Untangling Empowerment and Contraceptive Use Longitudinally in Five African Settings

ObjectiveEmpowerment impacts reproductive health behaviors profoundly. Similarly, contraceptive access and use result in broader social and economic opportunities. We aimed to quantify the directionality of this cyclical relationship. Study designThis study utilizes data from the Performance Monitoring for Action (PMA) surveys in Kenya, Nigeria (Kano), Burkina Faso, Democratic Republic of Congo (DRC), and Uganda. Using annual longitudinal data (2019-2021), we employed cross-lagged panel models (CLPM) to analyze the bidirectional relationship between womens empowerment and contraceptive use. ResultsThere was a significant positive impact of contraceptive use on womens empowerment. In Kenya and Kano, contraceptive use was associated with a 10.1% and 12.0% increase in paid work and 14.5% and 14.8% greater control over wages, respectively. In Kenya, women doing paid work with wage control were 5.2% more likely to use contraception the following year. In Kano, control over partners wages increased contraceptive use by 9.6%. Additionally, having savings, financial goals, increased financial autonomy, and knowledge of financial information were associated with higher future contraceptive use. ConclusionsContraceptive use can act as a catalyst for empowerment, while empowerment, particularly decision-making autonomy over finances, enhances contraceptive use. However, these dynamics vary across different settings, emphasizing the need for context-specific strategies.