Elsevier

Social Science & Medicine

Volume 115, August 2014, Pages 111-120
Social Science & Medicine

Review
Women's empowerment and fertility: A review of the literature

https://doi.org/10.1016/j.socscimed.2014.06.014Get rights and content

Highlights

  • 60 English-language articles examined women's empowerment and fertility.

  • The majority used household decision-making as a measure of women's empowerment.

  • The majority were conducted in South Asia.

  • Most found some positive associations between empowerment and fertility.

  • Further work is needed to address the many theoretical questions that remain.

Abstract

Women's empowerment has become a focal point for development efforts worldwide and there is a need for an updated, critical assessment of the existing evidence on women's empowerment and fertility. We conducted a literature review on studies examining the relationships between women's empowerment and several fertility-related topics. Among the 60 studies identified for this review, the majority were conducted in South Asia (n = 35) and used household decision-making as a measure of empowerment (n = 37). Overall, the vast majority of studies found some positive associations between women's empowerment and lower fertility, longer birth intervals, and lower rates of unintended pregnancy, but there was some variation in results. In many studies, results differed based on the measure of empowerment used, sociopolitical or gender environment, or sub-population studied. This article is one of the first evaluations of the literature assessing the relationships between women's empowerment and fertility. We identify several key issues that merit further investigation.

Introduction

Over the last two decades, women's empowerment has become a focus for development efforts worldwide. In 2000, 189 countries signed on to the eight Millennium Development Goals, which included a commitment to promoting gender equality and empowering women (MDG3) (United Nations, 2000).

Since then, several scholars have attempted to synthesize existing knowledge on women's empowerment and international development. In the only review that focused on reproductive-related outcomes, published over a decade ago, Blanc (2001) synthesized the research examining the role of gender-based power in sexual relationships and its impact on reproductive health. Malhotra et al. (2002) summarized the most promising methods to measure and analyze women's empowerment and provided a review of empirical studies from the fields of economics, sociology, anthropology, and demography. In 2008, Kishor and Subaiya (2008) provided data on the distribution and correlates of women's empowerment in 23 countries documenting the wide variation in levels of decision-making power and gender-equitable attitudes.

Recently, the World Bank devoted the World Development Report (2012) to the theme of Gender Equality and Development. The report argues that the success of global development efforts hinges on gender equality and recommends public policies that promote gender equity as a means of ensuring economic growth.

At the same time that these efforts aimed to improve the status of women globally, support for family planning—an integral component in transforming women's lives—waned (Cleland et al., 2006, Crossette, 2005). The recent London Summit on Family Planning brought renewed attention to the importance of family planning as a means of reducing fertility and expanding the options available to women beyond reproduction (Carr et al., 2012).

This literature review builds on previous reviews of women's empowerment, by focusing specifically on research that examines its associations with fertility. To guide our work we use a definition and conceptualization of women's empowerment based on Kabeer, 1999, Kabeer, 2001: “the expansion of people's ability to make strategic life choices in a context where this ability was previously denied to them.” Within this definition, two central components of empowerment are the agency and the resources needed to exercise life choices. This definition allows a broader conceptualization than interpersonal sexual relationship power.

Section snippets

Methods

We conducted literature searches using PubMed, POPLINE, and Web of Science search engines in May 2013. Searches were conducted by using the following individual and combined keywords (and MeSH terms in PubMed): fertility, family size, ideal family size, birth intervals, birth/birth spacing, induced abortion, reproductive health, unplanned pregnancy, unintended pregnancy, parturition, birth, pregnancy, pregnancy spacing/intervals, and childbearing, published from January 1990 to December 2012.

Measures of women's empowerment

We identified 19 domains of women's empowerment in the reviewed studies and for each, provided specific examples of how the studies operationalized empowerment (Table 1). While the majority of the 60 studies assessed empowerment across multiple domains, 4 studies examined only one domain. In over two-thirds (n = 47) of the studies, multidimensionality was determined through the use of composite or sum scores, indices, factor analysis and multi-item scales, while the remaining 17 studies used

Summary of findings

Overall, empowerment was inversely associated with number of children in the majority of studies, although many studies also found no association between some indicators of women's empowerment and number of children. Studies that used multiple and multidimensional measures of empowerment were more likely to find consistent associations, highlighting the importance of choosing appropriate measures that better approximate women's empowerment.

Empowerment was also demonstrated to be positively

Conclusion

Improvements in the status and empowerment of women is central to progress in global development efforts and, perhaps more importantly, to the achievement of equitable treatment and representation of the 3.5 billion women in the world. Understanding individual women's experience of empowerment and its effects is a crucial early step in making major advances in gender equity at the society level, and in achieving the Millennium Development Goal of promoting gender equality and empowering women.

Acknowledgments

This research was supported by the University of California Global Health Institute (UCGHI) Women's Health and Empowerment Center of Expertise. U. Upadhyay's participation was supported by the Advancing New Standards in Reproductive Health (ANSIRH) program at University of California, San Francisco (UCSF). J. Gipson's participation was supported by NIH Grant #1K01HD067677. A. Fraser and N. Prata's participation was supported by the Bixby Center for Population, Health and Sustainability,

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