Spousal age difference and its effect on contraceptive use among sexually active couples in Ethiopia: evidence from the 2016 Ethiopia demographic and health survey

Association between women's empowerment and demand for family planning satisfied among Christians and Muslims in multireligious African countries

BACKGROUND

Although the levels of demand for family planning satisfied (DFPS) have increased in many countries, cultural norms remain a significant barrier in low- and middle-income countries. In the context of multireligious African countries, our objective was to investigate intersectional inequalities in DFPS by modern or traditional contraceptives according to religion and women's empowerment.

METHODS

Analyses were based on Demographic and Health Surveys carried out between 2010 and 2021 in African countries. Countries with at least 10% of Muslims and Christians were selected to analyse inequalities in family planning. The religious groups were characterised by wealth, area of residence, women's age and women's empowerment. The mean level of empowerment was estimated for each religious group, and multilevel Poisson regression was used to assess whether DFPS varied based on the level of women's empowerment among Muslims and Christians.

RESULTS

Our study sample of 14 countries comprised 35% of Muslim and 61% of Christian women. Christians had higher levels of empowerment across all three domains compared with Muslims and women with no/other religion. DFPS was also higher among Christians (57%) than among Muslims (36%). Pooled analysis indicated a consistent association between DFPS and women's empowerment, with higher prevalence ratios among Muslims than Christians, especially in the decision-making domain.

CONCLUSIONS

The gap between Muslims and Christians in DFPS significantly reduced as the level of empowerment increased. It highlights the importance of understanding and addressing cultural factors sensibly and respectfully to satisfy the demand for family planning services.

Women's Sexual Empowerment and Its Relationship to Contraceptive Use in Bangladesh: Findings From a Recent National Survey

Objectives: This study aimed to assess the relationship between women's sexual empowerment and contraceptive use among married Bangladeshi women from a nationally representative sample. Methods: Secondary data analysis was conducted using the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The investigation covered a total of 14,515 married, non-pregnant women who were residing with their spouses. Multivariable logistic regression analysis was fitted to assess the relationship between the variables of interest. Results: A unit increase in the sexual empowerment scale increases the odds of contraceptive use by 13%. While increasing age, being Muslim, having a spouse who is older by more than 10 years, and living in rural areas are associated with lower odds of using contraceptives than their respective counterparts, secondary or higher levels of education, having more living children, exposure to TV or radio, and employment are associated with higher odds of using contraceptives. Conclusion: The study's findings point to the need for addressing women's perceptions of their right to sexual and reproductive health and equity in order to further efforts to achieve universal access to reproductive health services.

Union formation, within-couple dynamics, and child well-being: A global macrolevel perspective

Studies on global changes in families have greatly increased over the past decade, adopting both a country-specific and, more recently, a cross-national comparative perspective. While most studies are focused on the drivers of global changes in families, little comparative research has explored the implications of family processes for the health and well-being of children. This study aims to fill this gap and launch a new research agenda exploring the intergenerational implications of union-formation and within-couple dynamics for children's health and well-being across low- and middle-income countries (LMICs), both globally, regionally, and by the stage of fertility transition. We do so by adopting a macro-level perspective and a multi-axis conceptualization of children's outcomes - health at birth, health in later life, and schooling - and leveraging Demographic and Health Survey and World Bank data across 75 LMICs. Our results show that in societies where partnerships are characterized by more equal status between spouses - i.e., where the age range between spouses and differences in years of schooling between partners are narrower - children fare better on several outcomes. These associations are particularly strong in mid- and high-fertility settings. Despite a series of regularities, our results also highlight a set of findings whereby, at a macro-level, the prevalence of marriage and divorce/separation are not invariably associated with children's outcomes, especially in LMICs where fertility is comparatively lower. We document little cross-regional heterogeneity, primarily highlighting the centrality of demographic factors such as age vis-à-vis, for instance, region-specific characteristics that are more tied to the social fabric of specific societies.

Early Marriage in Adolescence and Risk of High Blood Pressure and High Blood Glucose in Adulthood: Evidence from India

Adolescence, the transition phase to adulthood, is a critical period for physical and psychological development. Disruptions during this period, such as getting married, could result in various adverse short- and long-term health outcomes. This study aimed to assess the differential risk of two common chronic conditions—high blood pressure and high blood glucose—in adult women (20–49 years) who were married during different stages of adolescence (10–19 years) compared to women who were married in their youth (20–24 years). Using the most recent nationally representative data from India, we separately assessed the odds in favor of having the two chronic conditions for women who were married during early (10–14 years), middle (15–17 years), and late (18–19 years) adolescence. We found that an earlier age at marriage during adolescence was associated with a higher risk of chronic conditions later in life. Women who were married during early adolescence were respectively 1.29 and 1.23 times more likely (p < 0.001) to have high blood pressure and high blood glucose compared to women who were married in their youth. These findings highlight the importance of preventing underage marriage among adolescent females to address the risk of downstream chronic health consequences as adults.

Married women’s decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey

Introduction:

Women’s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women’s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women’s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model.

Methods:

The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15–49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women’s decision-making autonomy on contraceptive use. Akaike’s information criterion was used to select the best-fitted model.

Results:

Overall, 21.6% (95% confidence interval = 20.3%–22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67–3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52–3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36–4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32–3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34–3.87) were positively associated with women’s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29–0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12–0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23–0.87) were negatively associated with women’s independent decision on contraceptive use.

Conclusion:

Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women’s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women’s decision-making autonomy on contraceptive use. The government should promote women’s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.

The determinants and impacts of age-disparate relationships on women in Zimbabwe: A life course perspective

Age-disparate relationships (ADR) with older men have been studied mostly in the context of HIV and found to be associated with increased HIV prevalence among young women in sub-Saharan Africa. Less is known about the impact of ADR on the broader life course of women. The objectives of this study are to identify the factors associated with being in ADR and estimate the association between ADR and a set of life outcomes in Manicaland, Zimbabwe. We used data from a general population open-cohort survey from 1998 to 2013 in Manicaland. We applied binary logistic regression models to estimate the odds ratios for association between socio-demographic determinants and ADR and multinomial logistic regression models to estimate the association between ADR and women's life outcomes. We found that women with less education, younger age at first sex and first marriage were more likely to be in ADR, and women in ADR have male partners with less education and less skilled employment. In terms of life and relationship outcomes, women in ADR had mostly negative life outcomes compared to women not in ADR. Future policies and research on ADR in women should reflect these complexities and study a wider range of life outcomes, beyond the commonly studied narrower topics such as HIV.