Women’s decision-making and contraceptive use in Pakistan: an analysis of Demographic and Health Survey data

Abstract

ABSTRACT This study examines the association of decision-making with contraceptive use along with other measures of women’s empowerment and the gender context. We use data on currently married women from the Demographic and Health Survey conducted in Pakistan in 2017–2018. We contrast patterns in modern contraception with traditional contraception and examine specific modern methods. Husband’s characteristics do not factor strongly in women’s modern contraceptive use. Contraceptive decision-making is more pertinent to women’s modern contraceptive use than household decision-making and is inhibited when husbands are the primary decision-makers of contraceptive decisions. In contrast, joint decision-making facilitates overall modern contraceptive use and the use of condoms in particular. Contraceptive use is reduced when the decision is made by someone other than the woman or her husband. Economic empowerment resources are weakly and inconsistently associated with modern contraceptive use. Furthermore, modern contraceptive use (particularly condoms and female sterilisation) is reduced when women live in an extended household. Region, education, and wealth remain important correlates of modern contraceptive use, even after controlling for other factors, as does the number of living children and, for female sterilisation and IUDs only, women’s working status. This study finds support for expanding the range of available methods and combining service improvements with promoting women’s empowerment, gender equity, and social behaviour change initiatives targeted to men and other family members.