Examining the Role of Women's Socio-Economic Empowerment in Contraceptive Use Among Reproductive-Aged Women (15-49 Years) in Uganda

Background Women's empowerment in contraceptive use is a multidimensional concept that includes assessing the availability of choices related to sexual activity, contraception, and pregnancy. It also involves evaluating women's ability to make and act on their family planning decisions, including their decision-making skills, negotiation, and self-efficacy. Empowering women to determine their own sexuality and reproductive health, including access to contraception, is essential to address challenges like unintended pregnancies. In this analysis, we examined the role of women's socio-economic empowerment and the effects of such empowerment on use of modern contraception and unintended pregnancies in Uganda Methods This study was a cross-sectional secondary data analysis using data from four Uganda Demographic and Health Surveys (UDHS) conducted in 2006, 2011, 2016, and 2022. The UDHS employs a multistage stratified sampling method to select households across urban and rural regions. Women aged 15-49 who were residents or visitors in the households were eligible for interviews. We merged the datasets from the four surveys, ensuring appropriate analysis weights and common variables were included before conducting the analysis. Data was analyzed using Stata version 18. Exploratory data analysis was conducted to generate descriptive statistics for all the key variables Results Over the four UDHS, there has been a fluctuation in the percentage of women involved in employment in the 12 months preceding the surveys. In 2006, 86.7% reported being currently working or on leave, which decreased in 2011 to 75%. This was followed by nearly a 5 % increase to 79.9% in 2016. Socio-empowerment, as defined by participating in at least one of the three key decisions (health, large purchases and visiting facility), was not associated with use of modern contraception across all four DHS surveys, and the pooled adj.PR=1.06(0.99, 1.14), adjusting for women's characteristics. Across all the DHS surveys factors associated with higher prevalence of unintended pregnancy were decision making in health seeking, large purchases and visiting family in DHS2006, adj.PR=1.15(0.99, 1.33), p=0.059 but not in the subsequent DHS. Also, women aged 35-49 years compared to adolescent (15-19 year) for all DHS except in 2006. Women with few children than ideal number, age first marriage below 18 years at DHS 2016, adj.PR=1.15(1.02, 1.30) or multiple partners (2+) at DHS2011, adj.PR=2.13(1.42, 3.19). Conclusion Women’s socio-economic empowerment is crucial for increasing contraceptive use and reducing unintended pregnancies. Family planning policymakers and programmers need to integrate women’s empowerment into the design of maternal health improvement interventions like contraceptive use to advance equity for better outcomes