Association of Women Empowerment and Domestic Violence on Family Planning and Reproductive Health in Bangladesh

Background: Poor family planning and reproductive health is a strong predictor of high fertility that leads to increased rates of maternal mortality and morbidity. Bangladesh is a developing country with high fertility, maternal mortality, and morbidity. However, this problem has not been fully comprehended to ensure development of comprehensive interventions needed to decrease the mortality rate of mother and children. Therefore, the purpose of this study is to examine whether women’s empowerment within the family and reported levels of domestic violence are associated with the women’s family planning usage and seeking of reproductive health services after controlling their socioeconomic status.   

Methods: The study used the Bangladesh Demographic and Health Survey (BDHS) of 2011. All married women (N=42,899) aged 13-49 in the sample households were eligible for the BDHS. Multivariate Logistic Regression was used to examine the association among women empowerment, domestic violence, and wealth with the likelihood of reproductive health outcomes. Women empowerment was operationalized based on person who usually decides on responder’s health care, large household purchases, and visits to family or relatives. Conflict tactics scale (CTS) was used to measure the domestic violence (DV). Standardized score of wealth index was constructed through household assets and dwelling characteristics. Outcome variables family planning and reproductive health service seeking behavior were examined through decision of contraceptive use and knowledge of family planning method gained from community health worker.

Results: Among all married women 69% lived in rural areas, approximately 36% had no education, 33% had primary education, and only 4.7% had higher education. While 49.2% of women reported being empowered to make daily, health, or household decisions, 30.1% reported a lack of empowerment in some domains and 20.7% reported no empowerment. After controlling for wealth, women reporting only some empowerment were 1.8 times (𝛽=.597, p<.001, exp[𝛽]=1.82) as likely to report not using contraception because their husband or partner opposed it. Women reporting at least some lack of empowerment were 42.7% to 68.1% (exp[𝛽] ranging from .319 to .573, all p<.001) more likely to have decisions surrounding contraception made mainly by their husbands or partners. Similarly, increased DV scores were associated with a decreased likelihood of making a joint decision about contraception compared to the husband or partner controlling the decision (𝛽=-.103, p<.001, exp[𝛽]=.902). Reported empowerment and DV were not significantly associated with having discussions about family planning with a community health worker after controlling for family wealth.

Conclusions: Results suggest that Bangladeshi married women’s empowerment within their households and experience of domestic violence are significantly associated with the joint family planning and awareness of reproductive health services even after controlling their socioeconomic status. The experience of low women empowerment and high domestic violence adversely impact on poor family planning and reproductive health. Findings indicate need for a multi-sectorial approach that addresses these problems through empowering women and educating them on the importance of contraceptive use and marital communications. Finally, the government should implement sex and reproductive health educational policies targeting students to ensure early empowerment before marriage.