Influence of reproductive agency on modern contraceptive use and unwanted sex among young women in Burkina Faso: Findings from cross-sectional and longitudinal data

Background Inconsistencies often observed between women's empowerment—or its various components—and young women's reproductive health can be attributed to several factors. These include gaps in defining autonomy through its context-specific determinants, methodological challenges in its measurement, and the frequent reliance on cross-sectional data, which fails to account for the multidimensional, contextual, and dynamic nature of empowerment. Methods This study uses both cross-sectional and longitudinal data from the Performance Monitoring for Action (PMA) research platform to assess the influence of young burkinabè women’s (ages 15–24) decision-making power on modern contraceptive use and the occurrence of unwanted sex. A multidimensional measure of agency was adapted to two domains of reproductive health: contraception and sexuality. For each domain, this measure comprises two sub-dimensions: motivation, defined as the ability to set reproductive goals, and self-efficacy, referring to the capacity to implement them. Results Our findings indicate that the influence of reproductive agency varies depending on the specific sub-dimension considered, the reproductive outcome assessed, and young women’s marital status. Within contraceptive agency, contraceptive motivation was positively and significantly associated with modern contraceptive use, but only among young women in union. Conversely, in the domain of sexual agency, sexual motivation was significantly linked to a lower risk of unwanted sex, but only among unmarried young women. Conclusions While reproductive agency is a key determinant of young women’s reproductive health, its assessment and the strategies aimed at strengthening it must account for its multidimensional and dynamic nature, with particular attention to young women’s marital status.