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

• Published in: BMJ open 2021-06, Vol.11 (6), p.e045952-e045952
• Main Authors: Haque, Rezwanul, Alam, Khorshed, Rahman, Syed Mahbubur, Keramat, Syed Afroz, Al-Hanawi, Mohammed Khaled
• Format: Article
• Language: English
• Subjects: Age; Attitudes; Children; Cross-sectional studies; Decision making; Domestic violence; Empowerment; Family planning; Fertility; Health care policy; Health planning; Health Policy; Health services; Households; Husbands; Investigations; Participation; Preferences; Public health; Questionnaires; Reproductive health; Social norms; Wives; Women; Womens health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-045952

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.