Women’s empowerment and life stage: assessing intersectional differences in contraceptive method mix in sub-Saharan Africa

Women’s empowerment and life stage: assessing intersectional differences in contraceptive method mix in sub-Saharan Africa | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (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];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Women’s empowerment and life stage: assessing intersectional differences in contraceptive method mix in sub-Saharan Africa View ORCID Profile Franciele Hellwig , View ORCID Profile Yohannes Dibaba Wado , View ORCID Profile Cheikh M Faye , View ORCID Profile Jennifer Requejo , View ORCID Profile Leontine Alkema , View ORCID Profile Rornald Muhumuza Kananura , Ties Boerma , View ORCID Profile Aluísio JD Barros doi: https://doi.org/10.1101/2025.02.14.25322228 Franciele Hellwig 1 International Center for Equity in Health, Federal University of Pelotas , Pelotas, Brazil 2 Post-graduation Program of Epidemiology, Federal University of Pelotas , Pelotas, Brazil Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Franciele Hellwig For correspondence: fhellwig{at}equidade.org Yohannes Dibaba Wado 3 African Population and Health Research Center , Nairobi, Kenya Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Yohannes Dibaba Wado Cheikh M Faye 4 African Population and Health Research Center , Dakar, Senegal Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Cheikh M Faye Jennifer Requejo 5 Global Financing Facility for Women, Children, and Adolescents, World Bank Group , Washington DC, United States of America 6 Johns Hopkins Bloomberg School of Public Health , Baltimore, United States of America Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Jennifer Requejo Leontine Alkema 7 Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, United States of America Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Leontine Alkema Rornald Muhumuza Kananura 3 African Population and Health Research Center , Nairobi, Kenya Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Rornald Muhumuza Kananura Ties Boerma 8 Institute for Global Public Health, University of Manitoba , Winnipeg, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Aluísio JD Barros 1 International Center for Equity in Health, Federal University of Pelotas , Pelotas, Brazil 2 Post-graduation Program of Epidemiology, Federal University of Pelotas , Pelotas, Brazil Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Aluísio JD Barros Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Women’s empowerment positively impacts family planning in sub-Saharan Africa, but little is known about its relationship with contraceptive method mix. Considering that contraceptive needs vary across life stages, we aimed to explore the intersectional differences in contraceptive method mix according to age and level of empowerment in sub-Saharan Africa. Methods We analyzed data from Demographic and Health Surveys conducted from 2015 to 2022 across 28 countries in West & Central and Eastern & Southern Africa. Within each region, we calculated pooled estimates of demand for family planning satisfied by any method (DFPS) and contraceptive method mix, stratifying by women’s age and empowerment level according to the SWPER Global index. Results Our sample included 138,374 married women of reproductive age. Across both regions, DFPS increased with empowerment, especially among women older than 19. Among adolescents, a substantial increase was only identified in terms of decision-making. Contraceptive method mix was skewed towards injectables and implants, but their shares dropped as empowerment increased. This trend appeared across all age groups and empowerment domains, with the largest declines observed for social independence. High-empowered women had a more diversified method mix, with adolescents and young women showing increased use of condoms, pills, and fertility-awareness methods, while women over 34 relied more on IUDs and sterilization. Conclusion Our findings reveal that age, empowerment, and contraceptive method mix intersect in diverse ways. Tailoring family planning policies and counseling while addressing empowerment drivers could enhance informed contraceptive choices and better meet women’s reproductive health goals. Introduction Expanding the use of contraception is a key commitment in several international initiatives, such as the Sustainable Development Goals (SDGs), the Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016-2030), and the Family Planning 2030 (FP2030). In response to these initiatives, massive investments have been made to promote family planning in low- and middle-income countries ( 1 ). While these investments have significantly increased contraceptive use worldwide, less attention has been given to the quality of family planning services being provided. Family planning is defined as the individual’s right to decide the number and spacing of their children and to choose the means by which this can be achieved ( 2 , 3 ). Today, when a variety of contraceptive methods are available, women’s method choice should ideally reflect their needs and preferences ( 2 ). However, while this choice is directly influenced by women’s and couples’ age, parity, desired family size, known side effects, and health conditions, it is also influenced by a complex interaction between these individual aspects with socioeconomic, cultural, structural, and political factors. In sub-Saharan Africa, family planning efforts are relatively recent compared to other regions and, as a result, have been occurring in a context in which a wide range of contraceptive methods is already available ( 4 ). However, the method mix in the region is still highly skewed though changes were identified over the last few decades ( 5 ). Family planning strategies adopted in the region have predominantly focused on injectables and implants, which can be easily provided even by community health workers, offer longer-term protection, and, once inserted, are not user-controlled ( 6 ). It is expected that family planning programs, particularly in areas with weak health systems, concentrate on one or two methods to increase and maintain coverage. However, once a method becomes culturally established, it tends to be favored by both healthcare providers and users, leading to a form of path dependency ( 7 , 8 ). Evidence shows that healthcare providers sometimes use various strategies to promote certain methods, ranging from enthusiasm for a particular method to practices like falsifying information to encourage adoption ( 8 , 9 ). There is substantial evidence showing the positive impact of women’s empowerment on women’s practice of family planning ( 10 – 13 ). More empowered women are more capable of overcoming sociocultural norms to adopt family planning practices and access contraception ( 10 , 13 ). However, the magnitude of this effect varies significantly across sub-Saharan African countries, with countries in West & Central Africa presenting lower levels of women’s empowerment and access to family planning compared to those in Eastern & Southern Africa ( 14 – 17 ). Additionally, the influence of empowerment varies across different life stages, as age affects both reproductive needs and the sociocultural pressures women face. The interaction between age, empowerment, and the type of contraceptive used has not yet been explored in the sub-Saharan African context. Understanding how empowerment shapes contraceptive choices at different life stages can help design age-appropriate interventions that better meet the reproductive needs of women. Using the SWPER Global ( 15 ), a standard measure of women’s empowerment based on ever-married/partnered women, this study aims to address this gap by analyzing how the intersection of women’s empowerment and age shapes the contraceptive method mix in West & Central Africa and Eastern & Southern Africa, providing evidence to guide more targeted family planning strategies in the regions. Methods Data We used publicly available data from the most recent Demographic and Health Surveys (DHS) carried out since 2015 in sub-Saharan Africa countries. These are publicly available, nationally representative cross-sectional surveys with information on women of reproductive age (15-49 years). A total of 28 surveys were included in the analyses, representing countries with data on family planning and women’s empowerment for ever-married women or those in union. Outcomes We first explored demand for family planning satisfied (DFPS), defined as the proportion of women in need of contraception who were using (or whose partner was using) any contraceptive method. A woman was considered in need of contraception if she was fecund and did not want to become pregnant within the next 2 years, or if she was unsure about whether or when she wanted to become pregnant. Pregnant women with a mistimed or unintended pregnancy are also considered in need of contraception ( 18 ). To study the method mix, we calculated the proportion of users of each of the following contraceptive methods. Modern contraceptives, defined as medical procedures or technological products ( 19 ), which include pills, injectables, male condoms, intrauterine devices (IUDs), implants, sterilization (male or female), or other modern. And non-modern methods: lactational amenorrhea (LAM), withdrawal, fertility-awareness based methods (including periodic abstinence, basal body temperature, TwoDay Method, and Standard Days Method), and other non-modern methods. Stratifiers Women’s empowerment was measured using the SWPER Global ( 15 ), an individual-level indicator estimated for married women of reproductive age. The SWPER was derived using principal component analyses based on 14 DHS questions and is comprised of three domains of women’s empowerment: (1) social independence, related to access to information, education and age of marriage and first birth; (2) decision-making, related to making decisions on important household matters and (3) attitude towards violence, related to how much the woman rejects domestic violence against the wife. The resulting scores were standardized so that positive values represent above-average levels of empowerment across LMICs used to derive the indicator, while negative values represent the opposite. The zero value represents average empowerment across the LMICs used to derive the indicator. Based on the continuous SWPER scores and standardized cut-offs, each domain was categorized into low, medium, and high levels of empowerment ( 15 ). Women’s age at the time of the survey was categorized into three groups (15-19, 20-34, and 35-49 years). All results were stratified and presented according to the UNICEF classification: West & Central Africa and Eastern & Southern Africa. Exploratory analyses were conducted to ensure comparability in the empowerment levels across the three empowerment categories, age groups, and regions. Additionally, to ensure that women classified into low, medium, or high empowerment levels had comparable levels of empowerment across key contextual factors, a sensitivity analysis was conducted comparing the mean empowerment scores of the SWPER Global across wealth quintiles and urban-rural residence within each category of empowerment level and age group, stratified by region. Statistical analyses Descriptive analyses were conducted with the countries pooled together. Data from the 28 countries were aggregated with weighting for population size in the median year (2019). All analyses were performed using Stata software version 18.0 (StataCorp LLC, College Station, TX) and adjusted for the sample design, including sample weights, clusters, and strata. All analyses relied on publicly available anonymized databases. Institutions and national agencies in each country obtained ethics approval for the surveys. Results We analyzed a sample of 138,374 women from 28 countries, 13 from Eastern and Southern Africa and 15 from West and Central Africa. DFPS ranged between 26.4% in Angola and 86.5% in Zimbabwe ( Table 1 ). View this table: View inline View popup Download powerpoint Table 1. Demand for family planning satisfied by any contraceptive method (DFPS) in the 28 countries. The two regions presented similar levels of empowerment within each age group and empowerment category. Additionally, within each empowerment and age subgroup, the mean SWPER scores were consistent across wealth quintiles and area of residence, with minimal variation observed. Demand for family planning satisfied according to women’s empowerment and age Figure 1 shows the overall levels of DFPS according to women’s age and empowerment across the three SWPER domains. DFPS was higher in Eastern & Southern Africa than in West & Central Africa and clear empowerment-related trends were identified in both regions. Among women 20 years or older, DFPS increased with the level of empowerment in the three SWPER domains. For women aged 15 to 19, a consistent positive trend was identified only in the decision-making domain. Although DFPS was lower among adolescents with low empowerment in the domains of attitude to violence and social independence, a linear increase in coverage with the increase in the level of empowerment was not observed. Download figure Open in new tab Figure 1. Pooled coverage of demand for family planning satisfied by any method according to region and women’s empowerment level. In West & Central Africa, the most significant differences were identified in terms of social independence, where the DFPS among high-empowered women aged 15-19, 20-34, and 35-49 was 1.7, 1.4, and 1.5 times higher, respectively, than among the low-empowered. In the decision-making domain, adolescents with low and medium empowerment levels showed similar DFPS, but coverage was 50% higher among the high-empowered. For adult women, DFPS was 1.3 and 1.5 times higher among high-empowered women aged 20-34 and 35-49, respectively, than among low-empowered women. In the attitude to violence domain, DFPS among high-empowered women aged 15-19, 20-34, and 35-49 was 1.2, 1.3, and 1.4 times higher than among the low-empowered ( Figure 1 ). In Eastern & Southern Africa, the level of coverage was generally higher for all women, with slightly smaller differences across empowerment levels. However, important differences were identified in terms of decision-making, where the DFPS among high-empowered women aged 15-19 and 20-34 was 40% higher than among the low-empowered, and among women aged 35-49, it was 30% higher among the high-empowered ( Figure 1 ). Method mix The contraceptive method mix across the three domains of women’s empowerment and by region is presented in Figure 2 . Regardless of empowerment level, the method mix in Eastern & Southern Africa was notably more skewed towards injectables compared to West & Central Africa. Implants accounted for 41.5% of contraceptive use in Eastern & Southern Africa and 23.3% in West & Central Africa. The most significant changes according to women’s empowerment were observed within the social independence domain. In Eastern & Southern Africa, the share of injectables was 33.7% lower among high-empowered women compared to the low-empowered (33.8% vs. 51.0%, respectively). This decrease was parallel with increases in the shares of condoms, fertility-awareness based methods, and pills, which were 3.1, 2.8, and 1.9 times higher among high-empowered women, respectively. In West & Central Africa, the largest variations were identified in the share of implants, which decreased from 30.5% among the low-empowered women to 21.0% among the high-empowered. The shares of condom and withdrawal increased significantly, from 3.7% to 10.9% and from 5.5% to 12.1%, respectively, between low- and high-empowered women. Similar trends were observed across the domains of attitude to violence and decision-making. Download figure Open in new tab Figure 2. Pooled contraceptive method mix according to region and empowerment. In terms of the intersectional differences in contraceptive method mix according to women’s empowerment and age, similar trends were also identified in the three SWPER domains, with more significant results according to women’s social independence than in decision-making and attitude to violence. Therefore, the results of these two domains are presented in the supplementary material, along with 95% confidence intervals for the three domains. The shares of each method by women’s age and empowerment within the social independence domain are presented in Figures 3 and 4 . Download figure Open in new tab Figure 3. Pooled contraceptive method mix according to women’s age and empowerment level in the social independence domain (West & Central Africa). Download figure Open in new tab Figure 4. Pooled contraceptive method mix according to women’s age and empowerment level in the social independence domain (Eastern & Southern Africa). The share of implants showed stronger reductions among women from West & Central Africa. Among those with high social independence, the share of implants dropped by 90%, 30%, and 40% for those aged 15-19, 20-34, and 35-49, respectively, compared to low-empowered women. In parallel, two methods—male condoms and fertility-awareness based methods—showed substantial increases with the increase in the level of empowerment. Among high-empowered adolescents, condom use increased by 50%, while among high-empowered adult women, it was over four times higher than among low-empowered women. Regarding the fertility-awareness based methods, its share was 2.3 and 2.4 times higher among high-empowered women aged 20-34 and 35-49, respectively. Among adolescents, no significant change was observed. Other contraceptive methods showed smaller and more variable changes ( Figure 3 ). In Eastern & Southern Africa, the largest reduction was identified in the share of injectables, which was reduced by 70%, 30%, and 40% among high-empowered women aged 15-19, 20-34, and 35-49, respectively. Decreases in the share of implants were also identified, especially among older women. Among the high-empowered women aged 35-49, the share of implants dropped by 40%. Conversely, there were consistent increases in the share of male condoms, pills, and fertility-awareness based methods across age groups. Among adolescents, the shares of condoms, pills, and fertility-awareness based methods were 3.4, 5.9, and 5.1 times higher, respectively, among high-empowered adolescents. In the 20-24 age group, these shares were 3.9, 2.5, and 3.2 times higher, while among women aged 35-49, they were 4.3, 2.6, and 2.5 times higher among high-empowered women compared to the low-empowered. Consistent increases were also identified in the share of IUDs among older women. It was 1.6 times higher among high-empowered women aged 35-49 in comparison to those who were low-empowered. No significant changes were observed in the share of other methods ( Figure 4 ). Discussion Our findings reveal increases in DFPS and a clear pattern of change in the contraceptive method mix according to women’s age and level of empowerment. In the three SWPER domains, we identified higher levels of DFPS and a more balanced method mix among high-empowered women, regardless of age. DFPS was higher in Eastern & Southern Africa than in West & Central Africa, with more consistent trends identified in terms of women’s decision-making in both regions. Regarding the contraceptive method mix, more significant changes were identified in the social independence domain. While the method mix was slightly different across regions, similar trends in terms of women’s age and empowerment were identified in both regions. Lower levels of family planning coverage have been persistently identified in West & Central Africa ( 16 , 17 ). Although this low coverage has been historically linked to low use of modern contraceptives ( 20 ), our findings indicate that the method mix in West & Central Africa was predominantly represented by implants and injectables. The shares of condoms, LAM, and withdrawal were somewhat higher than in Eastern & Southern Africa, where the method mix was highly skewed towards injectables. Regardless of region, the shares of injectables and implants were significantly reduced with the increase in the level of empowerment. Reductions that happened in parallel with increases in the proportion of male condoms, pills, and fertility-awareness based methods. Concentrating on a few methods has been used as a strategy to increase overall contraceptive use ( 2 , 4 , 7 , 8 , 21 – 23 ). This approach is simpler administratively and provides women with access to some form of contraception. However, there has been debate about whether family planning programs should prioritize expanding the acceptability and accessibility of less popular or newer methods or focus on increasing the availability of already widely accepted methods ( 23 ). The pathways for achieving broader contraceptive coverage and a method mix that aligns with women’s preferences, however, vary across different contexts. A sharp concentration of policies on only a few specific methods restricts choice and, therefore, is not aligned with the human rights-based approach to family planning and may not accommodate all women’s needs who may experience considerable side effects with available options. In sub-Saharan Africa, implants and injectables have been massively promoted as they can be easily provided through facility and community-based modalities, are less sensible to resupply issues as they last for more than only one reproductive cycle, and their efficacy is guaranteed as they are not dependent on users’ routine habits ( 22 , 23 ). Consequently, the introduction of injectables and implants in sub-Saharan Africa has been associated with significant increases in contraceptive use ( 20 , 24 ). The emphasis on specific contraceptive methods within family planning programs has been influenced by various factors, including the cost and complexity of providing a diverse range of contraceptives, as well as the idea that certain methods are more effective in preventing unintended pregnancies ( 2 ). However, the effectiveness of each contraceptive method strongly depends on women’s ability to use them properly ( 25 – 27 ). Rather than unchangeable, this ability can be improved through family planning counseling, education, and women’s empowerment. When used correctly, most of the contraceptive methods have similar levels of efficacy ( 28 ). The availability of a wide range of contraceptive options is a central characteristic of high-quality family planning services and any condition that constrains a woman’s ability to make a full, free, and informed choice, such as coercion by programs or providers and inadequate contraceptive supplies, violates her rights and must be addressed ( 29 ). Therefore, all methods must be acknowledged as legitimate options, and healthcare providers must be adequately trained to offer them. Among the three SWPER domains, the most strongly associated with DFPS was the decision-making, which considers the woman’s freedom to decide on visiting friends or relatives, on significant household purchases and on her own healthcare, while changes in the method mix were more significant in terms of women’s social independence. The social independence domain comprises aspects of women’s educational attainment, age at marriage and first child, access to mass media, and differences in age and education to the husband or cohabiting partner. The impact of women’s education on women’s sexual and reproductive health is among the most studied associations ( 16 , 30 – 33 ). More educated women tend to have more positive health-seeking attitudes and are better able to obtain, retain, and follow family planning counseling ( 32 , 33 ). Women’s age at marriage and age at first child, as well as age and educational differences to the husband, are important markers of family structure that have also been associated with family planning coverage ( 30 ). Earlier ages in these events and larger age differences between partners have been associated with more rigid social norms and lower levels of women’s agency ( 34 ). Other studies have also shown the effectiveness of access to mass media in increasing contraceptive use ( 30 , 32 , 33 , 35 ). More than just providing information, mass media channels, such as newspapers, magazines, and digital technologies, can increase the knowledge of women’s health and family planning options and combat myths about some family planning methods. As a result, it can build women’s self-efficacy and promote attitudes and behavioral changes ( 33 , 35 ). Our findings align with these associations, highlighting the stronger capability of more empowered women to navigate within the health system to choose the method that is best suited for them. With age, women’s empowerment interacts in various ways. While empowerment often increases with age, influenced by factors such as labor-force participation and shifting roles within families and households, younger cohorts tend to be more empowered than older cohorts due to changing societal norms and structures ( 36 ). This intersection of age and empowerment affects contraceptive needs and preferences. By analyzing contraceptive method mix within each age group, we identified how empowerment at different life stages shapes the contraceptive method mix. Our findings indicate that high empowerment correlates with reduced reliance on implants and injectables across all ages, though specific shifts in method preference vary. Among adolescents and young adults, increased empowerment was associated with substantial rises in the shares of condom and fertility-awareness based methods. For older women, high empowerment was also linked to higher use of IUDs and sterilization. Condoms and fertility-awareness based methods have important roles in such cases. Although our findings reveal a low share of condoms in the contraceptive method mix, substantial increases were identified with the increase in the level of women’s empowerment. This trend is consistent with the literature on gender norms surrounding condom use. A common barrier to condom use is the perception that it reduces men’s sexual pleasure ( 37 ). While all the hormonal contraceptives can also affect women’s sexual desire and pleasure ( 38 , 39 ), this side effect receives less attention, as gender norms implicitly or explicitly position sexual pleasure as a male privilege ( 37 ). Another common barrier to condom use among married couples is the women’s stigma of infidelity ( 40 , 41 ). Additionally, condoms are among the few contraceptive methods involving both partners, making partner cooperation essential. In consequence, low condom use has been partly attributed to women’s inability to negotiate its use with their partners ( 40 ). Side effects and health concerns are the most common reasons for nonuse or discontinuation of hormonal contraceptives among women who need family planning services ( 42 – 46 ). While it is commonly assumed that women use non-modern contraceptives due to a lack of access or misconceptions regarding modern methods, these choices often reflect their genuine preferences, especially for those seeking more natural options ( 47 ). Fertility-awareness based methods have been used for centuries. However, they have significantly evolved over time. Whereas past techniques relied on the basic knowledge that conception is possible only on certain days following menstruation, modern approaches involve tracking multiple fertility biomarkers that reflect personal hormonal changes throughout a woman’s ovulation cycle—such as menstrual start dates, basal body temperature, cervical mucus, and sensations at the vulva ( 47 , 48 ). Unfortunately, national health surveys do not collect information on how effectively women are using these methods. Although incorrect knowledge of ovulation timing remains common in many African countries, younger, more educated, and women with internet access tend to have higher awareness ( 49 – 51 ). Additionally, the effectiveness of fertility-awareness methods also depends on couples’ sexual behavior during the fertile period – an aspect that is strongly related to women’s ability to negotiate sexual activity. Aspects that improve with women’s empowerment and align with our finding of higher use among highly empowered young women. Women’s empowerment is a complex multidimensional construct ( 52 – 54 ). Beyond gender dynamics, it is linked to key contextual factors such as wealth and area of residence, both influencing and being influenced by them. While these interactions may partly shape the observed patterns, the standardized cut-offs of the SWPER Global help mitigate confounding by ensuring that women within each empowerment level have comparable levels of empowerment. Our findings from the sensitivity analysis further support this, showing that within each empowerment and age subgroup, the mean empowerment scores are consistent across urban and rural settings as well as wealth quintiles. On the other hand, the approach taken to generate the SWPER categories can result in small sample sizes for certain groups, which in this study was particularly evident among high-empowered adolescents. Although this is a considerable limitation, the stratification by women’s age remains valuable as it allows for the exploration of differences in contraceptive method mix by women’s empowerment across different life stages. Furthermore, the SWPER Global is limited to women who are married or in a union, excluding never-married women who may also have a demand for family planning services. Unfortunately, surveys do not measure the method preferred by women, but rather the methods used. The lack of this information limits the interpretation of our findings. While there is evidence that availability and choice are closely related, with method preference following method availability ( 3 ), the method used is certainly influenced by other barriers such as proper knowledge of all contraceptives, costs associated with each method and opposition by others. No ideal target level of use can be set for a specific method. However, considering the multiple circumstances women may be exposed to, their different desires, and the different side effects of each method, it is natural to ideally expect a more balanced method mix. Therefore, policymakers should consider the patterns of change in the method mix among high-empowered women in the development of their initiatives. Conclusion Our findings contribute to a nuanced understanding of how empowerment, age, and the type of contraceptive method used intersect in ways that should be respected and supported within family planning policies. They highlight that women’s empowerment translates into diverse contraceptive preferences, sometimes counter to conventional family planning expectations and priorities regarding contraceptive choices. While national policies often emphasize certain methods based on financial, logistical, and effectiveness considerations, women may prioritize methods that offer greater personal control and fewer side effects. Given that the effectiveness of most contraceptive methods is closely linked to a woman’s ability to use them confidently and correctly, our findings underscore the importance of family planning counseling, comprehensive education, and targeted empowerment efforts. Such initiatives can enable women to make informed choices that align with their preferences and circumstances while ensuring that policies strike a balance between national priorities and the need to offer methods that address the diverse preferences of all women. Recognizing that contraceptive preferences are shaped by an interplay of factors including relationship dynamics, personal autonomy, and exposure to family planning policies and programs, further research is needed to explore how these dimensions influence method choices and shifts in contraceptive use. Such research can guide the development of more inclusive and responsive family planning policies that respect and support women’s agency and reproductive health rights. Contributors FH: conceptualization, formal analysis, interpretation of results, writing original draft; AB: conceptualization, supervision, and validation; YDW, CMF, JR, LA, RMK, TB, and AJDB critically revised the manuscript; All authors approved the final version of the manuscript. AB accessed and verified the data underlying this study. Data sharing statement All data relevant to the study are included in the article or available as supplementary information. The data used in the analyses is publicly available, anonymized and geographically scrambled to ensure confidentiality. More information on DHS can be found at https://dhsprogram.com/ , where survey datasets can be obtained. Declaration of interests No conflicts of interest were declared by the other authors. Data Availability All data produced in the present work are contained in the manuscript. Funding Bill and Melinda Gates Foundation (Grant INV-007594/OPP1148933, through the Countdown to 2030 initiative). Acknowledgements We thank Cintia Borges for her assistance in the graphs production and Kristin Bietsch for reviewing the article. References 1. ↵ Haakenstad A , Angelino O , Irvine CMS , Bhutta ZA , Bienhoff K , Bintz C , et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970-2019: a systematic analysis for the Global Burden of Disease Study 2019 . Lancet [Internet] . 2022 Jul 23 ; 400 ( 10348 ): 295 – 327 . Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00936-9/fulltext OpenUrl 2. ↵ Boglaeva LV . Contraceptive method mix in the context of family planning programmes in developing countries . Population and Economics [Internet] . 2021 Sep 30 ; 5 ( 3 ): 56 – 75 . Available from: https://populationandeconomics.pensoft.net/article/70669/ OpenUrl 3. ↵ Ross J , Hardee K , Mumford E , Eid S . Contraceptive method choice in developing countries . Int Fam Plan Perspect [Internet] . 2002 Mar ; 28 ( 1 ): 32 . Available from: https://www.jstor.org/stable/3088273 OpenUrl 4. ↵ Hellwig F , Moreira LR , Silveira MF , Vieira CS , Rios-Quituizaca PB , Masabanda M , et al. Policies for expanding family planning coverage: lessons from five successful countries . Front Public Health [Internet] . 2024 May 14 ; 12 : 1339725 . Available from: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1339725/full OpenUrl 5. ↵ Bawah AA , Kyei PS , Agyei-Asabere C . Contraceptive use and method mix dynamics in Sub-saharan Africa: time trends and the influence of the HIV pandemic . Contracept Reprod Med [Internet] . 2024 Apr 9 ; 9 ( 1 ): 14 . Available from : doi: 10.1186/s40834-024-00273-z OpenUrl CrossRef 6. ↵ Sharan M , Ahmed S , May J , Soucat A . Family Planning Trends in Sub-Saharan Africa: Progress, Prospects, and Lessons Learned [Internet]. Available from: https://documents1.worldbank.org/curated/ru/304221468001788072/930107812_201408251045224/additional/634310PUB0Yes0061512B09780821387450.pdf 7. ↵ Cleland J , Ali M , Benova L , Daniele M . The promotion of intrauterine contraception in low- and middle-income countries: a narrative review . Contraception [Internet] . 2017 Jun [cited 2024 Jul 26]; 95 ( 6 ): 519 – 28 . Available from: https://pubmed.ncbi.nlm.nih.gov/28365165/ OpenUrl 8. ↵ Bertrand JT , Ross J , Sullivan TM , Hardee K , Shelton JD . Contraceptive method mix: Updates and implications . Glob Health Sci Pract [Internet] . 2020 Dec 23 ; 8 ( 4 ): 666 – 79 . Available from: https://pubmed.ncbi.nlm.nih.gov/33361234/ OpenUrl 9. ↵ Hodes R . “Foreign body”: a social history of Implanon in South Africa’s Eastern Cape . Cult Health Sex [Internet] . 2023 Aug [cited 2024 Jul 26]; 25 ( 8 ): 1039 – 54 . Available from: https://pubmed.ncbi.nlm.nih.gov/36149788/ OpenUrl 10. ↵ Hellwig F , Wado Y , Barros AJD . Association between women’s empowerment and demand for family planning satisfied among Christians and Muslims in multireligious African countries . BMJ Glob Health [Internet] . 2024 May 9 ; 9 ( 5 ): e013651 . Available from: https://gh.bmj.com/content/9/5/e013651 OpenUrl 11. Habte A , Tamene A , Bogale B . Women empowerment domains and unmet need for contraception among married and cohabiting fecund women in Sub-Saharan Africa: A multilevel analysis based on gender role framework . PLoS One [Internet] . 2023 Sep 8 [cited 2024 Jul 29]; 18 ( 9 ): e0291110 . Available from: https://pubmed.ncbi.nlm.nih.gov/37683011/ OpenUrl 12. Hameed W , Azmat SK , Ali M , Sheikh MI , Abbas G , Temmerman M , et al. Women’s empowerment and contraceptive use: the role of independent versus couples’ decision-making, from a lower middle income country perspective . PLoS One [Internet] . 2014 Aug 13 [cited 2024 Jul 29]; 9 ( 8 ): e104633 . Available from: https://pubmed.ncbi.nlm.nih.gov/25119727/ OpenUrl 13. ↵ Yaya S , Uthman OA , Ekholuenetale M , Bishwajit G . Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries . Reprod Health [Internet] . 2018 Dec 20 ; 15 ( 1 ): 214 . Available from: https://link.springer.com/article/10.1186/s12978-018-0658-5 OpenUrl 14. ↵ Rettig EM , Hijmans RJ . Increased women’s empowerment and regional inequality in Sub-Saharan Africa between 1995 and 2015 . PLoS One [Internet] . 2022 Sep 14 [cited 2024 Nov 23]; 17 ( 9 ): e0272909 . Available from: https://pubmed.ncbi.nlm.nih.gov/36103466/ OpenUrl 15. ↵ Ewerling F , Raj A , Victora CG , Hellwig F , Coll CV , Barros AJ . SWPER Global: A survey-based women’s empowerment index expanded from Africa to all low- and middle-income countries . J Glob Health [Internet] . 2020 Dec ; 10 ( 2 ): 020343 . Available from: https://pubmed.ncbi.nlm.nih.gov/33274055/ OpenUrl 16. ↵ Ewerling F , Victora CG , Raj A , Coll CVN , Hellwig F , Barros AJD . Demand for family planning satisfied with modern methods among sexually active women in low- and middle-income countries: who is lagging behind? Reprod Health [Internet] . 2018 Mar 6 ; 15 ( 1 ): 42 . Available from: https://pubmed.ncbi.nlm.nih.gov/29510682/ OpenUrl 17. ↵ Hellwig F , Coll CV , Ewerling F , Barros AJ . Time trends in demand for family planning satisfied: analysis of 73 countries using national health surveys over a 24-year period . J Glob Health [Internet] . 2019 Dec ; 9 ( 2 ): 020423 . Available from: https://pubmed.ncbi.nlm.nih.gov/31673339/ OpenUrl 18. ↵ Victora CG , Christian P , Vidaletti LP , Gatica-Domínguez G , Menon P , Black RE . Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda . Lancet [Internet] . 2021 Apr 10 ; 397 ( 10282 ): 1388 – 99 . Available from : doi: 10.1016/S0140-6736(21)00394-9 OpenUrl CrossRef PubMed 19. ↵ Hubacher D , Trussell J . A definition of modern contraceptive methods . Contraception [Internet] . 2015 Nov ; 92 ( 5 ): 420 – 1 . Available from: https://pubmed.ncbi.nlm.nih.gov/26276245/ OpenUrl 20. ↵ Ross JA , Agwanda AT . Increased use of injectable contraception in sub-Saharan Africa . Afr J Reprod Health [Internet] . 2012 Dec ; 16 ( 4 ): 68 – 80 . Available from: https://pubmed.ncbi.nlm.nih.gov/23444545/ OpenUrl 21. ↵ Sullivan TM , Bertrand JT , Rice J , Shelton JD . Skewed contraceptive method mix: why it happens, why it matters . J Biosoc Sci [Internet] . 2006 Jul ; 38 ( 4 ): 501 – 21 . Available from: https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/skewed-contraceptive-method-mix-why-it-happens-why-it-matters/2A050DF45A4D927D98EF00D26B25850D OpenUrl 22. ↵ United Nations: Department of Economic and Social Affairs . World family planning 2022: meeting the changing needs for family planning: Contraceptive Use by Age and Method, contraceptive use by age and method [Internet]. United Nations, editor. New York, NY: United Nations; 2023 . 30 p. Available from: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2023/Feb/undesa_pd_2022_world-family-planning.pdf 23. ↵ Ross J , Keesbury J , Hardee K . Trends in the contraceptive method mix in low- and middle-income countries: analysis using a new “average deviation” measure . Glob Health Sci Pract [Internet] . 2015 Feb 25 ; 3 ( 1 ): 34 – 55 . Available from : doi: 10.9745/GHSP-D-14-00199 OpenUrl Abstract / FREE Full Text 24. ↵ Jacobstein R . Liftoff: The blossoming of contraceptive implant use in Africa . Glob Health Sci Pract [Internet] . 2018 Mar 21 ; 6 ( 1 ): 17 – 39 . Available from : doi: 10.9745/ghsp-d-17-00396 OpenUrl CrossRef 25. ↵ Polis CB , Bradley SEK , Bankole A , Onda T , Croft T , Singh S . Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report . Contraception [Internet] . 2016 Jul ; 94 ( 1 ): 11 – 7 . Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970461/ OpenUrl 26. Polis C , Bradley S , Bankole A , Onda T , Croft T , Singh S . Contraceptive failure rates in the developing world: an analysis of Demographic and Health Survey data in 43 countries. 2016 ; Available from: https://www.guttmacher.org/sites/default/files/report_pdf/contraceptive-failure-rates-in-developing-world_1.pdf 27. ↵ Jain R , Muralidhar S . Contraceptive methods: needs, options and utilization . J Obstet Gynaecol India [Internet] . 2011 Dec ; 61 ( 6 ): 626 – 34 . Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307935/ OpenUrl 28. ↵ Trussell J . Contraceptive failure in the United States . Contraception [Internet] . 2011 May ; 83 ( 5 ): 397 – 404 . Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/ OpenUrl 29. ↵ Hardee K , Kumar J , Newman K , Bakamjian L , Harris S , Rodríguez M , et al. Voluntary, human rights-based family planning: a conceptual framework . Stud Fam Plann [Internet] . 2014 Mar ; 45 ( 1 ): 1 – 18 . Available from: https://pubmed.ncbi.nlm.nih.gov/24615572/ OpenUrl 30. ↵ Assefa AA , Selassie SG , Mesele A , Kebede HB , Fikrie A , Abera G . Unmet need for family planning and associated factors among currently married women in Hawella Tulla subcity, Hawassa, southern Ethiopia: community-based study . Contracept Reprod Med [Internet] . 2023 Feb 10 [cited 2024 Jul 30]; 8 ( 1 ): 14 . Available from: https://pubmed.ncbi.nlm.nih.gov/36759856/ OpenUrl 31. Blumenberg C , Hellwig F , Ewerling F , Barros AJD . Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys . Reprod Health [Internet] . 2020 Jun 1 ; 17 ( 1 ): 82 . Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-020-00931-w OpenUrl 32. ↵ Demeke H , Legese N , Nigussie S . Modern contraceptive utilization and its associated factors in East Africa: Findings from multi-country demographic and health surveys . PLoS One [Internet] . 2024 Jan 19 ; 19 ( 1 ): e0297018 . Available from: https://pubmed.ncbi.nlm.nih.gov/38241359/ OpenUrl 33. ↵ Tsega NT , Haile TT , Asratie MH , Belay DG , Endalew M , Aragaw FM , et al. Pooled prevalence and determinants of informed choice of contraceptive methods among reproductive age women in Sub-Saharan Africa: A multilevel analysis . Front Public Health [Internet] . 2022 Sep 14 ; 10 : 962675 . Available from: https://pubmed.ncbi.nlm.nih.gov/36187687/ OpenUrl 34. ↵ Crandall A , VanderEnde K , Cheong YF , Dodell S , Yount KM . Women’s age at first marriage and postmarital agency in Egypt . Soc Sci Res [Internet] . 2016 May [cited 2024 Jul 30]; 57 : 148 – 60 . Available from: https://pubmed.ncbi.nlm.nih.gov/26973037/ OpenUrl 35. ↵ Sserwanja Q , Turimumahoro P , Nuwabaine L , Kamara K , Musaba MW . Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey . BMC Womens Health [Internet] . 2022 Sep 16 [cited 2024 Jul 30]; 22 ( 1 ): 376 . Available from: https://pubmed.ncbi.nlm.nih.gov/36114503/ OpenUrl 36. ↵ Arestoff F , Djemai E . Women’s empowerment across the life cycle and generations: Evidence from sub-Saharan Africa . World Dev [Internet] . 2016 Nov ; 87 : 70 – 87 . Available from: https://dial.ird.fr/wp-content/uploads/2021/10/2013-16-Womens-empowerment-across-the-life-cycle-and-generations-Evidence-from-Sub-Saharan-Africa.pdf OpenUrl 37. ↵ Aventin Á , Gordon S , Laurenzi C , Rabie S , Tomlinson M , Lohan M , et al. Adolescent condom use in Southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators . BMC Public Health [Internet] . 2021 Jun 26 ; 21 ( 1 ): 1228 . Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11306-6 OpenUrl 38. ↵ Mark KP , Leistner CE , Garcia JR . Impact of contraceptive type on sexual desire of women and of men partnered to contraceptive users . J Sex Med [Internet] . 2016 Sep ; 13 ( 9 ): 1359 – 68 . Available from: https://www.sciencedirect.com/science/article/abs/pii/S1743609516303022 OpenUrl 39. ↵ Smith NK , Jozkowski KN , Sanders SA . Hormonal contraception and female pain, orgasm and sexual pleasure . J Sex Med [Internet] . 2014 Feb ; 11 ( 2 ): 462 – 70 . Available from: https://pubmed.ncbi.nlm.nih.gov/24286545/ OpenUrl 40. ↵ Broderick K , Aristide C , Bullington BW , Mwanga-Amumpaire J , Downs JA , Sundararajan R . Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania . Reprod Health [Internet] . 2023 Jan 11 ; 20 ( 1 ): 12 . Available from: https://pubmed.ncbi.nlm.nih.gov/36631809/ OpenUrl 41. ↵ Madiba S , Ngwenya N . Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa . Glob Health Action [Internet] . 2017 Jan ; 10 ( sup2 ): 1341597 . Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5645648/ OpenUrl 42. ↵ Mulugeta SS , Muluneh MW , Belay AT , Yalew MM , Agegn SB . Reason and associated factors for nonuse of contraceptives among Ethiopian rural married women: A multilevel mixed effect analysis . SAGE Open Nurs [Internet] . 2023 Jan ; 9 : 23779608221150600 . Available from : doi: 10.1177/23779608221150599 OpenUrl CrossRef 43. Moreira LR , Ewerling F , Barros AJD , Silveira MF . Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys . Reprod Health [Internet] . 2019 Oct 11 ; 16 ( 1 ): 148 . Available from : doi: 10.1186/s12978-019-0805-7 OpenUrl CrossRef PubMed 44. Kawuma R , Lunkuse JF , Ssembajjwe W , Kayesu I , Price MA , Brickley DB , et al. “I fear those things”: non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala , Uganda. Front Reprod Health [Internet] . 2023 Aug 15 ; 5 : 1198672 . Available from : doi: 10.3389/frph.2023.1198672 OpenUrl CrossRef 45. Demographic EF 60. Causes and consequences of contraceptive discontinuation: [Internet]. Available from: https://apps.who.int/iris/bitstream/handle/10665/75429/9789241504058_eng.p df 46. ↵ Keogh SC , Otupiri E , Castillo PW , Chiu DW , Polis CB , Nakua EK , et al. Hormonal contraceptive use in Ghana: The role of method attributes and side effects in method choice and continuation . Contraception [Internet] . 2021 Sep ; 104 ( 3 ): 235 – 45 . Available from : doi: 10.1016/j.contraception.2021.05.004 OpenUrl CrossRef 47. ↵ Polis CB , Otupiri E , Bell SO , Larsen-Reindorf R . Use of fertility awareness-based methods for pregnancy prevention among Ghanaian women: A nationally representative cross-sectional survey . Glob Health Sci Pract [Internet] . 2021 Jun 30 ; 9 ( 2 ): 318 – 31 . Available from: https://pubmed.ncbi.nlm.nih.gov/34234024/ OpenUrl 48. ↵ Duane M , Stanford JB , Porucznik CA , Vigil P . Fertility awareness-based methods for women’s health and family planning . Front Med (Lausanne) [Internet] . 2022 May 24 ; 9 : 858977 . Available from: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.8589 77/full OpenUrl 49. ↵ Ren Y , Xie Y , Xu Q , Long M , Zheng Y , Li L , et al. University students’ fertility awareness and its influencing factors: a systematic review . Reprod Health [Internet] . 2023 Jun 6 ; 20 ( 1 ): 85 . Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-023-01628-6 OpenUrl 50. Iyanda AE , Dinkins BJ , Osayomi T , Adeusi TJ , Lu Y , Oppong JR . Fertility knowledge, contraceptive use and unintentional pregnancy in 29 African countries: a cross-sectional study . Int J Public Health [Internet] . 2020 May ; 65 ( 4 ): 445 – 55 . Available from: https://pubmed.ncbi.nlm.nih.gov/32270234/ OpenUrl 51. ↵ Mosanya AU , Aluh DO , Anosike C , Akunne MO , Anene-Okeke CG , Isah A . Predictors of fertility awareness among selected married women of childbearing age in Nigeria: a cross-sectional survey . Afr Health Sci [Internet] . 2023 Sep ; 23 ( 3 ): 79 – 89 . Available from: https://www.ajol.info/index.php/ahs/article/view/256828 OpenUrl 52. ↵ Costa JC , Saad GE , Hellwig F , Maia MFS , Barros AJD . Measures of women’s empowerment based on individual-level data: a literature review with a focus on the methodological approaches . Front Sociol [Internet] . 2023 Sep 14 ; 8 : 1231790 . Available from : doi: 10.3389/fsoc.2023.1231790 OpenUrl CrossRef 53. Kabeer N . Resources, agency, achievements: Reflections on the measurement of women’s empowerment . Dev Change [Internet] . 1999 Jul ; 30 ( 3 ): 435 – 64 . Available from : doi: 10.1111/1467-7660.00125 OpenUrl CrossRef Web of Science 54. ↵ Kabeer N . Gender equality and women’s empowerment: A critical analysis of the third millennium development goal 1 . Gend Dev [Internet] . 2005 Mar ; 13 ( 1 ): 13 – 24 . Available from : doi: 10.1080/13552070512331332273 OpenUrl CrossRef View the discussion thread. Back to top Previous Next Posted February 20, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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