Family Planning, Women's Empowerment, and Population and Societal Impacts Proceedings of a Workshop (2021) / Chapter Skim
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5 Family Planning, Fertility, and Women's Empowerment in Low- and Middle-Income Countries
5 Family Planning, Fertility, and Women's Empowerment in Low- and Middle-Income Countries
Pages 41-52
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From page 41... ...
• Although low- and middle-income countries have increasingly recognized adolescent fertility as a major concern, sexual and reproductive health education is not universally available, and contraceptive use in these countries is low, despite evidence that access to contraception is key in reducing adolescent fertil ity. (Ndola Prata, University of California, Berkeley)
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From page 42... ...
The intersections of women's economic and reproductive empowerment were presented in a ri-level t framework: icro-level intersections, such as decisions about contracep m tive use and employment, meso-level intersections, such as social norms, labor marker practices, and informal sector employment, and macro-level intersections, such as the relationship between fertility, women's LFP, and national or regional economic growth.1 Research in this area examines the bidirectional effect of childbearing and access to reproductive health care on women's decisions to work as well as the quality of work that is avail able to them and vice versa. Rodgers outlined numerous economic benefits that result from invest ment in family planning or SRH.
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From page 43... ...
Rodgers shared a meso-level study that explored how the evolution of reproductive health services, social protections, and labor market institutions impact the type and quality of women's employment in 45 low- and middle-income countries.4 The study authors identified a clear, positive relationship between unmet family planning needs and the percentage of women employed in the informal sector, as well as a similar correlation between higher rates of fertility and higher rates of informal employment. Countries that had sharp transitions in fertility did not necessarily have higher rates of women's LFP.
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From page 44... ...
These low- and middle-income countries have restrictive legal regimes of their own surrounding abortion, which the analysis showed was associated with higher total fertility rates, unsafe abortions, maternal mortality, and adolescent birth rates. Unsafe abortion accounts for nearly 8 percent of maternal mortality globally and as much as 10 percent in sub-Saharan Africa, Latin America, and the Caribbean.
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From page 45... ...
In sub-Saharan Africa, the use of contraception remains low, and the need for family planning and SRH services is often unmet despite recent improvements. Wado said that gender-based power imbalances are pervasive across every factor in the causal framework for unmet family planning needs, including social norms that encourage large families and early marriage, opposition to contraception by partners, low engagement of men in contraceptive efforts, and a lack of informed choice at the health services level that leads to misconceptions about contraceptive side effects.
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From page 46... ...
It found that women with higher empowerment scores were more likely to use modern contraception in 8 of these 19 sub-Saharan African countries. Another study that leveraged DHS data from five African countries generated empowerment scores based on six dimensions of empowerment indicators and found a strong association between overall empowerment scores and contraceptive use; however, Wado noted that only countries with high contraceptive prevalence were included in that study.11 In a third study that aggregated DHS data from 34 sub-Saharan African countries, three dimensions of women's empowerment (attitude toward violence, social independence, and decision making)
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From page 47... ...
Injectables and implants were among the most common contraceptive methods used covertly, and these methods are also the ones driving the rise in contraceptive use in subSaharan Africa. Wado concluded his presentation by underscoring the challenges inherent in conceptualizing empowerment for research and measurement, pointing to a limited set of qualitative studies that describe what empowerment means in different contexts and noting that the common method of aggregating or pooling data from different countries may mask contextual variations.
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From page 48... ...
said that it is time to challenge some of the theoretical frameworks, such as the Demographic Transition Theory, that assume that a shift from higher fertility to replacement-level fertility rates will result in a lasting equilibrium between fertility intentions and outcomes as well as improvements to the welfare of women and girls. The "demographic dividend" -- the economic growth potential that can result from shifts in a population's age structure14 -- is often cited as one explanation for how fertility decline can have a beneficial impact on women, children, and household welfare: in this model, that decline promotes women's LFP and household savings.
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From page 49... ...
Similarly, other indicators of women's empowerment, such as domestic violence rates, fail to follow expected correlations with total fertility rates and contraceptive use. Sathar emphasized that the field needs to understand the regional drivers of marriage patterns and commonly used empowerment measures through more nuanced and qualitative studies to understand what these sorts of indicators mean for women's empowerment and autonomy.
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From page 50... ...
Prata presented an analytic framework to study adolescent reproductive health that identifies the key drivers of adolescent fertility as unsafe sexual practices, specifically lack of contraception, and harmful practices, such as child marriage and female genital mutilation. The framework also outlines the underlying causes or social determinants that contribute to these drivers to highlight potentially effective areas of programmatic inter vention.
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From page 51... ...
Prata focused on youth participation in SRH policies and programs, citing the United Nations' rec ognition of adolescent participation in matters that concern them directly or indirectly as a fundamental right. Four essential and interconnected features of meaningful adolescent participation have been outlined by the United Nations: space (i.e., safe and inclusive opportunity to form and express views)
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From page 52... ...
However, adolescent girls are pressured to have multiple children after marriage. Education on the importance of birth spacing to the health of mothers and children has increased use of contraception by young married mothers, but Prata said that in countries with high fertility rates and low contraceptive prevalence, such as Angola and Niger, young women will sometimes have four or five children before seeking family planning counsel.
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