Is women’s social independence a strong determinant for the reproductive health-related outcomes of the Turkish population?

Introduction: There is growing recognition of the importance of women's empowerment in achieving reproductive health goals. Many studies have shown that different aspects of empowerment are associated with fertility-related outcomes and family planning practices. There is a need to measure women's empowerment at the national level with a standard tool and to evaluate its relationship with reproductive health outcomes to contribute to social policy and health services in Türkiye. The present study aimed to provide a comprehensive assessment of the relationship between women’s empowerment in terms of social independence measured by a tool validated for low- and middle-income countries and various reproductive health-related outcomes in Türkiye. Methods: This study was based on a secondary analysis of the 2018 Türkiye Demographic and Health Survey data. A total of 5,156 married women aged 15–49 was analysed. The study included eight reproductive health-related outcomes: 1) Total number of births, 2) ideal number of children, 3) having more children than desired number, 4) unplanned births, 5) demand for family planning satisfied with modern methods: 6) contraceptive use by female-only or couple methods, 7) pregnancies terminated by induced abortion, and 8) pregnancies terminated by miscarriages. The main independent variable was women’s social independence, measured by a modified form of the Social Independence domain of the Survey-based Women's Empowerment Global Index. Social independence scores were classified into quintiles lowest, lower, middle, higher, and highest. The relationship between the dependent and independent variables was explored by calculating prevalence ratios using a robust Poisson regression analysis. Prevalence ratios were adjusted by the woman’s age, place of residence, region, and household wealth categories. Results: Women in the higher social independence quintiles had consistently more favourable reproductive health outcomes for almost all variables. Compared with the highest social independence quintile, the prevalence in the lowest quintile increased 16-fold for four or more births, 1.9-fold for the desire to have four or more children, 5.7-fold for having more children than desired, 2.3-fold for unplanned births, 1.9-fold for induced abortions, and 1.7-fold for miscarriages. The study also showed that women with lower social independence were more likely to use female-only contraceptive methods rather than couple methods. Conclusion: Our findings indicate that higher social independence quintiles are strongly associated with better reproductive health outcomes. The study highlights the impact of inequalities in terms of social independence on reproductive health and the critical importance of incorporating initiatives that support women's empowerment into reproductive health policies.