Abstract
BackgroundIn Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso.MethodsWe analyzed data from the 2010 Burkina Faso Demographic and Health Survey (DHS) on 4714 MWRA with reproductive needs living in 573 communities. We used principal component analysis (PCA) and Cronbach’s alpha test to explore and assess specific and consistently relevant components of women’s agency in marital relationships. Aggregated measures at the cluster level were used to assess gender norms and relationships in communities. Descriptive statistics were performed and multilevel logistic regression models were carried out to concurrently gauge the effects of women’s agency and community-level of gender equality on mDFPS, controlling for socioeconomic factors.ResultsOverall, less than one-third (30.8%) of the demand for family planning among MWRA were satisfied with modern methods. Participation in household decision-making, freedom in accessing healthcare, and opposition to domestic violence were underlying components of women’s agency in marital relationships. In the full model adjusted for socioeconomic status, freedom in accessing healthcare was significantly (aOR 1.27, CI 1.06–1.51) associated with mDFPS. For community-level variables, women’s greater access to assets (aOR 1.72, 95% CI 1.13–2.61) and family planning messages (aOR 2.68, 95% CI 1.64–4.36) increased mDFPS, while higher fertility expectations (aOR 0.75, 95% CI 0.64–0.87) reduced it. Unexpectedly, women in communities with higher rates of female genital mutilation were more likely (aOR 2.46, 95% CI 1.52–3.99) to have mDFPS.ConclusionsEmpowering women has the potential to reduce gender inequality, raise women’s agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships. Progress toward universal access to reproductive services should integrate the promotion of women’s rights.Trial registrationNo clinical trial has been performed in this study.
Highlights
In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths
Empowering women has the potential to reduce gender inequality, raise women’s agency and increase mDFPS. This influence may occur through both balanced marital relationships and fair community gender norms and relationships
The pronatalist nature of African societies prescribes strict gender roles and relationships that deprive women’s access to resources, rights, and opportunities to productive activities and confine them to reproductive roles [6]. We study this issue in Burkina Faso, where are gender inequality indices among the worst in West Africa but married women of reproductive age (MWRA) are still unable to meet their needs for family planning [14, 37]
Summary
In Burkina Faso, gender inequality prevents women from meeting their reproductive needs, leading to high rates of unintended pregnancies, abortions and deaths. Evidence shows that empowering women may increase the proportion of demand for family planning satisfied using modern methods (mDFPS), but few studies have measured this process in multiple spheres of life. We investigated how empowerment influences the mDFPS among married women of reproductive age (MWRA) in Burkina Faso. In sub-Saharan Africa, the modern contraceptive prevalence rate doubled among all married women of reproductive age (MWRA), from 14.7% in 2000 to 27.9% in 2019 [2]. Evidence shows that increasing women’s access to resources and rights has the potential to empower them to make decisions to use modern contraceptives and reduce fertility [8]. Contraceptive decision-making is primarily made in marital relationships, but it is influenced by community norms about gender roles and relationships [9, 10]
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