Women's empowerment and fertility decision-making in 53 low and middle resource countries: a pooled analysis of demographic and health surveys

Objective Women's empowerment and its association with fertility preference are vital for central-level promotional health policy strategies. This study examines the association between women's empowerment and fertility decision-making in low and middle resource countries (LMRCs). Design This cross-sectional study uses the Demographic and Health Survey database. Settings 53 LMRCs from six different regions for the period ranging from 2006 to 2018. Participants The data of women-only aged 35 years and above is used as a unit of analysis. The final sample consists of 91 070 married women. Methods We considered two outcome variables: women's perceived ideal number of children and their ability to achieve preferred fertility desire and the association with women empowerment. Women empowerment was measured by their participation in household decision-making and attitude towards wife-beating. The negative binomial regression model was used to assess women's perceived ideal number of children, and multivariable logistic regression was used to evaluate women's ability to achieve their preferred fertility desire. Results Our study found that empowered women have a relatively low ideal number of children irrespective of the measures used to assess women empowerment. In this study, the measures were participation in household decision-making (incidence rate ratio (IRR): 0.92, 95% CI: 0.91 to 0.93) and attitude towards wife-beating (IRR: 0.96, 95% CI: 0.95 to 0.97). In the LMRCs, household decision-making and negative attitude towards wife-beating have been found associated with 1.12 and 1.08 times greater odds of having more than their ideal number of children. Conclusion Our findings suggest that women's perceived fertility desire can be achieved by enhancing their empowerment. Therefore, a modified community-based family planning programme at the national level is required, highlighting the importance of women's empowerment on reproductive healthcare as a part of the mission to assist women and couples to have only the number of children they desire.

Automated summary

This study examined the association between women's empowerment and fertility decision-making in low and middle resource countries. Empowered women were found to have a relatively low ideal number of children, and participation in household decision-making and negative attitude towards wife-beating were associated with having more than their ideal number of children in LMRCs.