Association between women's empowerment and demand for family planning satisfied among Christians and Muslims in multi-religious African countries

BackgroundAlthough the levels of demand for family planning satisfied (DFPS) have increased in many countries, cultural norms remain a significant barrier in low- and middle-income countries. In the context of multi-religious African countries, our objective was to investigate intersectional inequalities in DFPS by modern or traditional contraceptives according to religion and womens empowerment. MethodsAnalyses were based on Demographic and Health Surveys carried out between 2010 and 2021 in African countries. Countries with at least 10% of Muslims and Christians were selected to analyze inequalities in family planning. The religious groups were characterized by wealth, area of residence, womens age, and womens empowerment. The mean level of empowerment was estimated for each religious group, and multilevel Poisson regression was used to assess whether demand for family planning satisfied varied based on the level of womens empowerment among Muslims and Christians. ResultsOur study sample of 14 countries comprised 35% of Muslim and 61% of Christian women. Christians had higher levels of empowerment across all three domains compared to Muslims and women with no/other religion. DFPS was also higher among Christians (57%) than among Muslims (36%). Pooled analysis indicated a consistent association between DFPS and womens empowerment, with higher prevalence ratios among Muslims than Christians, especially in the decision-making domain. ConclusionsThe gap between Muslims and Christians in DFPS significantly reduced as the level of empowerment increased. It highlights the importance of understanding and addressing cultural factors sensibly and respectfully to satisfy the demand for family planning services. Research in contextO_ST_ABSWhat is already known on this topicC_ST_ABS- Prior studies have demonstrated that there is a complex and variable relationship between religion and family planning beliefs in sub-Saharan Africa. - Higher fertility and lower use of contraceptives among Muslims than among Christians were documented in several African countries. - The literature on the relationship between womens empowerment and contraceptive use is mixed, with some studies identifying null associations and others finding positive associations. - A qualitative study conducted in Tanzania has identified that both religion and gender dynamics influence family planning practices. What this study adds- Our study builds on the prior literature by using data from 148,989 women to investigate intersectional inequalities in demand for family planning satisfied by religion and womens empowerment across multiple countries. - While Muslim was the group with lower levels of womens empowerment in the three SWPER domains, African Christians were on average more empowered than the average of women from all low- and middle-income countries. - Lower levels of DFPS were also identified among Muslim women, however, the coverage increased significantly with their empowerment. With the highly empowered Muslims having higher mDFPS than the highly empowered Christians. - Among the SWPER domains, stronger effects were found in the decision-making domain. - Higher pooled prevalence ratios were identified when considering traditional methods instead of modern contraceptives. How this study might affect research, practice, or policy- This study can help researchers, policymakers, and policy managers to better understand how social norms affect the use of family planning services. While religious beliefs can be a challenge to family planning, promoting gender equity and empowering women can help to mitigate these challenges and improve access to reproductive healthcare services for women.