Women’s empowerment and fertility decision-making in 53 low and middle resource countries: a pooled analysis of demographic and health surveys

Abstract

ObjectiveWomen’s empowerment and its association with fertility preference are vital for central-level promotional health policy strategies. This study examines the association between women’s empowerment and fertility decision-making in low and middle resource countries (LMRCs).DesignThis cross-sectional study uses the Demographic and Health Survey database.Settings53 LMRCs from six different regions for the period ranging from 2006 to 2018.ParticipantsThe data of women-only aged 35 years and above is used as a unit of analysis. The final sample consists of 91 070 married women.MethodsWe considered two outcome variables: women’s perceived ideal number of children and their ability to achieve preferred fertility desire and the association with women empowerment. Women empowerment was measured by their participation in household decision-making and attitude towards wife-beating. The negative binomial regression model was used to assess women’s perceived ideal number of children, and multivariable logistic regression was used to evaluate women’s ability to achieve their preferred fertility desire.ResultsOur study found that empowered women have a relatively low ideal number of children irrespective of the measures used to assess women empowerment. In this study, the measures were participation in household decision-making (incidence rate ratio (IRR): 0.92, 95% CI: 0.91 to 0.93) and attitude towards wife-beating (IRR: 0.96, 95% CI: 0.95 to 0.97). In the LMRCs, household decision-making and negative attitude towards wife-beating have been found associated with 1.12 and 1.08 times greater odds of having more than their ideal number of children.ConclusionOur findings suggest that women’s perceived fertility desire can be achieved by enhancing their empowerment. Therefore, a modified community-based family planning programme at the national level is required, highlighting the importance of women’s empowerment on reproductive healthcare as a part of the mission to assist women and couples to have only the number of children they desire.

Associations between Contraceptive Decision‐Making and Marital Contraceptive Communication and use in Rural Maharashtra, India

“…Our analysis of three existing measures of contraceptive decision-making in the context of rural India finds that only the DHS measure, which assesses joint decision-making, was associated with contraceptive communication and use. Findings are consistent with prior analyses documenting these associations across national contexts (Mutombo and Bakibinga 2014;Olakunde et al 2020;Mekonnen and Wubneh 2020;Haque et al 2021;Mahendra, Wilopo, and Putra 2019). Further analysis from our study, on type of contraceptive use, found that the DHS measure was associated specifically with condom and IUD use.…”

“…2020; Mekonnen and Wubneh 2020; Haque et al. 2021; Mahendra, Wilopo, and Putra 2019). Further analysis from our study, on type of contraceptive use, found that the DHS measure was associated specifically with condom and IUD use.…”

“…2020; Haque et al. 2021; Mekonnen and Wubneh 2020; Mahendra, Wilopo, and Putra 2019; Nazarbegian et al. 2021).…”

“…This DHS measure identifies who is involved in the contraceptive decision-making process: women themselves, husbands, others, or both spouses jointly (ICF 2020). This measure shows that joint contraceptive decision-making inclusive of both partners is associated with contraceptive use, including uptake of effective long-acting reversible and permanent contraceptive methods, lower contraceptive discontinuation, and increased ability to achieve fertility desire (Mutombo and Bakibinga 2014; Olakunde et al 2020;Haque et al 2021;Mekonnen and Wubneh 2020;Mahendra, Wilopo, and Putra 2019;Nazarbegian et al 2021). In contrast, contraceptive decisions made alone by husbands or wives yield heterogeneous contraceptive outcomes, and typically lower likelihood of contraceptive use (Mutombo and Bakibinga 2014;Olakunde et al 2020;Haque et al 2021;Mekonnen and Wubneh 2020;Anita, Nzabona, and Tuyiragize 2020).…”

Factors associated with the mental health status of pregnant women in China: A latent class analysis

“…People's material living standards and education level have gradually improved; however, the fertility rate does not seem to be optimistic in both developing countries and the least developed countries ( 1 , 2 ). In this case, the health of pregnant women deserves more attention.…”