Increasing literate and illiterate women’s met need for contraception via empowerment: a quasi-experiment in rural India.
Outcomes: Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study highlights that addressing gender norms within households—especially around women’s mobility and control over earnings—can empower women and increase their ability to meet contraceptive needs. Outreach visits that included messages about gender dynamics were more effective at shifting norms than clinic-based interactions alone. Programs that aim to improve family planning outcomes must directly engage with gender norms and promote joint decision-making within couples.
Objectives To assess whether a family planning intervention in rural Jharkhand, India, improved women’s empowerment—measured through household decision-making power—and whether that empowerment contributed to meeting contraceptive needs, particularly among literate and illiterate women.
Methods A quasi-experimental design was used, comparing an intervention block (Ormanjhi) with a control block (Burmu) through baseline and endline surveys conducted from 2004 to 2007. The sample included married women ages 15–49 with a need for contraception. Normative beliefs about decision-making in five household domains were assessed using a “participation model” that credited women for decisions made alone or jointly with their husbands. Generalized linear models tested the effects of the intervention, literacy, and decision-making power on met need for contraception.
Intervention Details The program included community outreach, introduction of the Standard Days Method (SDM), and training for providers on gender-sensitive service delivery. Activities included street theatre, puppet shows, health fairs, and home visits that encouraged couple communication and informed choice. Services were offered through both public and NGO-run health centers.
Results Women in the intervention area, especially those who were illiterate, showed significant increases in decision-making power over earnings and visiting relatives. Changes in purchasing decisions were not significant. Women who received home visits discussing family planning were more likely to report empowerment and improved contraceptive access. The intervention had a stronger effect on met need among women with higher decision-making power, regardless of literacy.
Conclusions Empowerment-focused family planning programs can increase women’s decision-making power and improve contraceptive outcomes. To be effective, these programs must go beyond access and information to challenge and transform household gender dynamics, particularly for those with limited formal education.
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