Reproductive Empowerment Research Articles

Adaptation and psychometric assessment of a sexual and reproductive empowerment scale in Arabic among refugee and non-refugee adolescent girls.

Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties. The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

Supporting contraceptive self-care and reproductive empowerment with a digital health game in Barbados: Development and Pre-implementation study for What’s My Method?

Effective contraceptive education is essential to reducing unwanted pregnancy, increasing uptake of modern contraceptive methods, and thoughtfully planning desired births. New WHO and family planning organization guidelines recommend situating contraceptive education and counseling within a broader context of self-care that emphasizes individual agency and reproductive empowerment. Digital health interventions, and games for health specifically, have been validated as effective and scalable tools for self-guided and interactive health education, especially among younger tech-savvy individuals. Barbados currently supplements provider-based contraceptive counseling with analog materials (pamphlets and posters) and informational videos that play on a screen in the waiting room. This study seeks to conduct a formative evaluation of the What’s My Method? (WMM) game intervention as a tool to support contraceptive counseling and increase reproductive empowerment among childbearing persons in Barbados. We test-deployed the WMM game in Bridgetown, Barbados, conducting focus groups and sample deployments with prototypes of the WMM game among three groups of stakeholders (youth contraception ambassadors: n=8; healthcare providers: n=7; and nursing students: n=27) to determine acceptability of the intervention, efficacy of the game as a learning tool, and willingness to adopt the tool in their healthcare context. Feedback on acceptability of the game was largely positive. Constructive feedback informed modifications and improvements to the game. Assessment of contraceptive knowledge gain was complicated by several factors and resulted in modifications of the questionnaire and methodology for measurement of efficacy. Results indicate that the WMM game is well-reviewed and accepted by the target audience of childbearing people and healthcare professionals who would be deploying it. The questionnaire did not perform as intended for our target audience. This pilot testing has informed the design and outcome selection for the upcoming RCT with the final version of the game.

Confirmatory Factor Analysis and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults in Kenya.

Understanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15-20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor structure, and logistic regression to examine construct validity through the relationship between empowerment scores and ability to mitigate risk of undesired pregnancy through consistent contraceptive use. Participants had a mean age of 17.5, and most were students (61 percent), were currently partnered (94 percent), and reported having sex in the past 3 months (70 percent). The final, 26-item CFA model had acceptable fit. All subscales had Cronbach's alpha scores >0.7, and all items had rotated factor loadings >0.5, indicating good internal consistency and robust factor-variable associations. The total SRE-Kenya (SRE-K) score was associated with increased odds of the consistent method used in the past three months (adjusted odds ratio: 1.98, 95 percent CI: 1.29-3.10). The SRE-K scale is a newly adapted and valid measure of sexual and reproductive empowerment specific to adolescent girls and young women in an East African setting.

Women’s autonomy and maternal health decision making in Kenya: implications for service delivery reform - a qualitative study

BackgroundMaternal and neonatal outcomes in, Kakamega County is characterized by a maternal mortality rate of 316 per 100,000 live births and a neonatal mortality rate of 19 per 1,000 live births. In 2018, approximately 70,000 births occurred in the county, with 35% at home, 28% in primary care facilities, and 37% in hospitals. A maternal and child health service delivery redesign (SDR) that aims to reorganize maternal and newborn health services is being implemented in Kakamega County in Kenya to improve the progress of these indicators. Research has shown that women’s ability to make decisions (voice, agency, and autonomy) is critical for gender equality, empowerment and an important determinant of access and utilization. As part of the Kakamega SDR process evaluation, this study sought to understand women’s processes of decision-making in seeking maternal health care and how these affect women’s ability to access and use antenatal, delivery, and post-natal services.MethodsWe adapted the International Centre for Research on Women (ICRW) conceptual framework for reproductive empowerment to focus on the interrelated concepts of “female autonomy”, and “women’s agency” with the latter incorporating ‘voice’, ‘choice’ and ‘power’. Our adaptation did not consider the influence of sexual relationships and leadership on SRH decision-making. We conducted key informant interviews, in-depth interviews, small group interviews and focus group discussions with pregnant women attending Antenatal clinics, women who had delivered, women attending post-natal clinics, and men in Kakamega County. A thematic analysis approach was used to analyze the data in NVivo 12.ResultsThe results revealed notable findings across three dimensions of agency. Women with previous birthing experiences, high self-esteem, and support from their social networks exhibited greater agency. Additionally, positive previous birthing experiences were associated with increased confidence in making reproductive health choices. Women who had control over financial resources and experienced respectful communication with their partners exhibited higher levels of agency within their households. Distance relational agency demonstrated the impact of health system factors and socio-cultural norms on women’s agency and autonomy. Finally, women who faced barriers such as long waiting times or limited staff availability experienced reduced agency in seeking healthcare.ConclusionsIndividual agency, immediate relational agency, and distance relational agency all play crucial roles in shaping women’s decision-making power and control over their utilization of maternal health services. This study offers valuable insights that can guide the ongoing implementation of an innovative service delivery redesign model, emphasizing the critical need for developing context-specific strategies to promote women’s voices for sustained use.

(111) Evaluation of Sexual Education Needs in Spina Bifida Adolescents and Correlation Between Sexual Satisfaction with Depression and Anxiety

Abstract Introduction Spina bifida is a congenital disorder with many neurological sequelae, most notably, decreased sexual function and infertility. While some neuro-urological related factors have been extensively studied among patients with spina bifida, sexual health and infertility continue to be largely unaddressed in this population, especially in the adolescent population. Although previous studies show the need to address sexual health in spina bifida patients, they do not assess the level of sexual health knowledge adolescents possess or the degree to which their psychological functioning is impacted by sexual dysfunction. Although a validated sexual and reproductive empowerment scale exists for adolescents, it has not been utilized in spina bifida patients. This can be due to stigmas that patients with spina bifida may not be engaging in or desire sexual activity. Overall, the stigma of addressing sexual health in adolescents and the inadequacy of current sexual health curriculum, prevents adolescent spina bifida patients from accessing sexual health related information. Objective This study will assess the baseline sexual health literacy and sexual health needs of adolescents with spina bifida. The second aim of this study is to identify the barriers that adolescent spina bifida patients face when attempting to gather information regarding their sexual health. The third aim of this study is to determine whether sexual literacy and sexual empowerment scores are associated with self-reported depression and anxiety as measured by the PHQ-9 and GAD-7 in this population. Methods English- and Spanish-speaking adolescent patients aged 15-21 presenting to a Spina Bifida Multidisciplinary Clinic for routine clinical care will be prospectively recruited for participation in a cross-sectional questionnaire study designed in REDCap. Correlation analysis will be utilized to identify the association between depression, anxiety, sexual health literacy, and sexual empowerment scores. The Patient Health Questionnaire-9 and then Generalized Anxiety Disorder-7 questionnaire will be utilized to assess depression and anxiety, respectively. Results Per literature review multiple studies show that adolescents with spina bifida do not have sexual health needs addressed by any provider or family member. Many of these patients feel that their providers assume they do not engage in sexual activity, or view them as asexual, and potential partners are hesitant to discuss sexual desire due to physical limitations. Studies done assessing sexual dysfunction and related emotional well-being, were based on interview studies and extrapolating significant themes. Upon an initial survey of 2 pediatric urologists at CHLA, we have found that many patients do not feel comfortable addressing sexual health and that there are no current tools for pediatric urologists to initiate sexual health related discussion. Currently no such validated comprehensive questionnaire exists to assess level of sexual health knowledge, sexual desires, and psychological state for adolescent spina bifida patients. Conclusions There is a need to establish a communication tool for providers to initiate discussion regarding sexual health in adolescents with spina bifida. Disclosure No.

Women's voices and meanings of empowerment for reproductive decisions: a qualitative study in Mozambique

BackgroundWomen in Mozambique are often disempowered when it comes to making decisions concerning their lives, including their bodies and reproductive options. This study aimed to explore the views of women in Mozambique about key elements of empowerment for reproductive decisions and the meanings they attach to these elements.MethodsQualitative in-depth interviews were undertaken with 64 women of reproductive age (18–49 years) in two provinces in Mozambique. Participants were recruited through convenience sampling. Data collection took place between February and March 2020 in Maputo city and Province, and during August 2020 in Nampula Province. A thematic analysis was performed.ResultsWomen described crucial elements of how power is exerted for reproductive choices. These choices include the ability to plan the number and timing of pregnancies and the ability either to negotiate with sexual partners by voicing choice and influencing decisions, or to exercise their right to make decisions independently. They considered that women with empowerment had characteristics such as independence, active participation and being free. These characteristics are recognized key enablers for the process of women’s empowerment.ConclusionsThis study’s findings contribute to an expanded conceptualization and operationalization of women’s sexual and reproductive empowerment by unveiling key elements that need to be considered in future research and approaches to women’s empowerment. Furthermore, it gave women the central role and voice in the research of empowerment's conceptualization and measurement where women’s views and meanings are seldom considered.

A comprehensive interventional program based on the needs and concerns related to female genital cosmetic surgeries: protocol for a multistage mixed methods study

BackgroundDissatisfaction with one's body and the subsequent rise in the cosmetic surgery trend pose significant public health concerns today. One unusual cosmetic surgical procedure involves enhancing the genital area. Numerous healthy women and girls have recently sought Genital Cosmetic Surgery (GCS) for beauty or improved sexual performance. There is a concern that this phenomenon may be linked to developing a new standard for vulvovaginal appearance. This stringent standard could potentially adversely affect women's mental health in the future, growing feelings of insecurity and possibly leading teenagers to consider plastic surgery.Implementing empowering and awareness-raising programs for women and girls is crucial, especially in light of the constantly evolving gender norms and the medicalization of sexuality and beauty as social constructs. It is essential that such training is integrated into comprehensive sexual education programs for adolescents. These efforts align perfectly with the SDG, recognizing that education in sexual and reproductive health, ensuring access to health, and empowering women are fundamental rights for women and girls. To accomplish these objectives, we will conduct this study to elucidate the needs and concerns related to the increasing trend of GCS. By doing so, we can concentrate on the factors motivating women to undergo GCS. This approach will enable us to develop effective interventions to empower women and girls considering GCS, thus enhancing their sexual and reproductive health.Methods and objectivesThe objectives of this multistage exploratory sequential mixed-method study will be structured into three phases:First phase: qualitative study.In-depth interviews will be conducted to elucidate the needs and concerns associated with GCS with women with a history of GCS, spouses of willing participants, and women actively seeking these procedures.A literature review in parallel with the qualitative phase will be conducted to gain insights into the needs and concerns of women worldwide considering GCS.Second phase: program design.To formulate an intervention grounded in the primary priorities identified during the qualitative stage and informed by the literature review.To prioritize the needs and concerns of women seeking GCS and to validate and endorse the intervention through input from an expert panel.Third phase: quantitative study.To assess and determine the effectiveness of the intervention designed to address the needs and concerns of women applying for GCS procedures.DiscussionThis study marks the first attempt to design and assess an intervention addressing the needs and concerns of cosmetic surgeries performed on the female genital and reproductive system. The hope is that this study's compilation and implementation will yield substantial evidence and documentation regarding the impact of educational interventions on women's and girls' sexual and reproductive empowerment. Given the rising prevalence of GCS among unmarried teenagers, this approach is of utmost significance. It underscores the necessity for gynecological and midwifery service providers to have comprehensive guidance on GCS. Such guidance can be an essential resource for healthcare providers in this field.

Adaptation of the sexual and reproductive empowerment scale for adolescents and young adults in Kenya.

Measuring empowerment is critical to understanding the level of control adolescents and young adults (AYA) have over their sexual and reproductive health (SRH) behaviors, and could provide a key window into addressing their unique SRH needs. We adapted the Sexual and Reproductive Empowerment (SRE) scale for AYA for use in an East African context. This multi-method qualitative study sampled 15-23 year-old female adolescents and young adults in Kisumu, Kenya. We conducted in-depth interviews (n = 30) and analyzed transcripts with an inductive, constant comparison approach. Empowerment domains were integrated with Kabeer's (1999) framework in a conceptual model, which we referenced to revise the original and develop new scale items. Items underwent expert review, and were condensed and translated through team-based consensus-building. We evaluated content validity in cognitive interviews (n = 25), during which item phrasing and word choice were revised to generate an adapted SRE scale. Participants (n = 55) had a median age of 18 (range 16-23), and 75% were under 19 years. We categorize three types of adaptations to the SRE scale: new item generation, item revision, and translation/linguistic considerations. We developed nine new items reflecting AYA's experiences and new domains of empowerment that emerged from the data; new domains relate to self-efficacy in accessing sexual and reproductive health care, and how material needs are met. All items were revised and translated to echo concepts and language relevant to participants, navigating the multilingualism common in many African countries. Centering the voices of female Kenyan AYA, this study provides insight into measuring the latent construct of adolescent sexual and reproductive empowerment in an East African setting, and supports the adapted SRE scale's content validity for Kenya. We detail our multi-method, theory-driven approach, contributing to limited methods guidance for measure adaptation across contexts and among diverse adolescent populations.

Keeping Girls in Schools Longer: The Kanyashree Approach in India

Regarding interventions aimed at preventing girls from prematurely dropping out of schools, this study shows that inducing economic empowerment of girls is possible with targeted policies that promote their reproductive empowerment. Using Kanyashree Prakalpa, a conditional cash transfer program implemented in West Bengal, India, that directly incentivized school attendance to delay child marriage, the study finds a strong association between program participation and successfully lowering the historically higher dropout rates post-middle school. Program-eligible girls are 12 percent (7 percent) more likely to be enrolled in or to complete secondary (higher secondary) school, respectively. Program participation is associated with approximately five more months of education. In fact, the efficacy of the program is highly correlated with the length of exposure, and the most benefits are reaped by children in the poorest households. The article discusses three policy interventions, including directly targeting girls as they transition from childhood to young adulthood. HIGHLIGHTS In West Bengal, Kanyashree Prakalpa, a unique cash incentive program, links educational empowerment with girls’ reproductive empowerment. Program participation is strongly associated with successfully lowering the historically higher dropout rates post-middle school. Policies directly targeting adolescent girls are fruitful compared to indirect influence. Policies complementing the cash transfer with other programs based on the girls’ academic achievement are useful.

Effects of a clinic-based reproductive empowerment intervention on proximal outcomes of contraceptive use, self-efficacy, attitudes, and awareness and use of survivor services: a cluster-controlled trial in Nairobi, Kenya

This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta −0.34, 95% CI −0.65, −0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs. Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women’s reproductive health. While one intervention, ARCHES – Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women’s proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.

The US in Uterus: A Collaborative Autoethnography of Psychologists Advocating for Reproductive Justice

In light of the recent Supreme Court decision to overturn Roe v. Wade, millions of people with uteruses have been forced to navigate precarious access to reproductive care. Although health service psychologists have an ethical responsibility to engage in reproductive justice advocacy, training programs often do not adequately address sexual and reproductive health. Therefore, we sought to better understand how health service psychologists’ personal and professional experiences influence each other and explore the ways in which we as reproductive beings and advocates sustain ourselves amidst tremendous sociopolitical uncertainty. In order to do so, we employed a feminist collaborative autoethnography approach grounded in critical theory. Attending to intersectional identities that help shape diverse expectations and experiences, two early career psychologists and four trainees uncovered 12 domains: barriers in academia; reproductive (dis)empowerment; relational connection; power(lessness) associated with social locations; internalization of sex-negative messages; the influence of sociopolitical climate; burdens related to reproductive rights; evaluations of reproductive justice efforts; component of professional identity; expectations from family and community; overwhelming and exhausting advocacy; and fears of inadequacy. We conclude with limitations and implications for the continued promotion of advocacy through practice and training within and beyond the field of psychology.

Women’s and male partners’ socio-demographic and economic characteristics associated with contraceptive decision making in Nigeria

BackgroundWomen’s ability to make contraceptive decision can determine their contraceptive use which can improve their reproductive health and career. Improvement in such ability can increase contraceptive prevalence in Nigeria. However, factors that promote contraceptive decision-making among women are scarcely studied. This study examined factors associated with women’s individual or joint contraceptive decision-making in Nigeria.MethodsSecondary (cross-sectional) data were analysed. The data were extracted from the individual recode file of the 2018 Nigeria Demographic and Health Survey (DHS). Partnered women (i.e., currently married or living with a partner) aged 15–49 years and currently using contraceptives before the survey were considered. They constituted 4,823 in total. Their data were analysed using frequency and percentage distributions of variables, Chi-square tests of independence and multinominal logistic regression.ResultsFindings reveal that 23% (1,125) of women made their own contraceptive decision, nearly 67% (3,213) were joint decision makers, and 10% (491) stated that their male partners had decided for them. The probability of solely making contraceptive decision and being a joint decision maker (relative to being a male partner’s decision) was higher among women above 29 years and aged 30–34 years (than women aged 15–24 years) respectively as well as among the employed (than the unemployed) and among those from Yoruba ethnic group (than their counterparts from Hausa/Fulani/Kanuri/Beri Beri) respectively. The probability of being responsible for contraceptive decision (than being the male partner’s decision) was higher among women from the Igbo group and women whose male partners desired more children (than those with the same number of desired children) respectively. The probability of being the main decision maker (relative to being the male partner) was lower among women in the poorer (RRR = 0.39; 95%CI = 0.21–0.73; p = 0.01), middle (RRR = 0.47; 95%CI = 0.25–0.90; p = 0.02) and richest (RRR = 0.41; 95%CI = 0.20–0.82; p = 0.01) groups respectively, than the poorest women. The probability of being a joint decision maker was higher among women with secondary education (than the uneducated), practised Christianity (than the Muslims/ others), and among those residing in the North West region (than those in North East) respectively. However, the probability of being a joint decision-maker was lower among women whose partners desire more children and those who did not know their partners’ desires.ConclusionsWomen’s age, highest level of education, employment status, wealth index, ethnicity, religion, region of residence and male partners’ desire for children are associated with contraceptive decision making respectively. There is a need for reproductive empowerment interventions in Nigeria that devise effective ways of improving contraceptive decision-making power of partnered women aged 15–24 years, unemployed, in the poorer and richest groups, from the Hausa/Fulani/Kanuri/Beri Beri ethnic group, practising Islam/ other religions, have the same fertility desire as their partners and those who do not know their male partner’s desire for children respectively. Women whose partners desire more children should be empowered to participate effectively in contraceptive decision making.

Thematic Analysis and Mapping of Reproductive Empowerment Scales: A Tool for Family Planning Self-Care Programming and Research.

<h3>Key Messages</h3> There is an evidence gap in the relationship between self-care and reproductive empowerment; understanding this relationship using validated scales is necessary to improve the design, implementation, and scale-up of family planning self-care interventions. We summarize 5 validated scales that measure reproductive empowerment-related concepts and offer a thematic analysis to help family planning programmers and researchers assess which scales best fit their needs for family planning self-care programming. Communication, decision making, and partner influence are the most measured domains among the scales we examined; however, measures of other reproductive empowerment domains are available and may be of interest to programs depending on their context and focus.

\u201cIt was my own decision\u201d: the transformational shift that influences a woman's decision to use contraceptives covertly

BackgroundFamily planning (FP) is an important element of sexual and reproductive health and rights, but socio-cultural barriers and unbalanced gender relations often limit women’s decision-making about contraceptive use. Covert contraceptive use (CCU) exemplifies the limits on women’s decision-making and represents a way in which some women overcome constraints to achieve their reproductive goals. This study explores the decision-making process through which women choose to use contraceptives covertly.MethodsA qualitative synthesis was conducted using data from women, health providers, community members, health administrators, and intervention implementers (n = 400) to explore the decision-making process through which women choose to use contraceptives covertly. Interviews and focus group discussions were conducted at two time points as part of an evaluation of interventions integrating FP and childhood immunisation services at sites in Benin, Kenya, Malawi and Uganda. The sexual and reproductive health empowerment framework by Karp et al. (2020) was adapted and used to guide the analysis.ResultsWomen recognised that although they suffered the negative consequences of frequent pregnancies and of raising large families, they lacked overt decision-making power over their fertility. Women were confident to engage in CCU because they believed their husbands did not understand these consequences nor acknowledged their suffering, which justified not informing them. CCU was a difficult choice however, women felt comfortable voicing their reproductive preferences in settings where health providers were supportive.ConclusionsWomen chose to use contraceptives covertly when they questioned the unfairness of their situation and recognised their own power to act in accordance with their reproductive preferences. This represented an important shift in a woman’s perception of who is entitled to make decisions about contraceptive use. Importantly, health providers can play a key role in supporting women’s autonomous decision making about contraceptive use and should be careful not to undermine women’s confidence.

"There Are Things We Can Do and There Are Things We Cannot Do." A Qualitative Study About Women's Perceptions on Empowerment in Relation to Fertility Intentions and Family Planning Practices in Mozambique.

IntroductionThe restrictive socio-cultural norms in Mozambique limit the power of women to decide, voice, and act on their reproductive choices. This study aimed to explore women's perceptions and experiences of empowerment relating to fertility intentions and family planning practices in Mozambique, focusing on facilitators and barriers toward reproductive empowerment.MethodsQualitative in-depth interviews were undertaken with women of reproductive age (18–49 years) in Nampula and Maputo provinces and Maputo city, Mozambique. Data collection took place between February and March 2020 in Maputo region and during August 2020 in Nampula Province. Convenience sampling was used to recruit participants from both urban and rural healthcare facilities and from within the communities serving the healthcare facilities. In Maputo city, a snowball sampling technique was used to recruit women from the community. A total of 64 women were interviewed, 39 from Maputo and 25 from Nampula. A thematic analysis was conducted with the support of NVivo12 software.ResultsSeveral factors that hinder and facilitate women's empowerment toward fertility and family planning practices in Mozambique were identified and were interpreted within the socio-ecological model. The identified barriers included women's lack of critical consciousness and oppressive relationships. At the community and societal levels, the role of traditions, culture and gender expectations and limited access to family planning and misinformation were also important hindering factors. The facilitators of reproductive empowerment included building critical consciousness and access to economic resources at the individual level. Negative experiences at the household level were triggers of women's empowerment for family planning. Building collective power and access to information, including education, were key at the community and societal levels.ConclusionsThis study identified various factors that positively or negatively influence women's empowerment journeys in Mozambique. The role of tradition, culture, and gender expectations, and oppressive relationships, were important barriers in both provinces. Women from rural areas would benefit from building of consciousness about their rights, and power to decide on their reproductive lives. Interactions with the health providers offer an opportunity to do this by favoring controlling behaviors concerning their reproductive lives, promoting social networking and levering collective power.

The Intersections of Women’s Economic and Reproductive Empowerment

The Intersections of Women’s Economic and Reproductive Empowerment

Assessment of Women's Reproductive Empowerment in Rural and Urban Areas: A Comparitive Study

Background: Empowering women is a key factor for better social and economic development of different countries because women empowerment enables much more working force and improves performance of organizations. Aim: This study aimed to assess women's reproductive empowerment in rural and urban areas. Design: A cross sectional descriptive research design was used. Setting: This study was carried out at Maternal and Child Health Care Center at Talkha and Salamoon health facility, Delta, Egypt. Study subjects: A non-probability purposive sample of 334 women who were fulfilling the inclusion criteria. Tools A structured interview schedule to cover the data related to general characteristics and women’s reproductive empowerment questionnaire to assess women’s reproductive empowerment. Results: There were highly statistical significant differences regarding cultural, individual family, social and family planning domain scores among rural and urban women with more empowerment in urban women (p < 0.001). Also, the highest of women’s reproductive empowerment among urban and rural residents were found in cultural domain with Mean ±SD 20.3 ±4.5 and 18.1 ±5.8 respectively and the lowest scores among rural and urban women were found in family planning domain with Mean ±SD 17.7 ±3.1 and 14.9 ±4.7 respectively. Else, women’s reproductive empowerment among the studied group was significantly associated with their occupation, educational level and their husband's educational level (p >0.05). Conclusion: The current study question was answered where urban women were more empowered regarding cultural, individual family, social and family planning domains than rural women. Women occupation, educational level and husband's educational level had an effective role in reproductive empowerment. Recommendations: The current study recommended more involvement of woman in membership in rural institutions and access to social networks, also increase awareness of rural woman about their right, legal empowerment and decision-making.

Women’s reproductive health and economic activity: A narrative review

• Income per capita moderates the effect of fertility on female labor force participation across LICs, MICs and HICs. • In LICs, fertility is high, and women work in the informal sector. Household income sharing is not always practiced, and women must work. • In LICs, women devise strategies of birth spacing, informal childcare, and switching job-type to enable childrearing and work. • In HICs, women work in the formal sector, but career advancement and gender wage gaps persist despite supportive policies. • For all women around the world, attaining the combination of reproductive empowerment, along with decent work, is a challenge. This paper provides a narrative review of the literature that addresses the connection between women’s reproductive health and women’s economic activity. Women’s reproductive health, gender equality and decent work, are all part of the Sustainable Development Goals and this review highlights how these Goals are interconnected. The review focuses on the relationship between fertility and women’s work and provides a detailed discussion of the academic literature that identifies the causal effect of fertility on changes in female labor force participation. Fertility is captured by timing, spacing and number of children, and career advancement, job quality, and hours worked are addressed on the work side. The review contrasts the fertility-work nexus for low-, middle- and high-income countries separately, recognizing national income per capita as a moderator of the effect of fertility on female labor force participation. In low-income countries, where labor force participation is for the most part in the informal sector, women must adopt their own strategies for balancing child rearing and labor force participation, such as selection of job type, relying on other women in the household for childcare, and birth spacing to limit infants in their care. In middle-income countries, women juggle child rearing and labor force participation with the overarching issue of income inequality, and early childbearing and lone motherhood perpetuate poverty. For women in high-income countries, social protection policies can assist women in managing the balance of childrearing and work, but these policies do not address underlying issues of gender inequality. Despite these policies, career advancement is interrupted by childbearing. As the relationship between fertility and women’s work varies by income per capita across countries, polices that support women in achieving balance in their desired family size and accessing decent work varies across countries.

Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women.

ObjectiveLow birthweight is one of the main causes of poor health outcomes among newborns, with Black women having a disproportionately high prevalence. A digital intervention targeted Black women in Orange County, Florida with information on positive pregnancy-related knowledge and attitudes related to low birthweight. This paper reports on campaign methods for the first 2.5 years of implementation.MethodsCampaign content was tailored toward Black women, around a reproductive empowerment lens. Content focused on emphasizing healthy pregnancy-related behaviors and creating positive representations of Black women throughout the various stages of pregnancy through both static images and a web series. Digital metrics gauged campaign engagement. Three cross-sectional online surveys conducted in the intervention county examined Black women’s pregnancy-related knowledge, attitudes, and behaviors.ResultsAfter two years of campaign implementation, social media accounts showed 1784 followers. While Facebook showed more average monthly impressions, Instagram showed more average monthly engagements. Survey results showed some increases in knowledge about prenatal care, weight gain, exercise, and the health impacts of low birthweight.Conclusions for PracticeThis study highlights the potential for a culturally-appropriate digital intervention to promote positive pregnancy outcomes among at-risk women. Digital interventions offer a potential way to achieve positive pregnancy-related behavior changes on a larger scale. This may be particularly important given that the COVID-19 pandemic may be changing the ways that pregnant women access information. Studies should examine the impact and feasibility of using culturally-appropriate digital interventions that directly address Black women and their specific experiences during pregnancy.

Development and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults

PurposeWe developed and validated a measure that assesses the latent construct of sexual and reproductive empowerment among adolescents and young adults. A specific measure for this group is critical because of their unique life stage and circumstances, which often includes frequent changes in sexual partners and involvement from parents in decision-making. MethodsAfter formative qualitative research, a review of the literature, and cognitive interviews, we developed 95 items representing nine dimensions of sexual and reproductive empowerment. Items were then fielded among a national sample of young people aged 15–24 years, and those who identified as sexually active completed a 3-month follow-up survey. We conducted psychometric analysis and scale validation. ResultsExploratory factor analysis on responses from 1,117 participants resulted in the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults, containing 23 items captured by seven subscales: comfort talking with partner; choice of partners, marriage, and children; parental support; sexual safety; self-love; sense of future; and sexual pleasure. Validation using logistic regression demonstrated that the subscales were consistently associated with sexual and reproductive health information and access to sexual and reproductive health services measured at baseline and moderately associated with the use of desired contraceptive methods at 3-month follow-up. ConclusionsThe Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults is a new measure that assesses young people’s empowerment regarding sexual and reproductive health. It can be used by researchers, public health practitioners, and clinicians to measure sexual and reproductive empowerment among young people.