Women's Reproductive Choices Research Articles

The EMERGE framework to measure empowerment for health and development

RationaleWomen's empowerment is a UN Sustainable Development Goal and a focus of global health and development but survey measures and data on gender empowerment remain weak. Existing indicators are often disconnected from theory; stronger operationalization is needed. ObjectiveWe present the EMERGE Framework to Measure Empowerment, a framework to strengthen empowerment measures for global health and development. MethodWe initiated development of this framework in 2016 as part of EMERGE – an initiative designed to build the science of survey research and availability of high-quality survey measures and data on gender empowerment. The framework is guided by existing theories of empowerment, evidence, and expert input. We apply this framework to understand women's empowerment in family planning (FP) via review of state of the field measures. ResultsOur framework offers concrete measurable constructs to assess critical consciousness and choice, agency and backlash, and goal achievement as the empowerment process, recognizing its operation at multiple levels-from the individual to the collective. Internal attributes, social norms, and external contexts and resources create facilitators or barriers to the empowerment process. Review of best evidence FP measures assessing empowerment constructs, social norms, and key influencers (e.g., partners and providers) show a strong landscape of measures, including those with women, partners, and providers, but they are limited in assessing translation of choice to agency to achievement of women's self-determined fertility or contraceptive goals, instead relying on assumption of contraceptive use as the goal. We see no measures on collective empowerment toward women's reproductive choice and rights. ConclusionThe EMERGE Framework can guide development and analysis of survey measures on empowerment and is needed as the current state of the field shows limited coverage of empowerment constructs even in areas which have received more study, such as family planning.

A Comparative Analysis of Attitude Resources in Chinese and American English News Reports on “Roe v. Wade”

In 1973, "Roe v. Wade" (hereinafter referred to as Roe) became one of the important judgements in modern American society because of its establishment of women's reproductive choice. In 2022, the US Supreme Court officially overturned the Roe case, which also caused an uproar at home and abroad. News media, as an important information dissemination medium, widely influences readers' attitudes and opinions. This paper mainly conducted by the application of the Appraisal Theory, which has developed by the linguist J. R. Martin covering three subsystems: attitude, engagement and graduation, to the study of news reports concerning the Roe. The study is focus on the perspective of the attitude system, and the research corpus consists of a total of 10 news articles selected from two mainstream media both in China and the U.S., China Daily and New York Times. Using a combination of quantitative and qualitative methods, this study has discussed in detail the attitude resources in the overturning of Roe in Chinese and American news discourse. Through analysis and comparison, the author finds that there are similarities and differences in the overall distribution of attitude resources between the two media. First of all, the distribution of attitude resources between the two sides is roughly in the same trend. Secondly, New York Times employs more attitude resources than that of China Daily, with a dominant air of negative attitude resources.

Factors associated with the health and reproductive autonomy of Quilombola women in Brazil.

To verify the association between reproductive autonomy and sociodemographic, sexual, and reproductive characteristics in Quilombola women (a term indicating the origin of politically organized concentrations of Afro-descendants who emancipated themselves from slavery). Cross-sectional and analytical study with 160 women from Quilombola communities in the southwest of Bahia, Brazil. Data were collected using the Reproductive Autonomy Scale and the questionnaire from the National Health Survey (adapted). Out of the 160 participating women, 91.9% declared themselves as black, one out of every three were aged ≤ 23 years, 53.8% were married or had a partner, 38.8% had studied for ≤ 4 years, over half (58.1%) were unemployed, only 32.4% had a monthly income > R$ 430 (80 US dollars), 52.5% had their first menstruation at the age of 12, 70.7% had not accessed family planning services in the last 12 months, and over half used some method to avoid pregnancy (59.0%). The women had a high level of reproductive autonomy, especially in the "Decision-making" and "Freedom from coercion" subscales with a score of 2.53 and 3.40, respectively. A significant association (p<0.05) was found between the "Total reproductive autonomy" score and marital status, indicating that single or unpartnered women had higher autonomy compared to married or partnered women. The association of social determinants of health such as marital status, education, and age impacts women's reproductive choices, implying risks for sexual and reproductive health. The intergenerational reproductive autonomy of Quilombola women is associated with sociodemographic and reproductive factors.

Ethiopian women's tokophobia of childbirth and its predictors: a systematic review and meta-analysis.

Fear of childbirth is recognized as a growing problem in developing countries, including Ethiopia. The impact of this fear on women's reproductive choices and decisions is significant. Therefore, the systematic review and meta-analysis will help to consolidate the existing research on childbirth-related fear in Ethiopia. Synthesizing the findings and providing a pooled prevalence estimate, can contribute to a better understanding of the scale of the problem in the country. This systematic review and meta-analysis assessed the pooled prevalence of childbirth-related fear and its associated factors among pregnant mothers in Ethiopia. PubMed, Google Scholar, and African Journals Online were searched for included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of childbirth-related fear. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific region where the study was conducted. Funnel plot and Egger's regression test were used to check for publication bias. STATA version 14 statistical software was used for meta-analysis. A total of 2,015 pregnant mothers were included. The combined prevalence of fear of childbirth among pregnant mothers was found to be 21% (95% CI: 19-22; I 2 = 0.00%, p value < 0.001). Based on the subgroup analysis, the prevalence of fear of childbirth among pregnant mothers was 24% in SNNPRs, 25% in Oromia, and 11% in Addis Ababa. The findings of the meta-analysis indicating a high prevalence of fear of childbirth among pregnant mothers in Ethiopia and identifying associated risk factors highlight the importance of addressing this issue within the healthcare system. Integrating prevention-based services for mothers with childbirth fears into the antenatal care model could be a valuable approach to support women and mitigate the impact of fear on their reproductive experiences. https://www.crd.york.ac.uk/prospero/#myprospero, identifier [CRD42023411103].

Conditional cash transfers and women's reproductive choices.

We study potential non-targeted effects of a large-scale national conditional cash transfer program-Peru's Juntos-on the fertility and reproductive decisions of adult beneficiaries. We use an event study design, exploiting time and geographic variation in the rollout of the program, to identify the causal effects of the program. We find that Juntos decreases the number of children that adult beneficiaries have and that these effects persist over time. We explore various mechanisms and find that Juntos does not affect fertility preferences but rather empowers women to avoid unwanted births. We provide evidence that this decrease is most likely due to better access to and more extensive use of modern birth control methods.

Employer funded egg freezing: An advance for women in the workplace or a return to the unencumbered employee?

This paper critically examines employer-funded egg freezing for female employees. It argues that the market-based approach to egg-freezing is highly problematic and does not sufficiently address existing workplace barriers and institutional obstacles affecting women's reproductive choices. Section two scrutinizes the cultural/social context of women's rights in the workplace. The third section examines feminist critiques of employer paid egg-freezing. It explores perspectives of the pregnant body and its acceptance or unacceptance in the domain of work. Section four investigates employer egg-freezing utilising a feminist-institutionalist framework as a conceptual tool for revealing and analysing the visible and invisible institutional pressures that shape decision making particularly for female employees in respect of their reproductive lives. This paper concludes that if employer-funded egg-freezing is to provide genuine benefits to female employees, it must be situated within the context of social and institutional reform that properly integrates pregnancy and reproductive choices into the workplace.

Physicians Controlling Women's Reproductive Choices: The Slow Liberalization of Abortion Laws in Finland.

This paper provides an overview of the development and the sociopolitical background of legislation pertaining to abortion in Finland from the nineteenth century to the current day. The first Abortion Act came to force in 1950. Before that, abortions were handled under criminal law. The 1950 law was restrictive and allowed abortions in very limited circumstances only. Its main aim was to reduce the number of abortions and especially illegal abortions. It was not very successful in reaching these goals, but, significantly, it moved abortions from the realm of the criminal law to the hands of medical professionals. The birth of the welfare state and the prenatal attitudes of 1930s and 1940s Europe played their part in shaping the law. By late 1960s, with the rise of the women's rights movement and other changes in society, there was pressure to change the outdated law. The new 1970 Abortion Act was broader and allowed abortions for limited social reasons too but left very limited, if any, room for a woman's right to choose. After a citizen's initiative in 2020, the year 2023 will see a significant amendment to the 1970 law; during the first 12weeks of pregnancy, an abortion can be performed on the woman's request alone. However, there is still a long way to go in terms of women's rights and abortion laws in Finland.

The Relationship between the Empowerment of Women and Preferences Related to Fertility in Pakistan

This study examines the relationship between women's empowerment and reproductive choices among married Pakistani women aged 15 to 49. The study utilized the most recent Pakistan Demographic and Health Survey 2017–2018 data. Four proxies were used to measure women's empowerment: spending on husbands' earnings, visits to family, major family purchases, and health care decisions. Health care choices and spending on the husband's salary are both greatly influenced by fertility. Binary logistic regression reveals a substantial and unfavorable link in connection with empowerment and the various education levels of children, males, and spouses. By focusing on this topic, this study can see beyond the constraints that currently exist in the relationship between women's empowerment and fertility preferences. The findings of this study suggest that female participation in the labor force is essential to preserving balanced reproduction and decision-making regarding the home.

“That's a woman's body, that's a woman's choice”: The influence of policy on women's reproductive choices

This study explored Victorian (Australia) women's lived experiences of policy regarding their reproductive choices. In-depth interviews were conducted with 15 women aged between 20 and 45 years. Five inter-connected themes emerged: social-cultural-political-legal-environmental context; access, information and experiences of resources and services; impacts and implications for everyday life; immediate personal; and the social-historical-individual context. Across these themes, it is apparent that the notion of freedom of choice in reproductive decision-making and family planning is constrained by legislation, law and public policy, which have consequences for women's lived experiences of their reproductive choices, restricting women's reproductive rights. More research is needed to explore the impacts of policy on women's lived experiences of reproductive choices over time, including how changes to policy impact women's reproductive choices, the consequences of these choices, and how policy constrains or supports women's reproductive rights.

Women's empowerment and fertility preferences of married women: analysis of demographic and health survey'2016 in Timor-Leste.

A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.

Marriage, Gender and Demographic Change: Managing Fertility in State-Socialist Poland

This paper explores fertility management practices in state-socialist Poland and investigates post-war demographic change through the lenses of gender and modernization. Using personal narratives from oral histories and memoirs, we examine reproductive decision-making processes from the 1940s to the 1980s, focusing on motivations, norms, and the means employed to achieve desired family size. Our analysis reveals the ambiguous nature of both modernization and women's emancipation in regard to reproduction. We argue that acceptance of the two-child model and the need to effectively manage fertility increased in Poland through the second half of the twentieth century, but was highly dependent on levels of spousal communication and equality. Personal narratives demonstrate how social pressure shaped women's reproductive choices, and how at times these choices were considerably limited by male violence and domination. As our analysis shows, gender relations in marriage and the modernization of fertility management in state-socialist Poland were deeply interrelated.

Sexual victims - supporting women's sexual and reproductive choices and wellbeing

In Japan, support systems for female victims of sexual violence are lacking. Assistant Professor Risa Koyake, Faculty of Contemporary Social Studies, Department of Contemporary Children, Doshisha Women's College of Liberal Arts, Japan, is working to ensure these women have the support they need and deserve. Her work is particularly focused on women in Japan and the US who are pregnant as a result of sexual violence. Abortion tends to be the assumed preference but the choice of whether or not to have an abortion is tied to the sexual and reproductive freedom of the victim and some of these women wish to give birth. Unfortunately, support is particularly lacking for female survivors of sexual violence who wish to give birth. In her work, Koyake conducts consultations and conversations with survivors of rape. She has experience as a volunteer at a group for survivors of domestic violence so is used to having sensitive and challenging discussions with women seeking expert support and guidance. Koyake's current project is entitled 'The Choice of Adoption or Abortion Among Women Pregnant as a Result of Sexual Violence in Japan and America', and involves looking at existing support and options for women in Japan who are pregnant as a result of sexual violence, ultimately seeking to build on exisiting support to ensure that it is adequate, particularly for rape victims who choose to give birth.

Prioritising Or Postponing?” Thematic Analysis Of Reproductive And Motherhood Choices Among Educated Indian Married Women

This paper attempts to understand and explains the intersection of reproductive and motherhood choices among educated working and non-working married women in India. The choices women pick in realm of sociological, cultural and religious controls have been largely silenced in literature.&#x0D; This phenomenological study looks into lives of 20 married educated Indian women and their reproductive and motherhood choices. With the help of semi-structured questionnaire, 20 women, predominantly educated middle class women, have been interviewed. A thematic analysis using a grounded approach has been used to analyse the qualitative data obtained from these 20 women. Two dominant themes emerged in the systematic qualitative review. Among educated working women, voices of career goals, self-accomplishments, and career promotions were the major theme manifested while exercising their reproduction choice. On the other hand, theme emerged among educated non-working mothers were enhancement in social influence, stability and social pressure. Study revealed the stress and social tensions embedded in exercising reproductive choice con-joined with family influences, economic priorities, career and biological clock urge.&#x0D; The study further describes how increase in technological advancements and modernism has not affected largely sphere of women reproductive choices and changed social perception of motherhood; rather complicated dilemmas for her.

Conditional Cash Transfers and Women's Reproductive Choices

Conditional Cash Transfers and Women's Reproductive Choices

Prenatal testing: Does reproductive autonomy succeed in dispelling eugenic concerns?

Traditionally, two main rationales for the provision of prenatal testing and screening are identified: the expansion of women's reproductive choices and the reduction of the burden of disease on society. With the number of prenatal tests available and the increasing potential for their widespread use, it is necessary to examine whether the reproductive autonomy model remains useful in upholding the autonomy of pregnant women or whether it allows public health considerations and even eugenic aims to be smuggled in under the smokescreen of autonomy. In this article I argue that if we are serious about upholding women's autonomy in the context of prenatal testing, what is needed is a model based on a more robust conception of reproductive autonomy, such as the one defended by Josephine Johnston and Rachel Zacharias as 'reproductive autonomy worth having'. While Johnston and Zacharias put forward a basic outline of this conception, I apply it to the specific case of prenatal testing and show how it responds to objections levelled against the reproductive autonomy model. I argue that adopting this kind of conception is necessary to avoid fundamental challenges to women's autonomy when it comes to prenatal screening and testing.

Freezing Eggs and Creating Patients: Moral Risks of Commercialized Fertility.

There's no doubt that reproductive technologies can transform lives for the better. Infertile couples and single, lesbian, gay, intersex, and transgender people have the potential to form families in ways that would have been inconceivable years ago. Yet we are concerned about the widespread commercialization of certain egg-freezing programs, the messages they propagate about motherhood, the way they blur the line between care and experimentation, and the manipulative and exaggerated marketing that stretches the truth and inspires false hope in women of various ages. We argue that although reproductive technology, and egg freezing in particular, promise to improve women's care by offering more choices to achieve pregnancy and childbearing, they actually have the potential to be disempowering. First, commercial motives in the fertility industry distort women's medical deliberations, thereby restricting their autonomy; second, having the option to freeze their eggs can change the meaning of women's reproductive choices in a way that is limiting rather than liberating.

Women's perceptions and treatment patterns related to contraception: results of a survey of US women

ObjectivesThe aim of this survey was to understand US women's contraception journey from her first prescribed method to her current one including reasons for choosing and stopping/switching methods, healthcare provider relationships, and bleeding preferences. Study designWe administered a nationally-representative, web-based survey of US women aged 16 to 50 years currently using (N=1656) or had previously used (N=1448) prescription contraception, or who had never used it but would consider using it in the future (N=103). Statistical analyses were based on overlap formulae with sample weights adjusted to 2010 US census demographic benchmarks. ResultsThe survey was sent to 11,906 women, and 5957 responded (50% response rate). Among qualified respondents, 3104 had experience with prescription contraception. Oral contraceptives (OC) remain the most frequently prescribed method as first or subsequent contraception. However, as women switch to their current prescription method, more chose IUD contraception. As reported by respondents, only 48% of current users received counseling on how to use specific methods, and 58% were counseled on bleeding patterns to expect, while 67% were offered counseling on potential side effects. Many of the side effects reported in this study for first and current prescription contraception were nonspecific and may be related to a nocebo effect, lack of understanding about normal bodily fluctuations, or poor compliance. Many women (34%) reported ‘making their periods lighter’ as a reason for using their current prescription method, and 53% would prefer to skip their monthly period altogether. ConclusionsMisperceptions about contraception are common, and prescription contraception choice can be quite complex. Clinicians can enhance patient satisfaction by providing adequate information and matching methods to women's lifestyles, reproductive choices, and pregnancy risk. ImplicationsThis study provides insight into modern women's attitudes and views toward prescription contraception that may be important to clinicians and women themselves.

The Consequences of Abortion and Contraception Policies on Young Women's Reproductive Choices, Schooling and Labor Supply

I specify a dynamic life-cycle model of abortion, contraceptive use, schooling, and labor supply decisions of US women. I structurally estimate the model, allowing for abortion misreporting, using data from the NLSY97, aggregate abortion provider data from the Guttmacher Institute, and information on mandatory counseling restrictions at the state level. I simulate a series of policies and find that eliminating access to abortion services increases contraceptive use but decreases women’s schooling and lifetime earnings. I also find that providing free contraception would increase contraceptive use and decrease abortion rates substantially, while also leading to an increase in women’s schooling.

Our bodies, our choices: Australian law on foetal personhood.

The debate revolving around foetal vs maternal rights has been philosophised for years. It has captured attention internationally with the European Court of Human Rights struggling for over five decades to define personhood, and is still yet to reach a definite formulation. A proposed Law Crimes Amendment Bill (Zoe's Law, 2) is currently fuelling public debate about women's reproductive choices in New South Wales, Australia. The proposed legal bill attempts to redefine a 'person' or 'human being' by placing a marker on when 'personhood begins' namely at 20 weeks or weighing a minimum of 400g. Similar laws recognising personhood at foetal viability have come into force in the United States of America that clearly show the broader consequences of this kind of legislation as American women now face county-by-county, state-by-state anti-choice legislative activism. Midwives work closely with women and their families giving them the authority to formulate opinions on issues of maternal-foetal conflict. If a law such as this is allowed to pass a number of legal and ethical issues will arise for Australian midwives that could potentially have far reaching implications for them and for the women and families that they provide women-centred care for.

For Whom the Clock Ticks: Reproductive Ageing and Egg Freezing in Dutch and British News Media

The last century saw struggles for women's reproductive choices both to avoid childbearing (i.e. abortion, contraception) and to achieve it (i.e. IVF, artificial insemination). Now, after the turn of the millennium, these two approaches to regulate reproduction are combined in oocyte cryopreservation (OC), or egg freezing. With it, a new reproductive question has emerged as egg freezing simultaneously represents an active choice not to have children at present and a commitment to a future, possibly assisted, reproduction. Women's usage of OC to preserve fertility is itself an act of refusing current childbearing, thus calling into question an easy distinction between reproductive and non-reproductive behaviour. In this article, I discuss the representation of this new choice by using a selection of Dutch and UK news media pieces, focusing specifically on the implications of egg freezing for conceptualisations of the female reproductive body as site of a gendered politics of ageing. Firstly, I address the rhetorical divisions between 'medical' and 'social' motivations for egg freezing and then I argue that the media narratives around these divisions create new subject positions related to reproductive identity through which medical authority becomes extended into new parts of social life. Secondly, I address the discursive construction of the decision to use egg freezing technology in relation to the notion of the 'biological clock' and the reconceptualisations of age-specific (non-)reproductive bodies, which focus on the ovum as the locus of fertility. The news coverage of OC thus reveals a gendered politics of ageing, predicated on reproductive ability as the organising principle for the temporal structuring of life, which not only interpellates (potentially) infertile women who desire to reproduce, but also has an impact on the wider public.