Women's agency and its relationship to current contraceptive use in lower- and middle-income countries: A systematic review of the literature

Glob Public Health. 2018 Jul;13(7):843-858. doi: 10.1080/17441692.2016.1239270. Epub 2016 Oct 1.


Research shows a positive relationship between women's empowerment and reproductive health. Yet we know little about the quantitative relationship between women's agency and contraceptive use. We conducted a systematic review of peer-reviewed literature assessing the link between women's decision-making and freedom of movement with their contraceptive use in lower- and middle-income countries. Of 102 articles that met the initial screening criteria, 12 met all inclusion and exclusion criteria. Of the 12 included studies, consistently positive associations with contraceptive use were found in those that measured decision-making and freedom of movement as separate constructs. Composite measures had a less clear relationship with contraceptive use. In conclusion, women's agency is associated with women's contraceptive use in lower- and middle-income countries. However, the relationship is sensitive to how agency and its components are measured. Our review suggests the need for consistent validation of scales for women's agency as well as more rigorous research using standardised and validated scales, when possible. Longitudinal and intervention studies in lower- and middle-income countries will be useful for understanding the causal impact of women's agency on contraceptive use, and will help to inform policies and programmes to increase contraceptive use in these settings.

Keywords: Contraception; lower-income countries; systematic review; women’s agency; women’s empowerment.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Contraception Behavior*
  • Developing Countries*
  • Female
  • Humans
  • Power, Psychological*
  • Women's Rights