title: Women's empowerment and contraceptive use: the role of independent versus couples' decision-making, from a lower middle income country perspective.
abstract: BACKGROUND
  There is little available evidence of associations between the various dimensions of women's empowerment and contraceptive use having been examined--and of how these associations are mediated by women's socio-economic and demographic statuses. We assessed these phenomena in Pakistan using a structured-framework approach.
  
  
  METHODS
  We analyzed data on 2,133 women who were either using any form of contraceptive or living with unmet need for contraception. The survey was conducted during May - June 2012, with married women of reproductive age (15-49 years) in three districts of Punjab. The dimensions of empowerment were categorized broadly into: economic decision-making, household decision-making, and women's mobility. Two measures were created for each dimension, and for the overall empowerment: women's independent decisions, and those taken jointly by couples. Contraceptive use was categorized as either female-only or couple methods on the basis of whether a method requires the awareness of, or some support and cooperation from, the husband. Multinomial regression was used, by means of Odds Ratios (OR), to assess associations between empowerment dimensions and female-only and couple contraceptive methods.
  
  
  RESULTS
  Overall, women tend to get higher decision-making power with increased age, higher literacy, a greater number of children, or being in a household that has superior socio-economic status. The measures for couples' decision-making for overall empowerment and for each dimension of it showed positive associations with couple methods as well as with female-only methods. The only exception was the measure of economic empowerment, which was associated only with the couple method.
  
  
  CONCLUSIONS
  Couples' joint decision-making is a stronger determinant of the use of contraceptive methods than women-only decision-making. This is the case over and above the contribution of women's socio-demographic and economic statuses. Effort needs to be made to educate women and their husbands equally, with particular focus on highly effective contraceptive methods.
authors.affiliation: Research, Monitoring and Evaluation Department, Marie Stopes Society, Karachi, Sindh, Pakistan.
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Research, Monitoring and Evaluation Department, Marie Stopes Society, Karachi, Sindh, Pakistan; Department of Uro-gynecology, University of Ghent, Ghent, East Flanders, Belgium.
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Moazzam
authors.initials: M
authors.lastname: Ali
authors.affiliation: Research, Monitoring and Evaluation Department, Marie Stopes Society, Karachi, Sindh, Pakistan.
authors.forename: Muhammad Ishaque
authors.initials: MI
authors.lastname: Sheikh
authors.affiliation: Research, Monitoring and Evaluation Department, Marie Stopes Society, Karachi, Sindh, Pakistan.
authors.forename: Ghazunfer
authors.initials: G
authors.lastname: Abbas
authors.affiliation: Department of Uro-gynecology, University of Ghent, Ghent, East Flanders, Belgium; Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Bilal Iqbal
authors.initials: BI
authors.lastname: Avan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003268:Contraception Behavior / Q000208:ethnology* / Q000706:statistics & numerical data; D003657:Decision Making; D005260:Female; D006801:Humans; D016017:Odds Ratio; D010154:Pakistan; D011209:Power, Psychological; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014933:Women's Rights