Searching for the link between contraceptive self-care and reproductive empowerment

This piece was originally written by Holly Burke, Behavioral Scientist, Reproductive, Maternal, Newborn, and Child Health (RMNCH), at FHI 360, and Reana Thomas, Technical Officer, Global Health, Population, and Nutrition at FHI 360.

WHAT’S THE ISSUE

The family planning and reproductive health field recognizes reproductive empowerment as a component of contraceptive self-care, but do we have the evidence to understand how they are related, and if so, in which directions the relationship flows? Do those who are more empowered use self-care? Does use of self-care lead to more empowered individuals? Or both? How are family planning practitioners and researchers measuring the relationship between the two? These are a few of the questions the Research for Scalable Solutions (R4S) team used to guide a systematic review and commentary on the relationship between contraceptive self-care and reproductive empowerment.

HOW DID WE FIND THE EVIDENCE? 

Following PRISMA guidelines, we systematically reviewed the grey and peer-reviewed literature written on reproductive empowerment and access, acceptability, use or intention to use contraceptive self-care. Thirty-seven studies (out of 3036) published between 2010-2020 met our inclusion criteria. We considered the WHO guideline on self-care interventions when defining the eligible types of contraceptive self-care for our review, for example, use of condoms for pregnancy prevention. We followed the Reproductive Empowerment Framework created by the International Center for Research on Women (ICRW) to define empowerment constructs eligible for inclusion, such as feeling empowered to make informed-decisions and equitable power dynamics in a relationship. More details on the inclusion criteria can be found within the review.  

WHAT DID WE FIND?

Most of the 37 studies we included focused on use of self-care (compared to access, acceptability, or intention to use), were set in high-income countries, were cross-sectional, and had a high risk of bias. Almost half included only women in the studies, and over 80% of the studies focused on male condoms. While we found positive relationships between condom use self-efficacy and use of/intention to use condoms, we did not see enough studies that showed the same relationship for other self-care contraceptive methods to state any strong conclusions or to assess directionality.

While several validated scales measuring reproductive empowerment exist, these scales were not used in the studies that meet the inclusion criteria for the review. We wrote this commentary to summarize and thematically map five scales that may help reproductive health practitioners and researchers working on advancing self-care select the most appropriate scales for their contexts.

WHAT DO WE NEED?

LET’S ASSESS CASUAL RELATIONSHIPS … between reproductive empowerment and self-care more often!

The lack of studies on the causal relationships between reproductive empowerment and contraceptive self-care (besides condom use) leaves us without confirmation on the direction and strength of the relationship between the two concepts. To improve reproductive health outcomes, let us continue to understand this relationship for a variety of self-care interventions so that health programs can identify what components will enable empowerment and self-care decision making amongst people who use reproductive health care.

LET’S USE WHAT EXISTS … for reproductive empowerment scales and indicators!

Our call for more research and understanding comes with scales that are already available to collectively build the evidence-base across programs and studies. We encourage reproductive health practitioners and researchers to use existing, validated reproductive empowerment scales that best fit your needs.

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