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Health policy
Original research
Women’s empowerment and fertility decision-making in 53 low and middle resource countries: a pooled analysis of demographic and health surveys
  1. Rezwanul Haque1,
  2. Khorshed Alam2,3,
  3. Syed Mahbubur Rahman4,
  4. Syed Afroz Keramat2,5,
  5. Mohammed Khaled Al-Hanawi6,7
  1. 1Department of Economics, American International University-Bangladesh (AIUB), Dhaka, Bangladesh
  2. 2School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
  3. 3Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
  4. 4Faculty of Business Administration, American International University-Bangladesh (AIUB), Dhaka, Bangladesh
  5. 5Economics Discipline, Khulna University, Khulna, Bangladesh
  6. 6Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
  7. 7Health Economics Reseach Group, King Abdulaziz University, Jeddah, Saudi Arabia
  1. Correspondence to Mr Rezwanul Haque; rezwanul_05{at}yahoo.com

Abstract

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.

  • health policy
  • public health
  • health economics

Data availability statement

Data are available in a public, open access repository. The data used in this study are freely accessible to the public at the DHS website (https://www.dhsprogram.com/Data/).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-045952

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    Data availability statement

    Data are available in a public, open access repository. The data used in this study are freely accessible to the public at the DHS website (https://www.dhsprogram.com/Data/).

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    Footnotes

    • Contributors Conceptualised the study: RH and SAK. Contributed during data extraction and analyses: RH. Result interpretation: RH. Prepared the first draft: RH and SMR. Contributed during the conceptualisation and interpretation of results and substantial revision: RH, KA, SMR, SAK and MKA. Revised and finalised the final draft manuscript: RH, KA, SMR, SAK and MKA. All authors read and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.