Women's empowerment and life stage: Assessing intersectional differences in contraceptive method mix in sub-Saharan...

Women's empowerment positively impacts family planning in sub-Saharan Africa, but little is known about its relationship with contraceptive method mix. Considering that contraceptive needs vary across life stages, we aimed to explore the intersectional differences in contraceptive method mix according to age and level of empowerment in sub-Saharan Africa.

We analyzed data from Demographic and Health Surveys conducted since 2015 across 28 countries in West & Central and Eastern & Southern Africa. Within each region, we calculated pooled estimates of demand for family planning satisfied by any method (DFPS) and contraceptive method mix, stratifying by women's age and empowerment level using the survey-based women's empowerment index (SWPER).

Our sample included 138,374 married women of reproductive age. Across both regions, more empowered women achieved higher DFPS, especially those older than 19. Among adolescents, we found a substantial increase only in the decision-making domain. Injectables and implants dominated the method mix, but their shares dropped as empowerment increased. This trend appeared across all age groups and empowerment domains, with the largest declines observed for social independence. High-empowered women had a more diversified method mix, with adolescents and young women with increased use of condoms, pills, and fertility-awareness methods, while women over 34 relied more on IUDs and sterilization.

Our findings reveal that age, empowerment, and contraceptive method mix intersect in diverse ways. Tailoring family planning policies and counseling while addressing empowerment drivers could enhance informed contraceptive choices and better meet women's reproductive health goals.

The evidence generated in this study emphasizes the importance of designing family planning programs that address age-specific reproductive needs and empowerment-related barriers, providing insights to guide more tailored interventions in sub-Saharan Africa.