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

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 uptake, 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 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 using current contraceptive use 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, which leads to variable findings when assessing current contraceptive use as an outcome. Consequently, 75% of studies showed at least one positive relationship between either decision making or freedom of movement with current contraceptive use; whereas the remainder found 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 showed that higher levels of women’s empowerment are associated with higher current contraceptive use. More research is needed using consistent empowerment measures.