Women's empowerment and its relationship to current contraceptive use in low, lower-middle, and upper-middle income countries: A systematic review of the literature Público

Abstract

This study assesses the peer-reviewed literature on women's empowerment and its relationship to current contraceptive use in low, lower-middle, and upper-middle income countries as defined by the World Bank. Although the empirical evidence suggests a positive relationship between empowerment and contraceptive use, the concept of empowerment is inconsistently defined and operationalized. This study looks specifically at women's agency, or the influence in family decisions and freedom of movement, as expressions of women's empowerment. Using systematic database search strategies, we identified 358 titles and abstracts for screening. Twelve full-text articles published between 1996 and 2013 met our inclusion criteria. We included quantitative studies of women ages 15-49, and we considered only studies using contraceptive use at time of survey as an outcome. The majority of included studies used DHS or other nationally representative survey data for secondary analyses, and all studies based their analyses on cross-sectional data. Using a standardized data-extraction form and quality checklist, we discovered that the definition and measurement of women's empowerment vary widely. These inconsistencies lead to variable findings when assessing current contraceptive use as an outcome. Consequently, 33% of included studies showed consistently positive relationships of either decision making or freedom of movement with contraceptive use at time of survey; whereas the remainder found inconsistent relationships or no association. These results were not specific to any geographic region; however, it is notable that no studies came from Latin America, Southeast Asia, or the Middle East. Overall, this systematic review demonstrated that higher levels of specific aspects of women's empowerment are associated with higher levels of contraceptive use at time of survey, particularly for freedom of movement. More research is needed using consistent measures of empowerment.

Table of Contents

Chapter 1: Introduction..............................................1-6

1.1 Background and Rationale......................................1

1.2 Problem Statement...............................................2-3

1.3 Objectives..........................................................3-4

1.4 Purpose of the Project..........................................5

1.5 Terminology........................................................5-6

Chapter 2: Comprehensive Review of the Literature.........7-16

2.1 Trends in Global Contraceptive Use.........................7-10

2.2 Women's Empowerment and Contraceptive Use.........10-12

2.3 A Conceptual Framework......................................12-15

2.4 Current Research Gaps.........................................16

Chapter 3: Manuscript...............................................17-67

Chapter 4: Conclusion and Recommendations.................68-73

4.1 Overall Conclusions..............................................68-70

4.2 Public Health and Policy Implications........................70-71

4.3 Recommendations................................................71-73

References..............................................................74-78

List of Tables and Figures...........................................79

Appendix.................................................................80-82

Data Extraction Form.................................................80-82

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Women's Studies
Palabra Clave	contraceptive use contraception women's agency women's empowerment women's decision making women's freedom of movement women's autonomy family planning
Committee Chair / Thesis Advisor	Yount, Kathryn, Emory University
Committee Members	VanderEnde, Kristin E, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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