Reproductive intentions and contraceptive behaviours

Johns Hopkins University, Baltimore MD

Investigators

Abstract

1 Project Summary 2 The proposed research aims to identify the drivers of women’s sexual and reproductive empowerment, including 3 male influences and subsequently demonstrate the predictive effect women’s SRH empowerment as a 4 mechanism to reduce unintended pregnancies by increasing their ability to better align their reproductive 5 intentions and behaviors. The project takes place in Burkina Faso, a high fertility and highly patriarchal country 6 in West Africa. It leverages existing data from the Performance Monitoring for Action (PMA) project, which 7 collects nationally representative longitudinal data on a range of SRH measures, including a validated SRH 8 empowerment scale. PMA currently includes 3500 partnered women of reproductive age who responded to four 9 annual surveys between 2019 and 2024. The project will expand the PMA female panel by adding a male 10 component, developed using a sequential mixed model design, including 1) a qualitative study among 120 adult 11 men in 4 communities in Burkina Faso, 2) cognitive interviewing and pilot testing of a novel SRH male module 12 derived from the qualitative study and 3) two new rounds of PMA panel data among 4500 couples, to enrich the 13 understanding of women’s SRH empowerment through a gender lens. Our specific aims are three-fold: 14 Aim 1. Evaluate short- and long-term changes in SRH empowerment and identify predictors of these 15 changes. we will use latent trajectory model and linear growth modeling to identify sociodemographic and life 16 events that predict yearly and long-term changes in SRH empowerment scores based on 4 rounds of existing 17 PMA female data. 18 Aim 2. Understand and evaluate men’s influence on women’s SRH empowerment. We will conduct a 19 qualitative study and use thematic analysis to understand men’s perspectives on childbearing and contraceptive 20 decisions. Findings will inform the development of a new male SRH module, that will be pretested and added to 21 the existing PMA female panel. We will use linear regression models to evaluate men’s influence on the 22 development and exercise of women’s SRH empowerment across the reproductive life span using couple linked 23 data. 24 Aim 3. Evaluate the effect of SRH empowerment on reproductive intentions and behaviors, accounting 25 for men’s influences. Adding an additional round of PMA couple data, we will employ generalized estimating 26 equation models to assess the predictive effect of women’s SRH empowerment in reducing the intentional gap 27 between fertility and contraceptive intentions and the behavioral gap between contraceptive intentions and 28 behaviors. We will also examine if male and couple factors change these associations.