Revisiting Women's Empowerment and Contraception

This essay explores and reviews the literature from low‐ and middle‐income countries on the pathways of influence between women's empowerment and reproductive outcomes, specially focusing on contraception, and points to some outstanding gaps. We adopt a framework that assesses the influence of contextual factors, notably kinship structures, and marriage systems, on women's empowerment and agency and other transformational factors affecting women's agency and gender roles and wielding direct and indirect influences on empowerment and contraceptive outcomes. The review of around 80 studies highlights that even after other factors are adjusted, women's agency has a strong influence on contraceptive outcomes. Contraceptive use levels are likely influenced by community‐level factors above and beyond individual‐level factors. Transformational factors, especially exogenous factors such as education and family planning programs, have independent and direct effects on contraceptive outcomes, at times even weakening or canceling out the effects of women's agency. Comprehensive contraceptive transition theory must reserve a central place for women's empowerment through agency and gender roles, particularly the ability of women and girls to make independent and free contraceptive choices. Relatedly, progress in contraceptive transition should be assessed according to not only contraceptive prevalence but also women's ability to use their preferred choice of methods for achieving reproductive rights.