TY - JOUR
T1 - Reproductive autonomy and modern contraceptive use at last sex among young women in Ghana
AU - Loll, Dana
AU - Fleming, Paul J.
AU - Manu, Abubakar
AU - Morhe, Emmanuel
AU - Stephenson, Rob
AU - King, Elizabeth J.
AU - Hall, Kelli Stidham
N1 - Publisher Copyright:
© 2019, Guttmacher Institute. All rights reserved.
PY - 2019
Y1 - 2019
N2 - CONTEXT: Variability in the conceptualization and measurement of women’s empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Reproductive autonomy—a specific measure of empowerment—and its role in modern contraceptive use have rarely been assessed in Sub-Saharan contexts. METHODS: Survey data were collected from a sample of 325 urban Ghanaian women aged 15–24 recruited from health facilities and schools in Kumasi and Accra in March 2015. Bivariate and multivariable logistic regression analyses were used to examine associations between two adapted reproductive autonomy subscales—decision making and communication—and women’s use of modern contraceptives at last sex, controlling for demographic, reproductive and social context (i.e., approval of and stigma toward adolescent sexual and reproductive health) covariates. RESULTS: In multivariable analyses, reproductive autonomy decision making—but not reproductive autonomy communication—was positively associated with women’s modern contraceptive use at last sex (odds ratio, 1.1); age, having been employed in the last seven days and living in Kumasi were also positively associated with modern contraceptive use (1.1–9.8), whereas ever having had a previous pregnancy was negatively associated with the outcome (0.3). Reproductive autonomy decision making remained positively associated with contraceptive use in a subsequent model that included social approval of adolescent sexual and reproductive health (1.1), but not in models that included stigma toward adolescent sexual and reproductive health. CONCLUSIONS: The reproductive autonomy construct, and the decision-making subscale in particular, demonstrated relevance for family planning outcomes among young women in Ghana and may have utility in global settings. Future research should explore reproductive autonomy communication and the potential confounding effects of social context.
AB - CONTEXT: Variability in the conceptualization and measurement of women’s empowerment has resulted in inconsistent findings regarding the relationships between empowerment and sexual and reproductive health outcomes. Reproductive autonomy—a specific measure of empowerment—and its role in modern contraceptive use have rarely been assessed in Sub-Saharan contexts. METHODS: Survey data were collected from a sample of 325 urban Ghanaian women aged 15–24 recruited from health facilities and schools in Kumasi and Accra in March 2015. Bivariate and multivariable logistic regression analyses were used to examine associations between two adapted reproductive autonomy subscales—decision making and communication—and women’s use of modern contraceptives at last sex, controlling for demographic, reproductive and social context (i.e., approval of and stigma toward adolescent sexual and reproductive health) covariates. RESULTS: In multivariable analyses, reproductive autonomy decision making—but not reproductive autonomy communication—was positively associated with women’s modern contraceptive use at last sex (odds ratio, 1.1); age, having been employed in the last seven days and living in Kumasi were also positively associated with modern contraceptive use (1.1–9.8), whereas ever having had a previous pregnancy was negatively associated with the outcome (0.3). Reproductive autonomy decision making remained positively associated with contraceptive use in a subsequent model that included social approval of adolescent sexual and reproductive health (1.1), but not in models that included stigma toward adolescent sexual and reproductive health. CONCLUSIONS: The reproductive autonomy construct, and the decision-making subscale in particular, demonstrated relevance for family planning outcomes among young women in Ghana and may have utility in global settings. Future research should explore reproductive autonomy communication and the potential confounding effects of social context.
UR - http://www.scopus.com/inward/record.url?scp=85071993553&partnerID=8YFLogxK
U2 - 10.1363/45e7419
DO - 10.1363/45e7419
M3 - Article
C2 - 31498115
AN - SCOPUS:85071993553
SN - 1944-0391
VL - 45
SP - 1
EP - 12
JO - International Perspectives on Sexual and Reproductive Health
JF - International Perspectives on Sexual and Reproductive Health
ER -