Journal Article

Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries

Uthman, Olalekan A., Yaya, Sanni, Bishwajit, Ghose, Ekholuenetale, Michael

2018

Overview

Background Women’s empowerment has a direct impact on maternal and child health care service utilization. Large scope measurement of contraceptive use in several dimensions is paramount, considering the nature of empowerment processes as it relates to improvements in maternal health status. However, multicountry and multilevel analysis of the measurement of women’s empowerment indicators and their associations with contraceptive use is vital to make a substantial intervention in the Sub-Saharan Africa context. Therefore, we investigated the impact of women’s empowerment on contraceptive use among women in sub-Saharan Africa countries. Methods Secondary data involving 474,622 women of reproductive age (15–49 years) from the current Demographic and Health Survey (DHS) in 32 Sub-Saharan Africa region was used in this study. Contraceptive use was the primary outcome variable. Multilevel analysis was conducted to examine the impact of women’s empowerment on contraceptive use. Percentages were conducted in univariate analysis. Furthermore, multilevel logistic regression models were used to analyze the association between individual, compositional and contextual factors of contraceptive use. Results Results showed large disparities in the number of women who reportedly ever use contraceptive methods; this range from as low as 6.7% in Chad and as much as 72% in Namibia. More than one-third of the respondents had no formal education and more than half were active labor force. Contraceptive use was significantly more common among respondents from the richest households (28.5% versus 18.9%). Various components of women’s empowerment were positively significantly associated with contraceptive use after adjusting for demographic and socioeconomic factors. There was a significant variation in the odds of contraceptive use across the 32 countries ( σ 2 = 1.12, 95% CrI 0.67 to 1.87) and across the neighbourhoods ( σ 2 = 0.95, 95% CrI 0.92 to 0.98). Conclusions Our findings suggest that an increase in contraceptive use and by better extension maternal health care services utilization can be achieved by enhancing women’s empowerment. Also, an increase in decision-making autonomy by women, their participation in labour force, reduction in abuse and violence and improved knowledge level are all key issues to be considered. Health-related policies should address inequalities in women’s empowerment, education and economic status which would yield benefits to individuals, families, and societies in general.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Analysis / Antenatal care / Birth control / Clinical decision making / Contraception Behavior - statistics & numerical data / Contraceptives / Cross-Sectional Studies / Decision Making / Empowerment / Family Planning Services - standards / Female / Gender equality / Gender equity / Households / Humans / Maternal & child health / Maternal and Child Health / Maternal health / Maternal health services / Medicine / Medicine & Public Health / Middle Aged / Power (Psychology) / Pregnancy / Prenatal care / Public Health / Reproductive health / Reproductive Medicine / Sex education / Social aspects / Social power / Sub-Saharan Africa / Surveys and Questionnaires / Women's Rights - standards / Women's Rights - trends / Womens health / Women’s empowerment / Young Adult