Women's empowerment, locus of contraceptive decision-making, and modern contraceptive use in Peru

Background: Women’s empowerment may shape contraceptive choices through intra-household bargaining and the degree of coordination a method requires. We examined how distinct empowerment dimensions relate to the locus of contraceptive decision (female-controlled vs couple-controlled methods) and to modern method use among partnered Peruvian women. Methods: We conducted an analytic cross-sectional study using nationally representative ENDES/DHS microdata (2015–2018) for women aged 15–49 in union (N=27 440; pregnant women and those desiring pregnancy were excluded). Four empowerment indicators were analyzed: (1) decision over household resources, (2) freedom of movement, (3) partner’s respect for the woman’s opinions/desires/rights, and (4) decision over own health. The first three indices were built via PCA, standardized, and split into terciles; “health decision” was a three-level item (partner alone / joint / woman alone). Survey-weighted logistic models reported average marginal effects (percentage points), adjusting for individual and household characteristics, sexual and reproductive health supply conditions (e.g., service density, perceived distance, availability of female staff), and year and department fixed effects. Results: Decision over one’s own health shows consistent associations: medium and high levels increase modern method use by approximately 5–8 p.p. and woman-controlled methods by approximately 5–7 p.p. Partner’s respect is especially associated with jointly controlled methods (approximately 4–5 p.p.) and, to a lesser extent, with modern methods overall (approximately 3 p.p.). Freedom of movement exhibits small, positive associations concentrated at intermediate levels. The household-resources indicator is weak and unstable. Supply-side coefficients display expected directions: better availability and shorter perceived distance are associated with greater contraceptive use. Conclusions: Empowerment domains map onto specific contraceptive margins: clinical autonomy shifts use toward female-controlled methods, while partner respect favors couple-controlled choices. Counseling and service organization should incorporate women’s empowerment profiles, expand self-administered options, and strengthen couple communication to support informed, preferred method use.