Exploring women’s empowerment in relation to contraceptive practices among married women in Bangladesh: a survey-weighted sequential logistic regression analysis

Abstract Background Women’s empowerment is multidimensional, yet contraceptive studies often combine distinct domains into one score. We examined whether household decision-making participation and rejection of wife-beating had different associations with current contraceptive use in Bangladesh. Methods We analyzed cross-sectional data from currently married or partnered, nonpregnant women aged 15–49 years in the 2022 Bangladesh Demographic and Health Survey. Tetrachoric principal component analysis derived standardized scores for household decision-making and rejection of wife-beating. Survey-weighted logistic regression estimated associations with current use of any contraceptive method across sequential adjustment models. Modified Poisson regression, marginal standardization, modern-method analyses, and alternative empowerment specifications assessed robustness. Results The complete-case sample included 17,345 women. Parallel analysis retained two empowerment components explaining 76.2% of total variance. In the fully adjusted model, each 1-standard-deviation higher household decision-making score was associated with higher odds of contraceptive use (OR = 1.068, 95% CI = 1.029–1.108; p < 0.001). The corresponding adjusted prevalence ratio was 1.023 (95% CI = 1.010–1.036), and the standardized prevalence difference comparing + 1 with − 1 standard deviation was 2.84% points (95% CI 1.25–4.42). Rejection of wife-beating was not independently associated with use (OR = 0.983, 95% CI = 0.946–1.021; p = 0.367). The domain-specific pattern persisted for modern contraceptive use and in reduced-adjustment analyses. Middle- and rich-wealth groups had lower adjusted odds than the poor group, showing that contraceptive use did not follow a simple positive wealth gradient. Conclusions Household decision-making participation, but not rejection of wife-beating, was associated with contraceptive use in this nationally representative sample. The findings show why empowerment domains should not be treated as interchangeable and support multidimensional measurement in family-planning research. Longitudinal studies are needed to clarify temporality.

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Journal
BMC Women s Health
Published
2026-08-20
DOI
https://doi.org/10.1186/s12905-026-04797-1
Primary Topic
Global Maternal and Child Health
Type
article
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article

Exploring women’s empowerment in relation to contraceptive practices among married women in Bangladesh: a survey-weighted sequential logistic regression analysis

Sushmita Sarkar, Md Muddasir Hossain Akib, Bikash Pal, Md. Abdus Salam Akanda
BMC Women s Health
Global Maternal and Child Health
article

Exploring women’s empowerment in relation to contraceptive practices among married women in Bangladesh: a survey-weighted sequential logistic regression analysis

Sushmita Sarkar, Md Muddasir Hossain Akib, Bikash Pal, Md. Abdus Salam Akanda
article en

Abstract

Abstract Background Women’s empowerment is multidimensional, yet contraceptive studies often combine distinct domains into one score. We examined whether household decision-making participation and rejection of wife-beating had different associations with current contraceptive use in Bangladesh. Methods We analyzed cross-sectional data from currently married or partnered, nonpregnant women aged 15–49 years in the 2022 Bangladesh Demographic and Health Survey. Tetrachoric principal component analysis derived standardized scores for household decision-making and rejection of wife-beating. Survey-weighted logistic regression estimated associations with current use of any contraceptive method across sequential adjustment models. Modified Poisson regression, marginal standardization, modern-method analyses, and alternative empowerment specifications assessed robustness. Results The complete-case sample included 17,345 women. Parallel analysis retained two empowerment components explaining 76.2% of total variance. In the fully adjusted model, each 1-standard-deviation higher household decision-making score was associated with higher odds of contraceptive use (OR = 1.068, 95% CI = 1.029–1.108; p < 0.001). The corresponding adjusted prevalence ratio was 1.023 (95% CI = 1.010–1.036), and the standardized prevalence difference comparing + 1 with − 1 standard deviation was 2.84% points (95% CI 1.25–4.42). Rejection of wife-beating was not independently associated with use (OR = 0.983, 95% CI = 0.946–1.021; p = 0.367). The domain-specific pattern persisted for modern contraceptive use and in reduced-adjustment analyses. Middle- and rich-wealth groups had lower adjusted odds than the poor group, showing that contraceptive use did not follow a simple positive wealth gradient. Conclusions Household decision-making participation, but not rejection of wife-beating, was associated with contraceptive use in this nationally representative sample. The findings show why empowerment domains should not be treated as interchangeable and support multidimensional measurement in family-planning research. Longitudinal studies are needed to clarify temporality.

BMC Women s Health
University of Dhaka (BD)
Good health and well-being
Openalex Percentile: Top 6%
Global Maternal and Child Health
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