lack formal education, are from low-income families, and have large family sizes. Governments should collaborate with insurance providers to increase health insurance coverage alongside incorporating family planning within the service package to minimize out-of-pocket costs. NGOs, government bodies, and program planners should collaborate across sectors to pool resources, advocate for policies, share best practices, and coordinate initiatives to maximize the capacity of women’s decision-making autonomy.

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“…Empowering women concerning making informed decisions about family planning is multifactorial. It can include enhancing access to education and involvement in paid labour (Efendi et al, 2023) and enabling greater control over finances within the home (Htay et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing rural Timor-Leste women’s utilisation of family planning services

Gomes,

Lees,

Shrestha-Ranjit

2023

pacifichealth

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In Timor-Leste, maternal fertility and mortality rates have been reducing over the past two decades; however, unmet family planning needs remain. Family planning is especially relevant for women with low socio-economic status as they often have unmet family planning needs, which is pertinent for Timor-Leste as its population experiences high rates of poverty and primarily lives rurally. Our qualitative descriptive study explores rural Timorese women’s knowledge, attitudes, and family planning practices to determine factors influencing their family planning decision-making. Purposive sampling resulted in twenty-five women from the rural Suai-Covalima district participating in three focus groups. While rural women preferred family planning, many lacked knowledge about specific methods, including misunderstandings about side effects and impact on fertility. Health literacy is central to improving understanding of family planning. Therefore, enhancing service providers’ capacity to provide accurate and up-to-date information and training is necessary to build rural women's understanding of family planning. The patriarchal nature of the Timorese society strongly influenced women’s family planning decisions. Hence, including men in future family planning education is essential. Despite the historical influence of the Catholic Church in Timor-Leste, women in this study did not feel its teachings influenced their family planning decisions. Further research exploring the role of the Church in reproductive decision-making and encompassing broader rural Timorese populations, including men, would increase understanding of family-planning decision-making and its influences.

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Association Between Women’s Empowerment and Unmet Family Planning Needs in Low- and Middle-Income Countries in Southeast Asia: A Cross-Sectional Study

Cited by 3 publications

References 50 publications

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda.

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda.

Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework

Factors influencing rural Timor-Leste women’s utilisation of family planning services

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