Previous evidence have illustrated that women’s empowerment indicators such as labor force participation, decision making capacity, knowledge and disposition towards wife beating affect women’s ability to enjoy their fundamental reproductive health rights and utilise their preferred health services [13, 21, 24]. In spite of this, the relationship between women empowerment indicators and women’s choice of contraceptives has not received much consideration. To this end, the present study investigated the association between women empowerment indicators and its relationship with the type of contraception women use.
The study revealed that women who were working had increased likelihood of using short-acting contraceptive methods. Another study from Nepal reported that women who work have lower likelihood of using long-acting methods, suggesting a higher inclination towards short-acting methods . Compared with women who do not work, those who work are likely to have the purchasing power and hence being able to access a wide array of contraceptives of their choice. For instance, a multi-country study on household wealth and contraception use reported that poorer women in Bangladesh and India had higher inclination towards long-acting contraception methods, than the wealthier women . This notwithstanding, other scholars have reported inconsistent findings, possibly due to variation in study design or differences in the socio-demographic characteristics of the samples studied [26, 27].
The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity. Couples in these 11 countries may be prioritizing long-acting contraception methods because of the advantages of the long-acting methods such as their cost effectiveness and the low failure rate as other authors have reported [7,8,9].
It was noted that women with medium knowledge level had higher odds of using long-acting methods than their counterparts with low knowledge level. Meanwhile, women with high acceptance of wife beating had higher likelihood of using long-acting contraception methods. Women who accept wife beating usually have no or low education, and do not participate much in decision making at the household level [28, 29]. On the part of women with medium level of knowledge, their inclination towards long-acting methods could imply that they consider the merits of these methods weightier compared to the benefits associated with short-acting contraception methods. For instance, long-acting methods do not require shorter interval visit to the health facility or service of a trained healthcare professional as would a short-term contraception method . Hence, these dynamics might account for the observed inclination towards short and long-acting contraception methods by the different groups.
Notably, different empowerment indicators were aligned with either short or long-acting methods, without any clear pattern or consistency in contraception type. These key findings might be indicative of possible structural motivations and barriers that intervene with the various empowerment indicators to determine the type of contraception that are preferred and accessible to the women. Irrespective of a woman’s empowerment status, she is more probable to prioritise a contraception method that is easily accessible. For instance, considering that most long-acting methods require the service of a trained health professional, women with limited access to locations where such a service can be accessed are likely to procure and utilise short-acting contraception methods such as pills and condoms and develop affinity for them as opposed to long-acting methods .
All things being equal, long-acting methods should commensurate the availability of facilities and health personnel who will administer these methods . Though our study was limited by its inability to explore whether the methods used are the preferred methods or not, the findings accentuate that beyond women’s empowerment status, structural factors may have to be targeted in ensuring that women are able to access and utilise their preferred methods but not just improvise what the system dictates to them .
In addition to the empowerment indicators, a number of socio-demographic characteristics proved relevant in contraception method selection. For instance, the odds of using long-acting methods increased with age. Evidence suggest that motivation for using long-acting methods include long term protection against unintended pregnancies, effectiveness and better child-spacing [12, 33]. Though short-acting methods have competitive advantages, this finding might suggest that as women advance in age, they weigh long-acting methods to be more protective, safe, and reliable as compared with short term contraceptive methods .
Compared to urban women, rural women had lower odds of long-acting method use. Contrary to these findings, dominance of long-acting contraception method use among rural women has been reported by some previous studies from China and Guatemala [34, 35]. However, our finding is an embodiment of the contraception use situation of SSA, considering that long-acting methods require trained service providers/health facilities coupled with the extent to which these facilities are skewed towards urban settings in the SSA context [34, 36].