Women's empowerment and choice of contraceptive methods in selected African countries.

CONTEXT It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in African countries. METHODS Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15-49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use. RESULTS Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-1.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3-1.6) and the ability to negotiate sexual activity (1.1-1.2). In Namibia, women's negative attitudes toward domestic violence were correlated with the use of couple methods (1.1). CONCLUSIONS Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence.