Untangling Empowerment and Contraceptive Use Longitudinally in Five African Settings

Marita Zimmermann, Bill and Melinda Gates Foundation
Cara Myers, Gender Equality Division Women’s Economic Empowerment Team, Bill and Melinda Gates Foundation
Diva Dhar, Gender Equality Division Women’s Economic Empowerment Team, Bill and Melinda Gates Foundation
Michelle O'Brien, Institute for Disease Modeling, Bill & Melinda Gates Foundation

Background: Empowerment impacts reproductive health behaviors profoundly, while contraceptive access enables women to make informed reproductive choices, resulting in broader economic opportunities. This study aimed to assess the bidirectional relationship between economic empowerment and contraceptive use. Methods: We analyzed data from the Performance Monitoring for Action (PMA) surveys in Kenya, Nigeria (Kano), Burkina Faso, the Democratic Republic of Congo, and Uganda, using longitudinal data from 2019 to 2021 to parameterize bi-directional cross-lagged panel models. Results: Sample sizes ranged from 842 (Kano) to 3,481 (Burkina Faso). In Kenya and Kano, contraceptive use led to an increase in paid work (10.1%-12.0%) and greater wage control (14.5%-14.8%). In Kenya, women doing paid work with wage control were 5.2% more likely to use contraception the following year. In Kano, control over partner's wages increased contraceptive use by 9.6%. Additionally, having savings, financial goals, increased financial autonomy, and knowledge of financial information were associated with higher future contraceptive use in both regions. Conclusions: Findings suggest that contraceptive use can act as a catalyst for various aspects of empowerment, while empowerment, particularly decision-making autonomy over finances, enhances contraceptive use. However, these dynamics vary across different settings, emphasizing the need for context-specific strategies.

Keywords: Family Planning and Contraception, Human Capital, Education, and Work, Structural equation modelling , Longitudinal studies

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