Influence of cultural context on young women contraceptive empowerment dynamics in Burkina Faso: Findings from longitudinal data

Influence of cultural context on young women contraceptive empowerment dynamics in Burkina Faso: Findings from longitudinal data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influence of cultural context on young women contraceptive empowerment dynamics in Burkina Faso: Findings from longitudinal data Fiacre Bazié, Clémentine Rossier, Yentéma Onadja, Abdramane B. Soura This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6974123/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Most research exploring the factors influencing women's decision-making power has focused on individual characteristics, particularly education, employment, or, more broadly, women's socioeconomic status. However, some contradictory findings suggest that individual characteristics alone are insufficient to fully explain disparities in women's empowerment. Methods This study leverages longitudinal data from the national Performance Monitoring for Action (PMA) survey to examine the dynamics of contraceptive agency among young women in Burkina Faso. Specifically, it analyzes the influence of contextual factors, particularly gender and fertility-related norms, on contraceptive agency. Contraceptive agency comprises two key dimensions: motivation—the ability to define reproductive goals—and self-efficacy—the capacity to act upon and achieve those goals. Results The explanatory models used in this study revealed a limited direct influence of community norms and perceptions, while individual attitudes played a predominant role in shaping contraceptive agency dynamics. An exception was observed: changes in the contraceptive motivation subdimension were influenced by norms related to fertility perceptions. Conclusion Programs and initiatives aimed at strengthening young women’s reproductive autonomy in Burkina Faso should implement strategies that simultaneously address norm shifts—particularly those that promote high fertility—while also fostering positive reproductive health attitudes, especially among unmarried young women. Agency Norms Attitudes Sexual and Reproductive Health Adolescent Girls Young Women Burkina Faso Background Unintended pregnancies among young women can have both short- and long-term negative consequences for their health and well-being, as well as for the health and well-being of their children and families (1). Contraceptive use is an effective strategy for preventing unintended pregnancies (2), and ensuring access to contraception, particularly for adolescent girls and young women, is a fundamental component of sexual and reproductive health and rights. A substantial body of research has highlighted the relationship between women’s empowerment—often conceptualized as decision-making power—and improved sexual and reproductive health behaviors and outcomes among women and girls (3), including contraceptive use (4, 5) and the prevention of unintended pregnancies (6). Women’s empowerment has been central to several theoretical frameworks explaining health behaviors (3, 7, 8, 9) and has been subject to multiple conceptualizations and definitions (10). Kabeer (11) defines empowerment broadly as “the expansion of an individual’s ability to make strategic life choices in contexts where such ability was previously denied.” This perspective, widely adopted in the literature, conceptualizes empowerment as a process involving three interrelated dimensions: resources (prerequisites for agency), agency (the ability to set goals and mobilize resources to achieve them), and achievements (outcomes). Resources encompass economic, informational, human, and social assets that enhance an individual’s capacity to make choices, while agency, which is central to empowerment, refers to the ability to define objectives and act upon them. Within the specific domain of contraceptive use, researchers have defined female agency as both woman’s ability to set goals related to contraception (representing her motivation) and her perceived capacity to act and achieve those goals (representing her self-efficacy) (5, 9, 12–15). Contraceptive motivation refers to a woman’s reproductive goals, which may be externally or internally driven (9, 14). Meanwhile, self-efficacy encompasses various competencies, particularly a woman’s confidence in exercising her choices and her ability to make decisions (13, 16). These two dimensions of agency are recognized as critical determinants of women’s and girls’ sexual health, particularly their contraceptive use (5, 9, 14, 15). Although the concepts of women’s empowerment and agency have increasingly been applied to various domains, including sexual and reproductive health (3, 7–10), knowledge of the factors that reinforce or determine them remains limited (7, 9, 17, 18). Most research examining the determinants of women’s decision-making power has focused on individual characteristics such as education, employment, or broader socio-economic status (3, 9, 19, 20). However, some contradictory findings suggest that individual characteristics alone cannot fully explain disparities in empowerment (18, 21). Given that empowerment is a dynamic process of change, numerous scholars have emphasized the critical role of context, particularly social structures and norms (3, 9, 10, 11, 17). These structures and norms significantly shape access to resources, the process of agency itself (motivation and capacity to act), and individual achievements (3, 9, 10, 17). Moreover, they define the constraints within which different social actors can pursue their interests, enabling the agency of some while inhibiting that of others (3, 10, 11, 17). Consequently, increasing attention has been given to analyzing the role of social context, particularly gender norms, in shaping women’s empowerment processes and dynamics (3, 9, 22, 23). As a first approximation, a social norm is what members of a group, community, or society consider normal within that group, community, or society, that is, a typical action, an appropriate action, or both (24). More generally, social norms are perceived, informal, and mostly unwritten rules that define acceptable and appropriate actions within a given group or community, thereby guiding human behavior (25, 26, 27). Gender norms, in particular, refer to social norms that describe how women and men should behave within a community (28, 29). They encompass expectations and beliefs regarding how women, men, girls, and boys should behave and interact in specific social contexts and at different stages of life (30). They are also perceived as a set of social norms that regulate gender relations and structure patriarchal hierarchies (17). In Burkina Faso and more broadly in Sub-Saharan Africa, contraceptive use occurs in a context still characterized by norms that value high fertility (31, 32) and that stigmatize premarital or extramarital sexuality among women and girls (33–35). These norms, through the sanctions resulting from non-compliance (36) and self-sanctions that deter behaviors considered deviant (37, 38), are likely to have a significant influence on decision-making power and agency dynamics concerning women's and girls' contraceptive use. However, due to the lack of direct measures of social norms, residence or ethnicity has often been used as proxy variables to empirically illustrate their effect on women's empowerment (37, 39, 40). For instance, in the case of India and Pakistan, Jejeebhoy and Sathar (37) demonstrated that the region of residence has predictive power on women's autonomy that goes well beyond other determinants. Similarly, Kritz and Makinwa-Adebusoye (40), considering education level as a substitute variable for empowerment, revealed the under-schooling of Hausa and Kanuri girls in Nigeria despite the availability of educational infrastructure in their environment. They explained these trends, among other factors, by the existence of seclusion norms for women in these two ethnic groups. Recent research has explored the contextual effects of gender norms on women's decision-making autonomy in Africa. For example, in a study conducted in Ghana, Kenya, Uganda, and Tanzania, Vissého and Legrand (18) showed that women living in contexts characterized by gender norms legitimizing violence were more likely to have low decision-making autonomy compared to those living in environments unfavorable to such norms. Despite these advances, most research exploring the contextual effects of norms on women's autonomy has been conducted either in Asia—which differs from Sub-Saharan Africa in many respects—or with decision-making autonomy measures inherited from Asian countries, which sometimes prove inadequate for the African context (12, 18, 41). Additionally, due to the scarcity of longitudinal data in the field, little research has examined the effect of social norms on autonomy from a dynamic perspective. Commonly used cross-sectional perspectives consider empowerment as a static state rather than a dynamic process and provide limited insights into the temporal links between the normative context and empowerment (12). In other words, cross-sectional data do not allow for determining whether and how context affects the reproductive empowerment trajectories of adolescent girls and young women. A longitudinal perspective is necessary to better reflect the processes of improving women's autonomy and to determine the causal mechanisms and mediating factors that may facilitate or hinder women's empowerment (7, 12), which are crucial data for program development in this field. This research leverages longitudinal data from the 2019–2021 Burkina Faso PMA survey to examine the dynamics of young women’s empowerment in contraceptive decision-making and to assess the influence of contextual factors, particularly gender and fertility-related norms. Specifically, from a dynamic perspective, this study aims to analyze how gender, fertility, and contraceptive-related norms and attitudes at both the individual and community levels shape changes in young women’s contraceptive motivation and self-efficacy over time in Burkina Faso. Methods 2.1 Data This study utilizes data from the Performance Monitoring for Action (PMA) research platform in Burkina Faso. PMA is a health surveillance platform that tracks reproductive health and family planning indicators and is implemented in eight countries across Sub-Saharan Africa and Asia, including Burkina Faso. In each participating country, PMA employs a multi-stage stratified cluster sampling approach to randomly select a representative sample of households and women of reproductive age (15–49 years) at both national and subnational levels, depending on the country. During the 2019–2021 period, PMA adopted a longitudinal survey model with a sample of 167 enumeration areas (EAs). The data used in this study come from a cohort of 2,709 adolescent girls and young women aged 15–24, who were followed longitudinally at approximately a one-year interval between December 2019 and February 2021. Approximately 80% of the enrolled sample was successfully tracked over time. For analyses examining the determinants of empowerment dynamics, a subset of 2,119 respondents—those who completed the follow-up survey—was included. Missing data from the follow-up survey, most of which accounted for less than 1% of the sample, were excluded from the analyses. 2.2 Variables 2.2.1 Dependent variables: " Transitions " in contraceptive agency Our main dependent variable is the dynamic (or "transition") of contraceptive agency observed from one year to the next among young women. Agency consists of two sub-dimensions: contraceptive motivation and contraceptive self-efficacy. Table 1 presents the specific questions used to construct each of these sub-dimensions. For the contraceptive motivation sub-dimension, which was constructed using five questions, a composite index was developed through factor analysis and the principal component analysis (PCA) method, retaining the latent factor score as the measurement index for motivation. The latent score ranged from − 2.75 (for women with low motivation) to 1.21 (for women with high motivation). For self-efficacy, which was measured using two questions, the index was constructed using a summative score corresponding to the sum of the average scores of both questions. The self-efficacy scores ranged from 1 (for women with low self-efficacy) to 5 (for women with high self-efficacy). The same index calculation methods were applied to both survey rounds. Terciles were then used to establish the levels of autonomy in the two sub-dimensions of agency. The first tercile represented young women with "low autonomy," the second those with "moderate autonomy," and the third those with "high autonomy." The "agency transition" variable in each of the two sub-dimensions was constructed based on the observed dynamics between the two survey rounds. Transitions within each sub-dimension were captured by tracking changes in the three autonomy categories (low, moderate, and high autonomy) between the baseline survey and follow-up one’s. This calculation was performed using a cross-tabulation of the three autonomy levels across the two surveys for each sub-dimension of contraceptive agency. Subsequently, for both sub-dimensions, the nine possible transitions were grouped into a dichotomous variable distinguishing young woman who experienced a negative autonomy dynamic or "negative transition" (coded as 0) from those who experienced a positive autonomy dynamic or "positive transition" (coded as 1). Further details on the methodology used to construct this variable are provided in one document in the appendix. Table 1 Items used to construct the contraceptive agency subdimensions Subdimensions Questions Contraceptive motivation : Five (05) items Cronbach’s Alpha: 0.78 Five items corresponding to distinct questions posed to young women were used to capture the contraceptive motivation dimension. These questions, structured as a five-point Likert scale (1- Strongly disagree to 5- Strongly agree), were: • If I use family planning, my husband/partner may seek another sexual partner. • If I use family planning, I may have trouble getting pregnant the next time I want to. • There could/will be conflict in my relationship/marriage if I use family planning. • If I use family planning, my children may not be born normal. • If I use family planning, my body may experience side effects that will disrupt my relations with my husband/partner. Contraceptive self-efficacy : Two (02) items Two items corresponding to distinct questions posed to young women were used to capture the contraceptive self-efficacy dimension. These questions, structured as a five -point Likert scale (1 - Strongly Disagree to 5 - Strongly Agree), were: • I can decide to switch from one family planning method to another if I want to. • I feel confident telling my provider what is important for me when selecting a family planning method. 2.2.2 The main explanatory variables The main explanatory variables are (women’s) attitudes and (community) norms related to contraception. During the baseline survey, young women were asked questions to assess their attitudes toward family planning. Three questions addressed contraception in relation to attitudes toward sexuality and fertility, while one question focused on the benefits of contraception. Response options were as follows: (1) Strongly agree, (2) Agree, (3) Disagree, (4) Strongly disagree. To construct the four dichotomous “individual attitudes” variables on family planning, response categories were grouped into two: (1) Agree and (2) Disagree. The same questions were then posed to young women in the form of perceived norms to capture their perceptions of what community members think about each statement or norm. This approach represents an alternative method for measuring social norms, allowing for the mitigation of biases associated with aggregating individual attitudes, which is often used to assess community norms (26, 42, 43). In this case, response options were: (1) The majority of people, (2) Some people, (3) Few people. At the individual level, the context is perceived as favorable when young women report the response category “few people” for the first three norms and “most people” for the fourth norm. To construct the four contextual “community norms” variables, we considered the proportion of respondents in each EA who reported the response category “few people” for the first three norms as an indicator of a favorable normative context. For the norm stating that “people who use family planning have a better quality of life,” we considered the proportion of respondents in the EA who reported the response category “majority of people” as indicative of a favorable normative context. Table 2 details the specific questions used to measure young women’s attitudes and community norms regarding contraception. The objective is to examine whether and how the normative context (favorability) of each of the four norms, along with positive individual attitudes, influence the dynamics of the two subdimensions of contraceptive agency among young women in Burkina Faso. Table 2 Questions used for measuring attitudes and community norms related to family planning Questions Individual attitudes related to family planning (individual factors) Four distinct questions were asked to assess young women's attitudes towards family planning: 1. Adolescents who use family planning are promiscuous. 2. Family planning is only for women who are married. 3. Family planning is only for women who don't want any more children. 4. People who use family planning have a better quality of life. The response options ranged from: 1) Strongly agree to 4) Strongly disagree Perceived community norms related to family planning The same questions were asked to each young woman to gather what she knows about the members of her community on this issue: (Within your community, would you say that the majority of people, some people, or few people share the following viewpoints:) 1. Adolescents who use family planning are promiscuous. 2. Family planning is only for women who are married. 3. Family planning is only for women who don't want any more children. 4. People who use family planning have a better quality of life. The response options were: 1) The majority of people, 2) Some people, 3) Few people 2.2.3 Other covariables At the individual level, key sociodemographic characteristics of young women, such as place of residence, marital status, education level, parity, household wealth, and employment status, were included as individual control variables in the various multivariate models. Although there was no strong correlation between the two "transition" variables of agency (correlation: 0.06 for the motivation subdimension and 0.08 for the self-efficacy subdimension), we observed that contraceptive use at baseline significantly predicted a "positive transition" in both subdimensions of contraceptive agency (motivation and self-efficacy) (OR = 1.37; p < 0.01 and OR = 1.62; p < 0.001, respectively). Therefore, contraceptive use status at baseline was also included as an adjustment variable in the multivariate models. At the contextual level, exposure to information 1 from various sources on family planning, used as an index of women's exposure to interventions and the availability of family planning services, was included as a contextual control variable. In addition to exposure to contraceptive information, the contextual levels of wealth 2 and education 3 among young women were also used as contextual control variables. These contextual variables were derived by aggregating individual-level data at the EA level. A collinearity test was conducted on all explanatory variables to assess their degree of multicollinearity. The mean Variance Inflation Factor (VIF) was 1.77, with the highest VIF being 3.19 for one of the contextual norm variables. Overall, this indicates an acceptable level of collinearity among the independent variables. 2.3 Analysis We employed both a descriptive and an explanatory approach. First, we examined bivariate relationships between the type of transition in each of the two sub-dimensions of contraceptive agency and key individual variables. For the explanatory analyses, we used a multilevel approach to predict the type of transition in each sub-dimension of agency, considering the contextual influence of each normative dimension and the individual attitudes of young women. In the multilevel modeling, the EA was considered as the contextual level. To ensure representativity, EAs with fewer than five individuals were excluded, resulting in the inclusion of 163 out of 167 EAs in the explanatory analyses. The average number of individuals per EA was 13, ranging from a minimum of 5 to a maximum of 26. This multilevel approach involved several models to capture the distinct effects of each norm and corresponding individual attitude. All explanatory analyses aimed to predict the conditions under which a "positive transition" or a favorable dynamic (rather than a "negative transition") occurs in each sub-dimension of contraceptive agency. In an unadjusted Model 1, we first estimated the raw effect of each normative contextual dimension through four separate logistic regressions (Model 1a). Then, each norm was analyzed alongside its corresponding individual attitude to compare their effects on the transitions (Model 1b). In a second, adjusted model, control variables (individual and contextual) were introduced into each of the four regressions to isolate the net effect of each norm and its corresponding attitude (Model 2a). Subsequently, in a full model (Model 2b), all four norms and corresponding attitudes were analyzed simultaneously, adjusting for all individual and contextual control variables to identify the most influential norms and attitudes on the transition variables. Since marital status is often considered a key factor in the exercise of autonomy, particularly in reproductive matters (7, 48, 49), we anticipated that community norms and individual attitudes might have differential effects on agency dynamics depending on marital status. Therefore, the full model (2b) was applied separately to two distinct subsamples of young women (married and unmarried) to better capture the differential influence of norms and attitudes on agency dynamics based on marital status. All data were weighted using the survey follow-up weighting coefficients, and analyses were conducted using the statistical software Stata 16. Results 2.4 Results from descriptive analysis At the bivariate level (Table 3 ), the results indicate positive relationships between certain individual attitudes of young women and the nature of transitions in the two sub-dimensions of contraceptive agency. Regarding motivation, a higher proportion of young women experienced a positive transition among those with favorable attitudes toward contraception compared to those with negative attitudes. Specifically, young women who disagreed with statements such as "Adolescent girls who use family planning are promiscuous”, " Family planning is only for women who don't want any more children" or "Family planning is only for married women" were more likely to experience a positive transition than those who agreed with these statements (Chi-square tests: p = 0.078, p = 0.098, p = 0.002 respectively). In the self-efficacy sub-dimension, young women who disagreed with the statement " Family planning is only for women who don't want any more children " were also more likely to experience a positive transition in autonomy compared to those who agreed with this statement (Chi-square test: p = 0.017). Additionally, contraceptive use at baseline was positively associated with a positive dynamic in both sub-dimensions of agency. Among other individual characteristics, marital status, age, and parity were positively associated with a positive transition, but only in the self-efficacy sub-dimension. 2.5 Results from explanatory analysis Tables 4 , 5 , and 6 present the odds ratios from the different multilevel logistic regression models predicting the conditions under which a positive transition occurs in the two sub-dimensions of contraceptive agency. The results indicate that in the motivation sub-dimension, at the contextual level, only young women living in a context where the majority disagreed with the statement that " Family planning is only for women who don't want any more children " were more likely to experience a positive transition compared to those in a context where the majority agreed with this norm (Models 1a, 2a, and 2b). At the individual level, Models 1b and 2a indicate that young women with positive attitudes—specifically, those who disagreed with statements such as "adolescent girls who use family planning are promiscuous," " Family planning is only for women who don't want any more children," or "Family planning is only for married women"—were more likely to experience a positive transition compared to those who agreed with these statements. In the full model (2b), disagreeing with the idea that "Adolescent girls who use family planning are promiscuous" (aOR 1.38, 95% CI 1.06–1.80, P 0.015) or that "Family planning is only for married women" (aOR 1.30, 95% CI 0.98–1.74, P 0.068) was positively associated with a positive dynamic in the contraceptive motivation sub-dimension among young women. In the self-efficacy sub-dimension, at the contextual level, living in an area where the majority of individuals disagreed with the norm stating that "Family planning is only for married women" was associated with lower odds to have a positive transition (aOR 0.006, 95% CI 0.005–0.69, P 0.024). Across Models 1a, 1b, 2a, and 2b, results show that young women living in an area where the majority of individuals disagreed with this norm were less likely to experience a positive transition compared to those in a context supportive of this norm. The three other norms were associated with lower odds with the direction of transition in contraceptive self-efficacy. At the individual level, the three previously mentioned attitudes (in motivation sub-dimension), were associated with higher odds to experience positive transition in Models 1b and 2a. Young women who disagreed with these attitudes were more likely to experience a positive transition from one year to the next in the domain of contraceptive self-efficacy. In the full model (2b), only disagreement with the idea that " Family planning is only for women who don't want any more children " was associated with higher odds with a positive transition. Young women who disagreed with this assertion were approximately 1.5 times more likely (aOR 1.48, 95% CI 1.09–2.01, P 0.010) to experience a positive transition compared to those who agreed with this norm. Table 6 presents the results of the full model (2b) disaggregated by the marital status of young women (married and unmarried). Regarding the influence of the normative context, living in a community perceived as disagreeing with the norm that " Family planning is only for women who don't want any more children" was associated with higher odds to experience a positive dynamic in the motivation sub-dimension for both married (aOR 4.31, 95% CI 0.91–20.32, P 0.064) and unmarried (aOR 4.30, 95% CI 0.85–21.68, P 0.077) young women. Beyond this norm, which appears to transcend marital status, the influence of the normative context related to the other norms considered here was mainly observed among married young women and had less impact on the dynamics among unmarried women. Indeed, in addition to the mentioned norm, it is also observed that married young women living in a context where "the majority of people in the community believes that people who use family planning have a better quality of life" had a higher likelihood of experiencing a positive transition in motivation from one year to the next (aOR 3.86, 95% CI 1.25–11.94, P 0.019). Furthermore, living in a context where the community rejects the idea that "Adolescent girls who use family planning are promiscuous" was also associated with a positive dynamic in the self-efficacy sub-dimension (aOR 6.15, 95% CI 0.80-47.03, P 0.080). Finally, living in a context where the community does not approve of the idea that "Family planning is only for married women" was negatively associated with a positive transition in the self-efficacy sub-dimension among married young women. Conversely, the same results (Table 6 ) indicate that the influence of individual attitudes is primarily evident among unmarried young women and much less among married ones. Indeed, while none of the attitudes considered were associated with high odds with the nature of the dynamic in either of the two sub-dimensions for married young women, disagreeing with the statement that " Family planning is only for women who don't want any more children" was associated with a positive empowerment dynamic in both sub-dimensions for unmarried young women. Similarly, disagreeing with the notion that "Adolescent girls who use family planning are promiscuous" was associated with a positive dynamic (aOR 1.55, 95% CI 1.05–2.28, P 0.027) in the motivation sub-dimension among unmarried young women. Table 3 Bivariate associations of sociodemographic characteristics and attitudes related to family planning with the nature of the transition in the subdimensions of contraceptive agency Sociodemographic characteristics and attitudes related to family planning Contraceptive motivation Contraceptive self-efficacy N Negative transition Positive transition Negative transition Positive transition % % % % All young women 2119 43.66 56.34 29.56 70.44 Marital status (Chi2) 2.84 (p = 0.365) 10.68 (p = 0.045) Unmarried 1204 45.49 54.51 32.82 67.18 Married 915 41.85 58.15 26.34 73.66 Education level (Chi2) 3.86 (p = 0.670) 7.77 (p = 0.294) None 518 42.30 57.70 28.07 71.93 Primary 422 42.30 57.70 30.06 69.94 Secondary level 1 836 46.71 53.29 32.64 67.36 Secondary level 2 or more 343 41.63 58.37 23.35 76.65 Household wealth (Chi2) 9.37 (p = 0.192) 2.18 (p = 0.715) Poorest 315 44.17 55.83 28.16 71.84 Middle 456 39.24 60.76 31.61 68.39 Wealthiest 1347 47.05 52.95 28.86 71.14 Employment (Chi2) 2.53 (p = 0.447) 4.83 (p = 0.204) No 1573 44.16 55.84 29.97 70.03 Yes 546 42.11 57.89 28.28 71.72 Age group (Chi2) 0.07 (p = 0.864) 14.16 (p = 0.006) 15–19 1098 43.93 56.07 32.95 67.05 20–24 1021 43.33 56.67 25.45 74.55 Parity (Chi2) 5.87 (p = 0.316) 11.50 (p = 0.084) Nulliparous 1295 45.90 54.10 33.09 66.91 1 child 506 39.96 60.04 26.51 73.49 2 or more 315 41.91 58.09 26.19 73.81 Using modern contraceptive at baseline (Chi2) 8.93 (p = 0.060) 15.77 (p = 0.015) No 1548 45.25 54.75 31.84 68.16 Yes 518 37.26 62.74 22.05 77.95 Adolescents who use family planning are promiscuous. (Chi2) 12.28 (p = 0.078) 0.01 (p = 0.943) Agree 910 47.66 52.34 29.66 70.34 Disagree 1173 40.02 59.98 29.45 70.55 Family planning is only for women who are married. (Chi2) 6.86 (p = 0.098) 3.03 (p = 0.203) Agree 851 46.55 53.45 31.30 68.70 Disagree 1242 40.85 59.15 27.81 72.19 Family planning is only for women who don't want any more children. (Chi2) 29.29 (p = 0.002) 12.97 (p = 0.017) Agree 475 53.29 46.71 35.10 64.90 Disagree 1608 40.02 59.98 27.01 72.99 People who use family planning have a better quality of life. (Chi2) 1.68 (p = 0.533) 0.56 (p = 0.661) Agree 1449 43.07 56.93 29.39 70.61 Disagree 611 46.29 53.71 27.70 72.30 Table 4 Odds ratios from multilevel logistic regressions predicting positive transition in the two subdimensions of contraceptive agency among adolescent girls and young women aged 15–24, based on individual attitudes and community norms (Reference = Negative transition). Model 1a (n = 2054) Model 1b (n = 2021) Motivation Self-efficacy Motivation Self-efficacy OR (IC 95%) p OR (IC 95%) p OR (IC 95%) p OR (IC 95%) p COMMUNITY NORMS RELATED TO FP The majority of people in the community do not believe that adolescents who use FP are promiscuous. 1.37 (0.50–3.75) 0.529 0.46 (0.17–1.27) 1.137 1.14 (0.41–3.11) 0.798 0.41 (0.15–15) 0.092 The majority of people in the community do not believe that FP is only for married women 1.45 (0.42–4.95) 0.549 0.21 (0.06–0.73) 0.014 1.22 (0.35–4.22) 0.745 0.19 (0.05–0.65) 0.008 The majority of people in the community do not believe that FP who don't want any more children 2.47 (1.02–6.02) 0.045 0.60 (0.24–1.51) 0.284 2.04 (0.84–4.97) 0.113 0.46 (0.18–1.16) 0.101 The majority of people in the community believe that those who use FP have a better quality of life 1.36 (0.62–3.00) 0.434 1.27 (0.57–2.85) 0.549 1.65 (0.73–1.30) 0.224 1.09 (0.48–2.47) 0.822 INDIVIDUAL ATTITUDES RELATED TO FP Agreement with the statement that adolescents who use FP are promiscuous. (ref = Agree) Disagree 1.54 (1.24–1.93) 0.000 1.30 (1.02–1.66) 0.028 Agreement with the statement that FP is only for married women. (ref = Agree) Disagree 1.42 (1.14–1.77) 0.002 1.35 (1.07–1.71) 0.011 Agreement with the statement that FP is only for women who do not want any more children. (ref = Agree) Disagree 1.69 (1.31–2.18) 0.000 1.74 (1.33–2.28) 0.000 Agreement with the statement that people who use FP have a better quality of life. (ref = Agree) Disagree 0.97 (0.73–1.30) 0.882 0.82 (0.60–1.11) 0.214 Model 1a is a crude effects model where each norm is considered individually. In Model 1b, each norm is adjusted for the corresponding individual attitude to assess their comparative influence on agency dynamics. Table 5 Odds ratios from multilevel logistic regressions predicting positive transition in the two subdimensions of contraceptive agency among adolescents and young women aged 15–24, based on individual attitudes and community norms (Reference = Negative transition). Model 2a (partially adjusted) (n = 1993) Model 2b (Full) (n = 1968) Motivation Self-efficacy Motivation Self-efficacy aOR (95% CI) p aOR (95% CI) p aOR (95% CI) p aOR (95% CI) p COMMUNITY NORMS RELATED TO FP The majority of people in the community do not believe that adolescents who use FP are promiscuous. 1.06 (0.37–3.02) 0.905 0.42 (0.15–1.20) 0.109 0.99 (0.16–5.86) 0.994 2.33 (0.41–13.25) 0.340 The majority of people in the community do not believe that FP is only for married women 1.16 (0.32–4.14) 0.811 0.19 (0.05–0.67) 0.010 0.29 (0.02–3.47) 0.335 0.06 (0.005–0.69) 0.024 The majority of people in the community do not believe that FP who don't want any more children 2.41 (0.96–6.06) 0.059 0.49 (0.19–1.26) 0.142 4.52 (1.18–17.26) 0.027 1.13 (0.30–4.22) 0.850 The majority of people in the community believe that those who use FP have a better quality of life 1.96 (0.84–4.58) 0.117 1.11 (0.48–2.59) 0.796 1.50 (0.59–3.81) 0.386 1.18 (0.46–2.99) 0.721 INDIVIDUAL ATTITUDES RELATED TO FP Agreement with the statement that adolescents who use FP are promiscuous. (ref = Agree) Disagree 1.51 (1.20–1.89) 0.000 1.21 (0.95–1.55) 0.118 1.38 (1.06–1.80) 0.015 1.10 (0.82–1.46) 0.505 Agreement with the statement that FP is only for married women. (ref = Agree) Disagree 1.35 (1.08–1.70) 0.007 1.20 (0.94–1.54) 0.126 1.08 (0.82–1.41) 0.557 1.08 (0.81–1.44) 0.575 Agreement with the statement that FP is only for women who do not want any more children. (ref = Agree) Disagree 1.57 (1.21–2.05) 0.001 1.48 (1.12–1.95) 0.005 1.30 (0.98–1.74) 0.068 1.48 (1.09–2.01) 0.010 Agreement with the statement that people who use FP have a better quality of life. (ref = Agree) Disagree 1.01 (0.75–1.36) 0.905 0.95 (0.69–1.30) 0.761 1.03 (0.77–1.39) 0.813 0.97 (0.71–1.34) 0.896 In Model 2a (partially adjusted), each norm and the corresponding individual attitude are adjusted for sociodemographic characteristics (place of residence, marital status, education, parity, age, household wealth, employment, and modern contraception use at baseline) as well as contextual control variables (contextual wealth level, education level, and degree of exposure to family planning information in the context). In Model 2b (full model) all norms and attitudes are adjusted with both the same sociodemographic characteristics and contextual control variables. Table 6 Odds ratios from multilevel logistic regressions predicting positive transition in the two subdimensions of contraceptive agency based on individual attitudes, norms on family planning, and marital status of adolescents and young women (Reference: Negative transition) Married (n = 860) Unmarried (n = 1110) Motivation Self-efficacy Motivation Self-efficacy (aOR 95% CI) p (aOR 95% CI) p (aOR 95% CI) p (aOR 95% CI) p COMMUNITY NORMS RELATED TO FP The majority of people in the community do not believe that adolescents who use FP are promiscuous. 1.30 (0.17–9.83) 0.797 6.15 (0.80–47.03) 0.080 0.37 (0.04–3.12) 0.361 0.41 (0.03–4.46) 0.471 The majority of people in the community do not believe that FP is only for married women 0.30 (0.01–5.23) 0.411 0.02 (0.001–0.48) 0.014 0.44 (0.02–7.94) 0.582 0.10 (0.004–2.60) 0.169 The majority of people in the community do not believe that FP who don't want any more children 4.31 (0.91–20.32) 0.064 1.71 (0.36–8.10) 0.497 4.30 (0.85 -21. 68) 0.077 1.15 (0.19–6.74) 0.873 The majority of people in the community believe that those who use FP have a better quality of life 3.86 (1.25–11.91) 0.019 1.44 (0.45–4.61) 0.529 0.70 (0.23–2.11) 0.537 1.01 (0.29–3.47) 0.975 INDIVIDUAL ATTITUDES RELATED TO FP Agreement with the statement that adolescents who use FP are promiscuous. (ref = Agree) Disagree 1.28 (0.88–1.87) 0.187 1.27 (0.83–1.93) 0.261 1.55 (1.05–2.28) 0.027 0.95 (0.62–1.46) 0.844 Agreement with the statement that FP is only for married women. (ref = Agree) Disagree 1.24 (0.85–1.83) 0.257 1.08 (0.71–1.63) 0.707 1.12 (0.75–1.68) 0.563 1.25 (0.80–1.94) 0.324 Agreement with the statement that FP is only for women who do not want any more children. (ref = Agree) Disagree 1.25 (0.82–1.89) 0.293 1.39 (0.90–2.16) 0.137 1.43 (0.94–2.17) 0.092 1.55 (1.02–2.45) 0.057 Agreement with the statement that people who use FP have a better quality of life. (ref = Agree Disagree 1.53 (0.97–2.41) 0.067 1.15 (0.69–1.90) 0.579 0.87 (0.58–1.31) 0.525 1.05 (0.68–1.64) 0.802 For each subdimension of contraceptive agency, all norms and attitudes are adjusted for sociodemographic characteristics (place of residence, marital status, education, parity, age, household wealth, employment, and modern contraception use at baseline) as well as contextual control variables (contextual wealth level, education level, and degree of exposure to family planning information in the context). Discussion Recognizing the dynamic and non-linear nature of women's empowerment in general, this research aimed to explore, beyond traditionally studied determinants such as education, employment, etc. (3, 9, 19, 20), both contextual and individual factors influencing adolescent girls’ and young women’s agency regarding contraception in Burkina Faso. Agency is a central component of empowerment, along with resources and outcomes. The norms and attitudes related to FP considered in this study pertain to social norms and perceptions regarding fertility and female sexuality in African societies in general. These norms—primarily injunctive—prohibit premarital or extramarital sexual activity while also valuing high fertility, which has been recognized as an obstacle to the approval and use of contraception, particularly among young women (31, 32, 34, 35). Examining their effects on the dynamics of contraceptive empowerment over time is relevant, as it can help identify which aspects of norms and attitudes best support the process of contraceptive empowerment, with clear programmatic implications. The explanatory models used in this study generally revealed a weak direct influence of community norms and perceptions, but a strong influence of individual attitudes on agency dynamics. One exception was found: the dynamics of contraceptive motivation were influenced by the norm stating that "FP is only for women who do not want any more children." This norm implicitly disapproves of FP by associating it exclusively with birth limitation. This result further confirms the importance of high fertility ideals within communities for individual contraceptive use (41, 44). Indeed, in a context where high fertility is generally valued, perceiving contraception as a means of limiting births likely results in frequent disapproval of FP by partners, families, and the wider community (41). This, in turn, can impact contraceptive behaviors and young women’s decision-making power. The positive relationship between fertility norms and contraceptive motivation trajectories highlights both the continued influence of fertility preferences on reproductive behavior and the notion that reproductive attitudes and behaviors are shaped by multiple institutions—marital relationships, family structures, kinship systems, and the broader community (32, 45)—making them less likely to be private and individual compared to sexual behavior. Thus, the influence of this norm on reproductive empowerment dynamics among both married and unmarried young women indicates that high fertility ideals remain deeply ingrained within communities. At the same time, our findings showing differential influences of norms based on marital status align with prior research demonstrating that the impact of norms varies depending on the population to which they apply (46, 47). In our case, marriage likely subjects young women to greater social control and the influence of community values and norms, which tend to be restrictive regarding sexuality and fertility (48, 49). This explains why norms exert a stronger influence on their reproductive empowerment dynamics compared to unmarried women. Our findings indicate, on the one hand, an absence of a contextual relationship between norms related to contraception and sexuality and contraceptive agency dynamics and, on the other hand, a significant individual-level influence of these same dimensions through young women’s attitudes. These results have interesting implications. In the Burkinabè context—and more broadly in sub-Saharan Africa—sexual norms still tend to condemn premarital and extramarital sex. However, our results suggest that this conservatism may be "superficial" or performative. Socioeconomic and cultural transformations have led to a rise in the age at first union and an increase in premarital sexual activity (32, 34, 50–52). As the age at first marriage rises, female sexuality—and more broadly, reproductive behaviors—once socially controlled through early unions, increasingly occurs outside of marriage, beyond community control (53). This shift has led to the emergence of a "period of autonomous juvenile sexuality," outside the control of older generations, resulting in greater individualization of sexual and reproductive behaviors (54). Our findings thus suggest that reproductive empowerment dynamics among unmarried young women are primarily influenced by individual attitudes rather than collective norms. Regarding the observed inverse relationship between the norm stating that contraception is reserved for married women (as perceived by respondents regarding their community) and self-efficacy dynamics, one possible explanation is that young women overestimate the community’s expectations regarding the link between marital status and contraceptive use. This perception may not reflect current realities in many communities in Burkina Faso, particularly urban ones. Instead, this overestimation may indicate young women’s internalization of socially desirable responses rather than actual community expectations. From a programmatic perspective, this suggests that young women may be unduly influenced by outdated stereotypes, and that targeted awareness campaigns—especially those directed at youth—could be beneficial. Regarding other individual characteristics, while education appears to be a key factor in contraceptive agency dynamics, employment and household socioeconomic status show limited influence on contraceptive autonomy trajectories. These findings confirm that employment and, more broadly, economic status are not necessarily reliable proxies for measuring women's autonomy and its dynamics (18, 55). Finally, it is well established that the impact of norms on reproductive behaviors depends on context, the type of norms in question, and the population studied (46, 56, 57). Future exploratory research is needed to better account for prevailing norms in Burkina Faso’s evolving social context. This study is not without limitations. One key limitation lies in the contextual "norm" variables, which were constructed based on respondents' perceptions of their community's viewpoints. Additionally, the use of the enumeration area as the contextual unit—commonly employed in population-based studies using cluster sampling—may pose challenges. Conclusion Our study demonstrates that contexts favoring high fertility rates continue to hinder not only contraceptive use but also the reproductive autonomy of young women. From a programmatic perspective, these findings imply the need to continue and intensify programs and policies aimed at changing norms that valorize high fertility and stigmatize premarital sexuality. Theoretical frameworks suggest that changing a social norm requires reaching the reference group of individuals, meaning that it is crucial to involve the entire network of those who share the given norm (58, 59, 60). In the sub-Saharan African context, including Burkina Faso, high fertility is recognized as being driven by social systems such as production modes primarily based on an agricultural economy and, on the other hand, by moral and religious imperatives (61). In this regard, initiatives involving traditional and religious leaders, as well as men in general, in programs and policies aimed at improving young people's access to sexual and reproductive health services and products, as implemented in Burkina Faso, should be encouraged and strengthened. If effectively implemented, these initiatives could act as catalysts for changing norms that negatively influence young women's agency dynamics. At the individual level, our results suggest that positive attitudes towards sexual and reproductive health, particularly those that do not stigmatize premarital sexuality, foster young women's reproductive autonomy. It is therefore essential to undertake initiatives that aim to equip young women with favorable attitudes toward reproductive health. In this regard, the Family Life Education program in Burkina Faso, which aims to provide young people and adolescents with life skills through “a better integration of social issues surrounding sexuality and reproduction, particularly social norms and other specificities of adolescents and young people, using both formal and informal education” (62, 63), is particularly relevant. This ambitious program, designed to "enable adolescents and young people to make informed decisions about their sexuality," was adopted in May 2022, but its effective implementation remains pending. If successfully and effectively executed, it should enable young women to develop positive attitudes toward reproductive health, ultimately contributing to their reproductive autonomy. Abbreviations RH Reproductive Health SRH Sexual and Reproductive Health PMA Performance Monitoring for Action Declarations Ethics approval and consent to participate: As this study uses secondary datasets that have been de-identified and are openly available through the Performance Monitoring for Action (PMA) website (www.pmadata.org ), ethics approval and informed consent were not required. Consent for publication: Not applicable. Availability of Data: The datasets supporting the conclusions shared in this article are available upon request at: https://www.pmadata.org/data/available-datasets Competing interests : The authors declare that they have no competing interests. Funding: The authors did not receive support from any organization for the submitted work Author contributions: FB: Conceptualization, data curation, formal analysis, writing – original draft, review and editing; CR: Writing – review and editing; YO: Writing – review and editing; BAS: Writing – review and editing Acknowledgements : The authors would like to acknowledge the PMA Burkina Faso central staff and interviewers for their invaluable contribution to this work, as well as the respondents for their participation in this study. The authors also acknowledge The Bill and Melinda gates Foundation for funding the PMA’s surveys in Burkina Faso (grant number OPP1163880). The funding body had no role in the design of the study, data collection, analysis, and interpretation of data and in writing of the manuscript. References Ganchimeg, T., Ota, E., Morisaki, N., Laopaiboon, M., Lumbiganon, P., Zhang, J., Yamdamsuren, B., Temmerman, M., Say, L., Tunçalp, Ö., Vogel, J. P., Souza, J. 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Footnotes This contextual variable corresponds to the proportion of young women in each EA who reported having received information on family planning from at least one of the following sources in the past twelve months: television, radio, newspapers/magazines, mobile phone messages, and social media. The contextual wealth level variable corresponds to the proportion of young women in each EA who belong to households in the richest quintile. The contextual education level variable corresponds to the proportion of young women in each EA who have at least a "Secondary 1" level of education. Additional Declarations No competing interests reported. Supplementary Files Appendixconstructiontransitionvariable.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6974123","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476545885,"identity":"974b8ff7-4576-466e-83f3-fde13f797138","order_by":0,"name":"Fiacre Bazié","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACAyA+wGAjAWIzPgCxITRBLWlgLcwGEC0gmoAWBoY0MMkmQZQWc/bjDw98SLCQ5599+Fg1T80dOX4GZrYP+LRY9iQkHJyRIGE441xa2m2eY8+MJRuYmWfgddiBhAOHeX9IMG7g4TG7zcN2OHHDAf7D+P1y/mHD4T8JEvYbePi/FfP8A2lhZsav5UYyw2GGBIlEoC1szLxtRGixnPGM4WBPgkTyjDNsxpJz+w4bSzYT0GLOn/74w4+EOtv+HuaHH958OyzHz96MXwsKYOIBkSRoAKaUH6SoHgWjYBSMghEDAPc9SnVKcGX2AAAAAElFTkSuQmCC","orcid":"","institution":"Université Joseph Ki-Zerbo","correspondingAuthor":true,"prefix":"","firstName":"Fiacre","middleName":"","lastName":"Bazié","suffix":""},{"id":476545886,"identity":"8abeaae4-69a8-47e5-b72e-d9518fb25d8a","order_by":1,"name":"Clémentine Rossier","email":"","orcid":"","institution":"University of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Clémentine","middleName":"","lastName":"Rossier","suffix":""},{"id":476545887,"identity":"6ffca76b-de87-47c3-9b6f-62d96a090c56","order_by":2,"name":"Yentéma Onadja","email":"","orcid":"","institution":"Université Joseph Ki-Zerbo","correspondingAuthor":false,"prefix":"","firstName":"Yentéma","middleName":"","lastName":"Onadja","suffix":""},{"id":476545888,"identity":"b4cbf869-ebb3-4988-a852-a7f152105ee0","order_by":3,"name":"Abdramane B. Soura","email":"","orcid":"","institution":"Université Joseph Ki-Zerbo","correspondingAuthor":false,"prefix":"","firstName":"Abdramane","middleName":"B.","lastName":"Soura","suffix":""}],"badges":[],"createdAt":"2025-06-25 11:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6974123/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6974123/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87037537,"identity":"e7033df2-698f-475f-a62b-9404052b68d3","added_by":"auto","created_at":"2025-07-18 13:24:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2549441,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6974123/v1/015b3fc3-49a2-48cf-8ece-52f8a018709b.pdf"},{"id":85466515,"identity":"6ac780e6-4820-4623-850c-9afcf81c13f2","added_by":"auto","created_at":"2025-06-26 08:32:35","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":57233,"visible":true,"origin":"","legend":"","description":"","filename":"Appendixconstructiontransitionvariable.docx","url":"https://assets-eu.researchsquare.com/files/rs-6974123/v1/8f2abdb87e284135b3a2c42b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influence of cultural context on young women contraceptive empowerment dynamics in Burkina Faso: Findings from longitudinal data","fulltext":[{"header":"Background","content":"\u003cp\u003eUnintended pregnancies among young women can have both short- and long-term negative consequences for their health and well-being, as well as for the health and well-being of their children and families (1). Contraceptive use is an effective strategy for preventing unintended pregnancies (2), and ensuring access to contraception, particularly for adolescent girls and young women, is a fundamental component of sexual and reproductive health and rights.\u003c/p\u003e \u003cp\u003eA substantial body of research has highlighted the relationship between women\u0026rsquo;s empowerment\u0026mdash;often conceptualized as decision-making power\u0026mdash;and improved sexual and reproductive health behaviors and outcomes among women and girls (3), including contraceptive use (4, 5) and the prevention of unintended pregnancies (6). Women\u0026rsquo;s empowerment has been central to several theoretical frameworks explaining health behaviors (3, 7, 8, 9) and has been subject to multiple conceptualizations and definitions (10). Kabeer (11) defines empowerment broadly as \u0026ldquo;the expansion of an individual\u0026rsquo;s ability to make strategic life choices in contexts where such ability was previously denied.\u0026rdquo; This perspective, widely adopted in the literature, conceptualizes empowerment as a process involving three interrelated dimensions: resources (prerequisites for agency), agency (the ability to set goals and mobilize resources to achieve them), and achievements (outcomes). Resources encompass economic, informational, human, and social assets that enhance an individual\u0026rsquo;s capacity to make choices, while agency, which is central to empowerment, refers to the ability to define objectives and act upon them.\u003c/p\u003e \u003cp\u003eWithin the specific domain of contraceptive use, researchers have defined female agency as both woman\u0026rsquo;s ability to set goals related to contraception (representing her motivation) and her perceived capacity to act and achieve those goals (representing her self-efficacy) (5, 9, 12\u0026ndash;15). Contraceptive motivation refers to a woman\u0026rsquo;s reproductive goals, which may be externally or internally driven (9, 14). Meanwhile, self-efficacy encompasses various competencies, particularly a woman\u0026rsquo;s confidence in exercising her choices and her ability to make decisions (13, 16). These two dimensions of agency are recognized as critical determinants of women\u0026rsquo;s and girls\u0026rsquo; sexual health, particularly their contraceptive use (5, 9, 14, 15).\u003c/p\u003e \u003cp\u003eAlthough the concepts of women\u0026rsquo;s empowerment and agency have increasingly been applied to various domains, including sexual and reproductive health (3, 7\u0026ndash;10), knowledge of the factors that reinforce or determine them remains limited (7, 9, 17, 18). Most research examining the determinants of women\u0026rsquo;s decision-making power has focused on individual characteristics such as education, employment, or broader socio-economic status (3, 9, 19, 20). However, some contradictory findings suggest that individual characteristics alone cannot fully explain disparities in empowerment (18, 21).\u003c/p\u003e \u003cp\u003eGiven that empowerment is a dynamic process of change, numerous scholars have emphasized the critical role of context, particularly social structures and norms (3, 9, 10, 11, 17). These structures and norms significantly shape access to resources, the process of agency itself (motivation and capacity to act), and individual achievements (3, 9, 10, 17). Moreover, they define the constraints within which different social actors can pursue their interests, enabling the agency of some while inhibiting that of others (3, 10, 11, 17). Consequently, increasing attention has been given to analyzing the role of social context, particularly gender norms, in shaping women\u0026rsquo;s empowerment processes and dynamics (3, 9, 22, 23).\u003c/p\u003e \u003cp\u003eAs a first approximation, a social norm is what members of a group, community, or society consider normal within that group, community, or society, that is, a typical action, an appropriate action, or both (24). More generally, social norms are perceived, informal, and mostly unwritten rules that define acceptable and appropriate actions within a given group or community, thereby guiding human behavior (25, 26, 27). Gender norms, in particular, refer to social norms that describe how women and men should behave within a community (28, 29). They encompass expectations and beliefs regarding how women, men, girls, and boys should behave and interact in specific social contexts and at different stages of life (30). They are also perceived as a set of social norms that regulate gender relations and structure patriarchal hierarchies (17).\u003c/p\u003e \u003cp\u003eIn Burkina Faso and more broadly in Sub-Saharan Africa, contraceptive use occurs in a context still characterized by norms that value high fertility (31, 32) and that stigmatize premarital or extramarital sexuality among women and girls (33\u0026ndash;35). These norms, through the sanctions resulting from non-compliance (36) and self-sanctions that deter behaviors considered deviant (37, 38), are likely to have a significant influence on decision-making power and agency dynamics concerning women's and girls' contraceptive use.\u003c/p\u003e \u003cp\u003eHowever, due to the lack of direct measures of social norms, residence or ethnicity has often been used as proxy variables to empirically illustrate their effect on women's empowerment (37, 39, 40). For instance, in the case of India and Pakistan, Jejeebhoy and Sathar (37) demonstrated that the region of residence has predictive power on women's autonomy that goes well beyond other determinants. Similarly, Kritz and Makinwa-Adebusoye (40), considering education level as a substitute variable for empowerment, revealed the under-schooling of Hausa and Kanuri girls in Nigeria despite the availability of educational infrastructure in their environment. They explained these trends, among other factors, by the existence of seclusion norms for women in these two ethnic groups.\u003c/p\u003e \u003cp\u003eRecent research has explored the contextual effects of gender norms on women's decision-making autonomy in Africa. For example, in a study conducted in Ghana, Kenya, Uganda, and Tanzania, Viss\u0026eacute;ho and Legrand (18) showed that women living in contexts characterized by gender norms legitimizing violence were more likely to have low decision-making autonomy compared to those living in environments unfavorable to such norms.\u003c/p\u003e \u003cp\u003eDespite these advances, most research exploring the contextual effects of norms on women's autonomy has been conducted either in Asia\u0026mdash;which differs from Sub-Saharan Africa in many respects\u0026mdash;or with decision-making autonomy measures inherited from Asian countries, which sometimes prove inadequate for the African context (12, 18, 41). Additionally, due to the scarcity of longitudinal data in the field, little research has examined the effect of social norms on autonomy from a dynamic perspective. Commonly used cross-sectional perspectives consider empowerment as a static state rather than a dynamic process and provide limited insights into the temporal links between the normative context and empowerment (12). In other words, cross-sectional data do not allow for determining whether and how context affects the reproductive empowerment trajectories of adolescent girls and young women. A longitudinal perspective is necessary to better reflect the processes of improving women's autonomy and to determine the causal mechanisms and mediating factors that may facilitate or hinder women's empowerment (7, 12), which are crucial data for program development in this field.\u003c/p\u003e \u003cp\u003eThis research leverages longitudinal data from the 2019\u0026ndash;2021 Burkina Faso PMA survey to examine the dynamics of young women\u0026rsquo;s empowerment in contraceptive decision-making and to assess the influence of contextual factors, particularly gender and fertility-related norms. Specifically, from a dynamic perspective, this study aims to analyze how gender, fertility, and contraceptive-related norms and attitudes at both the individual and community levels shape changes in young women\u0026rsquo;s contraceptive motivation and self-efficacy over time in Burkina Faso.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data\u003c/h2\u003e \u003cp\u003eThis study utilizes data from the Performance Monitoring for Action (PMA) research platform in Burkina Faso. PMA is a health surveillance platform that tracks reproductive health and family planning indicators and is implemented in eight countries across Sub-Saharan Africa and Asia, including Burkina Faso. In each participating country, PMA employs a multi-stage stratified cluster sampling approach to randomly select a representative sample of households and women of reproductive age (15–49 years) at both national and subnational levels, depending on the country.\u003c/p\u003e \u003cp\u003eDuring the 2019–2021 period, PMA adopted a longitudinal survey model with a sample of 167 enumeration areas (EAs). The data used in this study come from a cohort of 2,709 adolescent girls and young women aged 15–24, who were followed longitudinally at approximately a one-year interval between December 2019 and February 2021. Approximately 80% of the enrolled sample was successfully tracked over time.\u003c/p\u003e \u003cp\u003eFor analyses examining the determinants of empowerment dynamics, a subset of 2,119 respondents—those who completed the follow-up survey—was included. Missing data from the follow-up survey, most of which accounted for less than 1% of the sample, were excluded from the analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Variables\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Dependent variables: \"\u003cem\u003eTransitions\u003c/em\u003e\" in contraceptive agency\u003c/h2\u003e \u003cp\u003eOur main dependent variable is the dynamic (or \"transition\") of contraceptive agency observed from one year to the next among young women. Agency consists of two sub-dimensions: contraceptive motivation and contraceptive self-efficacy. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the specific questions used to construct each of these sub-dimensions.\u003c/p\u003e \u003cp\u003eFor the contraceptive motivation sub-dimension, which was constructed using five questions, a composite index was developed through factor analysis and the principal component analysis (PCA) method, retaining the latent factor score as the measurement index for motivation. The latent score ranged from − 2.75 (for women with low motivation) to 1.21 (for women with high motivation). For self-efficacy, which was measured using two questions, the index was constructed using a summative score corresponding to the sum of the average scores of both questions. The self-efficacy scores ranged from 1 (for women with low self-efficacy) to 5 (for women with high self-efficacy). The same index calculation methods were applied to both survey rounds.\u003c/p\u003e \u003cp\u003eTerciles were then used to establish the levels of autonomy in the two sub-dimensions of agency. The first tercile represented young women with \"low autonomy,\" the second those with \"moderate autonomy,\" and the third those with \"high autonomy.\"\u003c/p\u003e \u003cp\u003eThe \"agency transition\" variable in each of the two sub-dimensions was constructed based on the observed dynamics between the two survey rounds. Transitions within each sub-dimension were captured by tracking changes in the three autonomy categories (low, moderate, and high autonomy) between the baseline survey and follow-up one’s. This calculation was performed using a cross-tabulation of the three autonomy levels across the two surveys for each sub-dimension of contraceptive agency. Subsequently, for both sub-dimensions, the nine possible transitions were grouped into a dichotomous variable distinguishing young woman who experienced a negative autonomy dynamic or \"negative transition\" (coded as 0) from those who experienced a positive autonomy dynamic or \"positive transition\" (coded as 1). Further details on the methodology used to construct this variable are provided in one document in the appendix.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItems used to construct the contraceptive agency subdimensions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubdimensions\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraceptive motivation\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eFive (05) items\u003c/p\u003e \u003cp\u003eCronbach’s Alpha: 0.78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFive items corresponding to distinct questions posed to young women were used to capture the contraceptive motivation dimension. These questions, structured as a five-point Likert scale (1- Strongly disagree to 5- Strongly agree), were:\u003c/p\u003e \u003cp\u003e• If I use family planning, my husband/partner may seek another sexual partner.\u003c/p\u003e \u003cp\u003e• If I use family planning, I may have trouble getting pregnant the next time I want to.\u003c/p\u003e \u003cp\u003e• There could/will be conflict in my relationship/marriage if I use family planning.\u003c/p\u003e \u003cp\u003e• If I use family planning, my children may not be born normal.\u003c/p\u003e \u003cp\u003e• If I use family planning, my body may experience side effects that will disrupt my relations with my husband/partner.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContraceptive self-efficacy\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eTwo (02) items\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo items corresponding to distinct questions posed to young women were used to capture the contraceptive self-efficacy dimension. These questions, structured as a five -point Likert scale (1 - Strongly Disagree to 5 - Strongly Agree), were:\u003c/p\u003e \u003cp\u003e• I can decide to switch from one family planning method to another if I want to.\u003c/p\u003e \u003cp\u003e• I feel confident telling my provider what is important for me when selecting a family planning method.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 The main explanatory variables\u003c/h2\u003e \u003cp\u003eThe main explanatory variables are (women’s) attitudes and (community) norms related to contraception. During the baseline survey, young women were asked questions to assess their attitudes toward family planning. Three questions addressed contraception in relation to attitudes toward sexuality and fertility, while one question focused on the benefits of contraception. Response options were as follows: (1) Strongly agree, (2) Agree, (3) Disagree, (4) Strongly disagree.\u003c/p\u003e \u003cp\u003eTo construct the four dichotomous “individual attitudes” variables on family planning, response categories were grouped into two: (1) Agree and (2) Disagree.\u003c/p\u003e \u003cp\u003eThe same questions were then posed to young women in the form of perceived norms to capture their perceptions of what community members think about each statement or norm. This approach represents an alternative method for measuring social norms, allowing for the mitigation of biases associated with aggregating individual attitudes, which is often used to assess community norms (26, 42, 43).\u003c/p\u003e \u003cp\u003eIn this case, response options were: (1) The majority of people, (2) Some people, (3) Few people. At the individual level, the context is perceived as favorable when young women report the response category “few people” for the first three norms and “most people” for the fourth norm.\u003c/p\u003e \u003cp\u003eTo construct the four contextual “community norms” variables, we considered the proportion of respondents in each EA who reported the response category “few people” for the first three norms as an indicator of a favorable normative context. For the norm stating that “people who use family planning have a better quality of life,” we considered the proportion of respondents in the EA who reported the response category “majority of people” as indicative of a favorable normative context.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e details the specific questions used to measure young women’s attitudes and community norms regarding contraception.\u003c/p\u003e \u003cp\u003eThe objective is to examine whether and how the normative context (favorability) of each of the four norms, along with positive individual attitudes, influence the dynamics of the two subdimensions of contraceptive agency among young women in Burkina Faso.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestions used for measuring attitudes and community norms related to family planning\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual attitudes related to family planning (individual factors)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour distinct questions were asked to assess young women's attitudes towards family planning:\u003c/p\u003e \u003cp\u003e1. Adolescents who use family planning are promiscuous.\u003c/p\u003e \u003cp\u003e2. Family planning is only for women who are married.\u003c/p\u003e \u003cp\u003e3. Family planning is only for women who don't want any more children.\u003c/p\u003e \u003cp\u003e4. People who use family planning have a better quality of life.\u003c/p\u003e \u003cp\u003eThe response options ranged from: 1) Strongly agree to 4) Strongly disagree\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived community norms related to family planning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe same questions were asked to each young woman to gather what she knows about the members of her community on this issue:\u003c/p\u003e \u003cp\u003e(Within your community, would you say that the majority of people, some people, or few people share the following viewpoints:)\u003c/p\u003e \u003cp\u003e1. Adolescents who use family planning are promiscuous.\u003c/p\u003e \u003cp\u003e2. Family planning is only for women who are married.\u003c/p\u003e \u003cp\u003e3. Family planning is only for women who don't want any more children.\u003c/p\u003e \u003cp\u003e4. People who use family planning have a better quality of life.\u003c/p\u003e \u003cp\u003eThe response options were: 1) The majority of people, 2) Some people, 3) Few people\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Other covariables\u003c/h2\u003e \u003cp\u003eAt the individual level, key sociodemographic characteristics of young women, such as place of residence, marital status, education level, parity, household wealth, and employment status, were included as individual control variables in the various multivariate models.\u003c/p\u003e \u003cp\u003eAlthough there was no strong correlation between the two \"transition\" variables of agency (correlation: 0.06 for the motivation subdimension and 0.08 for the self-efficacy subdimension), we observed that contraceptive use at baseline significantly predicted a \"positive transition\" in both subdimensions of contraceptive agency (motivation and self-efficacy) (OR = 1.37; p \u0026lt; 0.01 and OR = 1.62; p \u0026lt; 0.001, respectively). Therefore, contraceptive use status at baseline was also included as an adjustment variable in the multivariate models.\u003c/p\u003e \u003cp\u003eAt the contextual level, exposure to information\u003csup\u003e1\u003c/sup\u003e from various sources on family planning, used as an index of women's exposure to interventions and the availability of family planning services, was included as a contextual control variable. In addition to exposure to contraceptive information, the contextual levels of wealth\u003csup\u003e2\u003c/sup\u003e and education\u003csup\u003e3\u003c/sup\u003e among young women were also used as contextual control variables. These contextual variables were derived by aggregating individual-level data at the EA level.\u003c/p\u003e \u003cp\u003eA collinearity test was conducted on all explanatory variables to assess their degree of multicollinearity. The mean Variance Inflation Factor (VIF) was 1.77, with the highest VIF being 3.19 for one of the contextual norm variables. Overall, this indicates an acceptable level of collinearity among the independent variables.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Analysis\u003c/h2\u003e \u003cp\u003eWe employed both a descriptive and an explanatory approach. First, we examined bivariate relationships between the type of transition in each of the two sub-dimensions of contraceptive agency and key individual variables.\u003c/p\u003e \u003cp\u003eFor the explanatory analyses, we used a multilevel approach to predict the type of transition in each sub-dimension of agency, considering the contextual influence of each normative dimension and the individual attitudes of young women. In the multilevel modeling, the EA was considered as the contextual level. To ensure representativity, EAs with fewer than five individuals were excluded, resulting in the inclusion of 163 out of 167 EAs in the explanatory analyses. The average number of individuals per EA was 13, ranging from a minimum of 5 to a maximum of 26.\u003c/p\u003e \u003cp\u003eThis multilevel approach involved several models to capture the distinct effects of each norm and corresponding individual attitude. All explanatory analyses aimed to predict the conditions under which a \"positive transition\" or a favorable dynamic (rather than a \"negative transition\") occurs in each sub-dimension of contraceptive agency.\u003c/p\u003e \u003cp\u003eIn an unadjusted Model 1, we first estimated the raw effect of each normative contextual dimension through four separate logistic regressions (Model 1a). Then, each norm was analyzed alongside its corresponding individual attitude to compare their effects on the transitions (Model 1b).\u003c/p\u003e \u003cp\u003eIn a second, adjusted model, control variables (individual and contextual) were introduced into each of the four regressions to isolate the net effect of each norm and its corresponding attitude (Model 2a). Subsequently, in a full model (Model 2b), all four norms and corresponding attitudes were analyzed simultaneously, adjusting for all individual and contextual control variables to identify the most influential norms and attitudes on the transition variables.\u003c/p\u003e \u003cp\u003eSince marital status is often considered a key factor in the exercise of autonomy, particularly in reproductive matters (7, 48, 49), we anticipated that community norms and individual attitudes might have differential effects on agency dynamics depending on marital status. Therefore, the full model (2b) was applied separately to two distinct subsamples of young women (married and unmarried) to better capture the differential influence of norms and attitudes on agency dynamics based on marital status.\u003c/p\u003e \u003cp\u003eAll data were weighted using the survey follow-up weighting coefficients, and analyses were conducted using the statistical software Stata 16.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003e2.4 Results from descriptive analysis\u003c/h2\u003e\u003cp\u003eAt the bivariate level (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), the results indicate positive relationships between certain individual attitudes of young women and the nature of transitions in the two sub-dimensions of contraceptive agency.\u003c/p\u003e\u003cp\u003eRegarding motivation, a higher proportion of young women experienced a positive transition among those with favorable attitudes toward contraception compared to those with negative attitudes. Specifically, young women who disagreed with statements such as \"Adolescent girls who use family planning are promiscuous”, \" Family planning is only for women who don't want any more children\" or \"Family planning is only for married women\" were more likely to experience a positive transition than those who agreed with these statements (Chi-square tests: p = 0.078, p = 0.098, p = 0.002 respectively). In the self-efficacy sub-dimension, young women who disagreed with the statement \" Family planning is only for women who don't want any more children \" were also more likely to experience a positive transition in autonomy compared to those who agreed with this statement (Chi-square test: p = 0.017). Additionally, contraceptive use at baseline was positively associated with a positive dynamic in both sub-dimensions of agency. Among other individual characteristics, marital status, age, and parity were positively associated with a positive transition, but only in the self-efficacy sub-dimension.\u003c/p\u003e\u003ch2\u003e2.5 Results from explanatory analysis\u003c/h2\u003e\u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e present the odds ratios from the different multilevel logistic regression models predicting the conditions under which a positive transition occurs in the two sub-dimensions of contraceptive agency.\u003c/p\u003e\u003cp\u003eThe results indicate that in the motivation sub-dimension, at the contextual level, only young women living in a context where the majority disagreed with the statement that \" Family planning is only for women who don't want any more children \" were more likely to experience a positive transition compared to those in a context where the majority agreed with this norm (Models 1a, 2a, and 2b).\u003c/p\u003e\u003cp\u003eAt the individual level, Models 1b and 2a indicate that young women with positive attitudes—specifically, those who disagreed with statements such as \"adolescent girls who use family planning are promiscuous,\" \" Family planning is only for women who don't want any more children,\" or \"Family planning is only for married women\"—were more likely to experience a positive transition compared to those who agreed with these statements. In the full model (2b), disagreeing with the idea that \"Adolescent girls who use family planning are promiscuous\" (aOR 1.38, 95% CI 1.06–1.80, P 0.015) or that \"Family planning is only for married women\" (aOR 1.30, 95% CI 0.98–1.74, P 0.068) was positively associated with a positive dynamic in the contraceptive motivation sub-dimension among young women.\u003c/p\u003e\u003cp\u003eIn the self-efficacy sub-dimension, at the contextual level, living in an area where the majority of individuals disagreed with the norm stating that \"Family planning is only for married women\" was associated with lower odds to have a positive transition (aOR 0.006, 95% CI 0.005–0.69, P 0.024). Across Models 1a, 1b, 2a, and 2b, results show that young women living in an area where the majority of individuals disagreed with this norm were less likely to experience a positive transition compared to those in a context supportive of this norm. The three other norms were associated with lower odds with the direction of transition in contraceptive self-efficacy.\u003c/p\u003e\u003cp\u003eAt the individual level, the three previously mentioned attitudes (in motivation sub-dimension), were associated with higher odds to experience positive transition in Models 1b and 2a. Young women who disagreed with these attitudes were more likely to experience a positive transition from one year to the next in the domain of contraceptive self-efficacy. In the full model (2b), only disagreement with the idea that \" Family planning is only for women who don't want any more children \" was associated with higher odds with a positive transition. Young women who disagreed with this assertion were approximately 1.5 times more likely (aOR 1.48, 95% CI 1.09–2.01, P 0.010) to experience a positive transition compared to those who agreed with this norm.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the results of the full model (2b) disaggregated by the marital status of young women (married and unmarried). Regarding the influence of the normative context, living in a community perceived as disagreeing with the norm that \" Family planning is only for women who don't want any more children\" was associated with higher odds to experience a positive dynamic in the motivation sub-dimension for both married (aOR 4.31, 95% CI 0.91–20.32, P 0.064) and unmarried (aOR 4.30, 95% CI 0.85–21.68, P 0.077) young women. Beyond this norm, which appears to transcend marital status, the influence of the normative context related to the other norms considered here was mainly observed among married young women and had less impact on the dynamics among unmarried women.\u003c/p\u003e\u003cp\u003eIndeed, in addition to the mentioned norm, it is also observed that married young women living in a context where \"the majority of people in the community believes that people who use family planning have a better quality of life\" had a higher likelihood of experiencing a positive transition in motivation from one year to the next (aOR 3.86, 95% CI 1.25–11.94, P 0.019). Furthermore, living in a context where the community rejects the idea that \"Adolescent girls who use family planning are promiscuous\" was also associated with a positive dynamic in the self-efficacy sub-dimension (aOR 6.15, 95% CI 0.80-47.03, P 0.080). Finally, living in a context where the community does not approve of the idea that \"Family planning is only for married women\" was negatively associated with a positive transition in the self-efficacy sub-dimension among married young women.\u003c/p\u003e\u003cp\u003eConversely, the same results (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) indicate that the influence of individual attitudes is primarily evident among unmarried young women and much less among married ones. Indeed, while none of the attitudes considered were associated with high odds with the nature of the dynamic in either of the two sub-dimensions for married young women, disagreeing with the statement that \" Family planning is only for women who don't want any more children\" was associated with a positive empowerment dynamic in both sub-dimensions for unmarried young women. Similarly, disagreeing with the notion that \"Adolescent girls who use family planning are promiscuous\" was associated with a positive dynamic (aOR 1.55, 95% CI 1.05–2.28, P 0.027) in the motivation sub-dimension among unmarried young women.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Bivariate associations of sociodemographic characteristics and attitudes related to family planning with the nature of the transition in the subdimensions of contraceptive agency\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSociodemographic characteristics and attitudes related to family planning\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eContraceptive motivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eContraceptive self-efficacy\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative transition\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive transition\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNegative transition\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePositive transition\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd\u003e\u003c/td\u003e\u003ctd\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAll young women\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2119\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.44\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2.84 (p = 0.365)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10.68 (p = 0.045)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1204\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.49\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e32.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e67.18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e915\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e26.34\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e73.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3.86 (p = 0.670)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.77 (p = 0.294)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e518\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.93\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.94\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary level 1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e836\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.36\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary level 2 or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.37\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.65\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold wealth (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e9.37 (p = 0.192)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.18 (p = 0.715)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorest\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.84\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e456\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.76\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.39\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWealthiest\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1347\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.14\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2.53 (p = 0.447)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.83 (p = 0.204)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1573\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.03\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e546\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.72\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.07 (p = 0.864)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e14.16 (p = 0.006)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15–19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1098\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e32.95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e67.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20–24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.67\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e25.45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e74.55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5.87 (p = 0.316)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e11.50 (p = 0.084)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNulliparous\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1295\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e33.09\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e66.91\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 child\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e506\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.96\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.04\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e26.51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e73.49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 or more\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e26.19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e73.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUsing modern contraceptive at baseline (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8.93 (p = 0.060)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15.77 (p = 0.015)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1548\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e45.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e54.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e31.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e68.16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e518\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e37.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e62.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e22.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e77.95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdolescents who use family planning are promiscuous. (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e12.28 (p = 0.078)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.01 (p = 0.943)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e910\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e47.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e52.34\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.66\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.34\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1173\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e40.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e59.98\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.55\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily planning is only for women who are married. (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6.86 (p = 0.098)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.03 (p = 0.203)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e851\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e46.55\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e53.45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.70\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1242\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e40.85\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e59.15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.19\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily planning is only for women who don't want any more children. (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29.29 (p = 0.002)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e12.97 (p = 0.017)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e475\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e53.29\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e46.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e35.10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e64.90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1608\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e40.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e59.98\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e27.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e72.99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeople who use family planning have a better quality of life. (Chi2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.68 (p = 0.533)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.56 (p = 0.661)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1449\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.39\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.61\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e611\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.30\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds ratios from multilevel logistic regressions predicting positive transition in the two subdimensions of contraceptive agency among adolescent girls and young women aged 15–24, based on individual attitudes and community norms (Reference = Negative transition).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eModel 1a (n = 2054)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eModel 1b (n = 2021)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOR (IC 95%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (IC 95%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eOR (IC 95%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOR (IC 95%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eCOMMUNITY NORMS RELATED TO FP\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that adolescents who use FP are promiscuous.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.37 (0.50–3.75)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46 (0.17–1.27)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.137\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.14 (0.41–3.11)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.41 (0.15–15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that FP is only for married women\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.45 (0.42–4.95)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21 (0.06–0.73)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.22 (0.35–4.22)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.19 (0.05–0.65)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that FP who don't want any more children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.47 (1.02–6.02)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.60 (0.24–1.51)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e2.04 (0.84–4.97)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.46 (0.18–1.16)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community believe that those who use FP have a better quality of life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36 (0.62–3.00)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.27 (0.57–2.85)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.65 (0.73–1.30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.09 (0.48–2.47)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eINDIVIDUAL ATTITUDES RELATED TO FP\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that adolescents who use FP are promiscuous. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.54 (1.24–1.93)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.30 (1.02–1.66)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that FP is only for married women. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.42 (1.14–1.77)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.35 (1.07–1.71)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that FP is only for women who do not want any more children. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1.69 (1.31–2.18)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.74 (1.33–2.28)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that people who use FP have a better quality of life. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.97 (0.73–1.30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.82 (0.60–1.11)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eModel 1a is a crude effects model where each norm is considered individually. In Model 1b, each norm is adjusted for the corresponding individual attitude to assess their comparative influence on agency dynamics.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds ratios from multilevel logistic regressions predicting positive transition in the two subdimensions of contraceptive agency among adolescents and young women aged 15–24, based on individual attitudes and community norms (Reference = Negative transition).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eModel 2a (partially adjusted) (n = 1993)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eModel 2b (Full) (n = 1968)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eaOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eaOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eaOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003eaOR (95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOMMUNITY NORMS RELATED TO FP\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that adolescents who use FP are promiscuous.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.06 (0.37–3.02)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.42 (0.15–1.20)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.99 (0.16–5.86)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.33 (0.41–13.25)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that FP is only for married women\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.16 (0.32–4.14)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.19 (0.05–0.67)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.29 (0.02–3.47)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.06 (0.005–0.69)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that FP who don't want any more children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.41 (0.96–6.06)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49 (0.19–1.26)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.52 (1.18–17.26)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.13 (0.30–4.22)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community believe that those who use FP have a better quality of life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.96 (0.84–4.58)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.11 (0.48–2.59)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.50 (0.59–3.81)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.18 (0.46–2.99)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003eINDIVIDUAL ATTITUDES RELATED TO FP\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that adolescents who use FP are promiscuous. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.51 (1.20–1.89)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.21 (0.95–1.55)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.38 (1.06–1.80)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.10 (0.82–1.46)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that FP is only for married women. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.35 (1.08–1.70)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20 (0.94–1.54)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.08 (0.82–1.41)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.08 (0.81–1.44)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that FP is only for women who do not want any more children. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.57 (1.21–2.05)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.48 (1.12–1.95)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.30 (0.98–1.74)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.48 (1.09–2.01)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that people who use FP have a better quality of life. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.01 (0.75–1.36)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.95 (0.69–1.30)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.03 (0.77–1.39)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.97 (0.71–1.34)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eIn Model 2a (partially adjusted), each norm and the corresponding individual attitude are adjusted for sociodemographic characteristics (place of residence, marital status, education, parity, age, household wealth, employment, and modern contraception use at baseline) as well as contextual control variables (contextual wealth level, education level, and degree of exposure to family planning information in the context). In Model 2b (full model) all norms and attitudes are adjusted with both the same sociodemographic characteristics and contextual control variables.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Odds ratios from multilevel logistic regressions predicting positive transition in the two subdimensions of contraceptive agency based on individual attitudes, norms on family planning, and marital status of adolescents and young women (Reference: Negative transition)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMarried (n = 860)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c14\" namest=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUnmarried (n = 1110)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003eSelf-efficacy\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e(aOR 95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003e(aOR 95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003e(aOR 95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e(aOR 95% CI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCOMMUNITY NORMS RELATED TO FP\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c11\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that adolescents who use FP are promiscuous.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30 (0.17–9.83)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6.15 (0.80–47.03)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e0.37 (0.04–3.12)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.41 (0.03–4.46)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that FP is only for married women\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30 (0.01–5.23)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.02 (0.001–0.48)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e0.44 (0.02–7.94)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.10 (0.004–2.60)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community do not believe that FP who don't want any more children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.31 (0.91–20.32)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.71 (0.36–8.10)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e4.30 (0.85 -21. 68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.15 (0.19–6.74)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe majority of people in the community believe that those who use FP have a better quality of life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.86 (1.25–11.91)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.44 (0.45–4.61)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e0.70 (0.23–2.11)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.01 (0.29–3.47)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"13\" nameend=\"c14\" namest=\"c2\"\u003e \u003cp\u003eINDIVIDUAL ATTITUDES RELATED TO FP\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that adolescents who use FP are promiscuous. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.28 (0.88–1.87)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.27 (0.83–1.93)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e1.55 (1.05–2.28)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.95 (0.62–1.46)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that FP is only for married women. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.24 (0.85–1.83)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.08 (0.71–1.63)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e1.12 (0.75–1.68)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.25 (0.80–1.94)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that FP is only for women who do not want any more children. (ref = Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25 (0.82–1.89)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.39 (0.90–2.16)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e1.43 (0.94–2.17)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.55 (1.02–2.45)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAgreement with the statement that people who use FP have a better quality of life. (ref = Agree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c12\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.53 (0.97–2.41)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.15 (0.69–1.90)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e0.87 (0.58–1.31)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.05 (0.68–1.64)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eFor each subdimension of contraceptive agency, all norms and attitudes are adjusted for sociodemographic characteristics (place of residence, marital status, education, parity, age, household wealth, employment, and modern contraception use at baseline) as well as contextual control variables (contextual wealth level, education level, and degree of exposure to family planning information in the context).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRecognizing the dynamic and non-linear nature of women's empowerment in general, this research aimed to explore, beyond traditionally studied determinants such as education, employment, etc. (3, 9, 19, 20), both contextual and individual factors influencing adolescent girls’ and young women’s agency regarding contraception in Burkina Faso. Agency is a central component of empowerment, along with resources and outcomes. The norms and attitudes related to FP considered in this study pertain to social norms and perceptions regarding fertility and female sexuality in African societies in general. These norms—primarily injunctive—prohibit premarital or extramarital sexual activity while also valuing high fertility, which has been recognized as an obstacle to the approval and use of contraception, particularly among young women (31, 32, 34, 35). Examining their effects on the dynamics of contraceptive empowerment over time is relevant, as it can help identify which aspects of norms and attitudes best support the process of contraceptive empowerment, with clear programmatic implications.\u003c/p\u003e \u003cp\u003eThe explanatory models used in this study generally revealed a weak direct influence of community norms and perceptions, but a strong influence of individual attitudes on agency dynamics. One exception was found: the dynamics of contraceptive motivation were influenced by the norm stating that \"FP is only for women who do not want any more children.\" This norm implicitly disapproves of FP by associating it exclusively with birth limitation. This result further confirms the importance of high fertility ideals within communities for individual contraceptive use (41, 44). Indeed, in a context where high fertility is generally valued, perceiving contraception as a means of limiting births likely results in frequent disapproval of FP by partners, families, and the wider community (41). This, in turn, can impact contraceptive behaviors and young women’s decision-making power. The positive relationship between fertility norms and contraceptive motivation trajectories highlights both the continued influence of fertility preferences on reproductive behavior and the notion that reproductive attitudes and behaviors are shaped by multiple institutions—marital relationships, family structures, kinship systems, and the broader community (32, 45)—making them less likely to be private and individual compared to sexual behavior. Thus, the influence of this norm on reproductive empowerment dynamics among both married and unmarried young women indicates that high fertility ideals remain deeply ingrained within communities.\u003c/p\u003e \u003cp\u003eAt the same time, our findings showing differential influences of norms based on marital status align with prior research demonstrating that the impact of norms varies depending on the population to which they apply (46, 47). In our case, marriage likely subjects young women to greater social control and the influence of community values and norms, which tend to be restrictive regarding sexuality and fertility (48, 49). This explains why norms exert a stronger influence on their reproductive empowerment dynamics compared to unmarried women.\u003c/p\u003e \u003cp\u003eOur findings indicate, on the one hand, an absence of a contextual relationship between norms related to contraception and sexuality and contraceptive agency dynamics and, on the other hand, a significant individual-level influence of these same dimensions through young women’s attitudes. These results have interesting implications. In the Burkinabè context—and more broadly in sub-Saharan Africa—sexual norms still tend to condemn premarital and extramarital sex. However, our results suggest that this conservatism may be \"superficial\" or performative. Socioeconomic and cultural transformations have led to a rise in the age at first union and an increase in premarital sexual activity (32, 34, 50–52). As the age at first marriage rises, female sexuality—and more broadly, reproductive behaviors—once socially controlled through early unions, increasingly occurs outside of marriage, beyond community control (53). This shift has led to the emergence of a \"period of autonomous juvenile sexuality,\" outside the control of older generations, resulting in greater individualization of sexual and reproductive behaviors (54). Our findings thus suggest that reproductive empowerment dynamics among unmarried young women are primarily influenced by individual attitudes rather than collective norms.\u003c/p\u003e \u003cp\u003eRegarding the observed inverse relationship between the norm stating that contraception is reserved for married women (as perceived by respondents regarding their community) and self-efficacy dynamics, one possible explanation is that young women overestimate the community’s expectations regarding the link between marital status and contraceptive use. This perception may not reflect current realities in many communities in Burkina Faso, particularly urban ones. Instead, this overestimation may indicate young women’s internalization of socially desirable responses rather than actual community expectations. From a programmatic perspective, this suggests that young women may be unduly influenced by outdated stereotypes, and that targeted awareness campaigns—especially those directed at youth—could be beneficial.\u003c/p\u003e \u003cp\u003eRegarding other individual characteristics, while education appears to be a key factor in contraceptive agency dynamics, employment and household socioeconomic status show limited influence on contraceptive autonomy trajectories. These findings confirm that employment and, more broadly, economic status are not necessarily reliable proxies for measuring women's autonomy and its dynamics (18, 55).\u003c/p\u003e \u003cp\u003eFinally, it is well established that the impact of norms on reproductive behaviors depends on context, the type of norms in question, and the population studied (46, 56, 57). Future exploratory research is needed to better account for prevailing norms in Burkina Faso’s evolving social context.\u003c/p\u003e \u003cp\u003eThis study is not without limitations. One key limitation lies in the contextual \"norm\" variables, which were constructed based on respondents' perceptions of their community's viewpoints. Additionally, the use of the enumeration area as the contextual unit—commonly employed in population-based studies using cluster sampling—may pose challenges.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study demonstrates that contexts favoring high fertility rates continue to hinder not only contraceptive use but also the reproductive autonomy of young women. From a programmatic perspective, these findings imply the need to continue and intensify programs and policies aimed at changing norms that valorize high fertility and stigmatize premarital sexuality. Theoretical frameworks suggest that changing a social norm requires reaching the reference group of individuals, meaning that it is crucial to involve the entire network of those who share the given norm (58, 59, 60).\u003c/p\u003e\u003cp\u003eIn the sub-Saharan African context, including Burkina Faso, high fertility is recognized as being driven by social systems such as production modes primarily based on an agricultural economy and, on the other hand, by moral and religious imperatives (61). In this regard, initiatives involving traditional and religious leaders, as well as men in general, in programs and policies aimed at improving young people's access to sexual and reproductive health services and products, as implemented in Burkina Faso, should be encouraged and strengthened. If effectively implemented, these initiatives could act as catalysts for changing norms that negatively influence young women's agency dynamics.\u003c/p\u003e\u003cp\u003eAt the individual level, our results suggest that positive attitudes towards sexual and reproductive health, particularly those that do not stigmatize premarital sexuality, foster young women's reproductive autonomy. It is therefore essential to undertake initiatives that aim to equip young women with favorable attitudes toward reproductive health. In this regard, the Family Life Education program in Burkina Faso, which aims to provide young people and adolescents with life skills through “a better integration of social issues surrounding sexuality and reproduction, particularly social norms and other specificities of adolescents and young people, using both formal and informal education” (62, 63), is particularly relevant. This ambitious program, designed to \"enable adolescents and young people to make informed decisions about their sexuality,\" was adopted in May 2022, but its effective implementation remains pending. If successfully and effectively executed, it should enable young women to develop positive attitudes toward reproductive health, ultimately contributing to their reproductive autonomy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReproductive Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual and Reproductive Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePerformance Monitoring for Action\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eAs this study uses secondary datasets that have been de-identified and are openly available through the Performance Monitoring for Action (PMA) website (www.pmadata.org ), ethics approval and informed consent were not required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data:\u0026nbsp;\u003c/strong\u003eThe datasets supporting the conclusions shared in this article are available upon request at: https://www.pmadata.org/data/available-datasets\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors did not receive support from any organization for the submitted work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e FB: Conceptualization, data curation, formal analysis, writing \u0026ndash; original draft, review and editing; CR: Writing \u0026ndash; review and editing; YO: Writing \u0026ndash; review and editing; BAS: Writing \u0026ndash; review and editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The authors would like to acknowledge the PMA Burkina Faso central staff and interviewers for their invaluable contribution to this work, as well as the respondents for their participation in this study. The authors also acknowledge The Bill and Melinda gates Foundation for funding the PMA\u0026rsquo;s surveys in Burkina Faso (grant number OPP1163880). The funding body had no role in the design of the study, data collection, analysis, and interpretation of data and in writing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGanchimeg, T., Ota, E., Morisaki, N., Laopaiboon, M., Lumbiganon, P., Zhang, J., Yamdamsuren, B., Temmerman, M., Say, L., Tun\u0026ccedil;alp, \u0026Ouml;., Vogel, J. P., Souza, J. P., Mori, R., \u0026amp; WHO Multicountry Survey on Maternal Newborn Health Research Network. 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The effects of status on women\u0026rsquo;s autonomy in Bolivia, Peru,and Nicaragua. \u003cem\u003ePopul Res Policy Rev\u003c/em\u003e. 2005; 24, 283\u0026ndash;300. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1007/s11113-005-4082-5\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDynes, M., Stephenson, R., Rubardt, M., \u0026amp; Bartel, D. The influence of perceptions of community norms on current contraceptive use among men and women in Ethiopia and Kenya. \u003cem\u003eHealth Place\u003c/em\u003e. 2012; 18(4), 766\u0026ndash;773. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://doi.org/10.1016/j.healthplace.2012.04.006\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarson, E. A. Individual attitudes, social norms, deviance, and contraceptive use in Burkina Faso (Doctoral dissertation, Johns Hopkins University). 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMackie, G., Moneti, F., Shakya, H., \u0026amp; Denny, E. What are social norms? How are they measured. \u003cem\u003eUniversity of California at San Diego-UNICEF Working Paper, San Diego\u003c/em\u003e. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller, D. T., \u0026amp; Prentice, D. A. Changing norms to change behavior. \u003cem\u003eAnnual review of psychology\u003c/em\u003e. 2016; 67(1), 339\u0026ndash;361.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCislaghi, B., Denny, E. K., Ciss\u0026eacute;, M., Gueye, P., Shrestha, B., Shrestha, P. N.,. .. Clark, C. J. Changing social norms: the importance of \u0026ldquo;organized diffusion\u0026rdquo; for scaling up community health promotion and women empowerment interventions. \u003cem\u003ePrevention Science.\u003c/em\u003e 2019; \u003cem\u003e20\u003c/em\u003e, 936\u0026ndash;946.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuiella, G., \u0026amp; Poirier, J. Fondements socio-\u0026eacute;conomiques de la f\u0026eacute;condit\u0026eacute; chez les Mossi du plateau central (Burkina Faso). Pilon M. et Guillaume A.(\u0026eacute;ds), Ma\u0026icirc;trise de la f\u0026eacute;condit\u0026eacute; et planification familiale au Sud. \u003cem\u003eIRD, Paris\u003c/em\u003e. 2000; 93\u0026ndash;110.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCodina, M., \u0026amp; Marielle Le Mat, K. I. T. L\u0026rsquo;\u0026eacute;ducation \u0026agrave; la sant\u0026eacute; sexuelle et reproductive au Mali, Burkina Faso et Niger.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNFPA-Burkina Faso, L\u0026rsquo;\u0026eacute;ducation compl\u0026egrave;te \u0026agrave; la sexualit\u0026eacute; enseign\u0026eacute;e dans les centres de formation professionnelle au Burkina Faso : une cl\u0026eacute; de plus pour pr\u0026eacute;parer l\u0026rsquo;avenir. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ehttps://burkinafaso.unfpa.org/fr/news/l%C3%A9ducation-compl%C3%A8te-%C3%A0-la-sexualit%C3%A9-enseign%C3%A9e-dans-les-centres-de-formation-professionnelle%C2%A0au\u003c/span\u003e accessed on 20 March 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e This contextual variable corresponds to the proportion of young women in each EA who reported having received information on family planning from at least one of the following sources in the past twelve months: television, radio, newspapers/magazines, mobile phone messages, and social media.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e The contextual wealth level variable corresponds to the proportion of young women in each EA who belong to households in the richest quintile.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e The contextual education level variable corresponds to the proportion of young women in each EA who have at least a \"Secondary 1\" level of education.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Agency, Norms, Attitudes, Sexual and Reproductive Health, Adolescent Girls, Young Women, Burkina Faso","lastPublishedDoi":"10.21203/rs.3.rs-6974123/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6974123/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMost research exploring the factors influencing women's decision-making power has focused on individual characteristics, particularly education, employment, or, more broadly, women's socioeconomic status. However, some contradictory findings suggest that individual characteristics alone are insufficient to fully explain disparities in women's empowerment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study leverages longitudinal data from the national Performance Monitoring for Action (PMA) survey to examine the dynamics of contraceptive agency among young women in Burkina Faso. Specifically, it analyzes the influence of contextual factors, particularly gender and fertility-related norms, on contraceptive agency. Contraceptive agency comprises two key dimensions: motivation\u0026mdash;the ability to define reproductive goals\u0026mdash;and self-efficacy\u0026mdash;the capacity to act upon and achieve those goals.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe explanatory models used in this study revealed a limited direct influence of community norms and perceptions, while individual attitudes played a predominant role in shaping contraceptive agency dynamics. An exception was observed: changes in the contraceptive motivation subdimension were influenced by norms related to fertility perceptions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePrograms and initiatives aimed at strengthening young women\u0026rsquo;s reproductive autonomy in Burkina Faso should implement strategies that simultaneously address norm shifts\u0026mdash;particularly those that promote high fertility\u0026mdash;while also fostering positive reproductive health attitudes, especially among unmarried young women.\u003c/p\u003e","manuscriptTitle":"Influence of cultural context on young women contraceptive empowerment dynamics in Burkina Faso: Findings from longitudinal data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-26 08:32:30","doi":"10.21203/rs.3.rs-6974123/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0db2b158-5844-4604-8c1f-a867eb5058b6","owner":[],"postedDate":"June 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T13:23:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-26 08:32:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6974123","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6974123","identity":"rs-6974123","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}