This study evaluates the contraceptive empowerment subscale of the Women's and Girls' Empowerment in Sexual and Reproductive Health (WGE-SRH) index across seven sub-Saharan African countries. Using structural equation mo...This study evaluates the contraceptive empowerment subscale of the Women's and Girls' Empowerment in Sexual and Reproductive Health (WGE-SRH) index across seven sub-Saharan African countries. Using structural equation modeling and logistic regression among population-based samples of women aged 15-49, we find evidence that the abbreviated eight-item subscale is a reliable measure of contraceptive empowerment (Cronbach's alpha range: 0.67-0.78), significantly associated with women's involvement in the decision to use contraception. Results show geographic variability, with the highest overall contraceptive empowerment in Kenya (mean = 4.26, range: 1-5) and lowest in Uganda (mean = 3.67), reflecting diverse fertility trends, contraceptive norms, and gendered power dynamics. The subscale's two-dimensional structure-distinguishing existence and exercise of choice-proves effective, with existence of choice being a stronger correlate of involvement in contraceptive use decisions than exercise in most settings. Despite some challenges, such as variable factor loadings, the subscale shows acceptable internal consistency and construct validity. This research underscores the need for multidimensional measures of reproductive empowerment to capture this nuanced process.
Stud Fam Plann
· 2025 Jun · PMID 40405558
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The ICPD Programme of Action and the Sustainable Development Goals both underscore the essential role of sexual and reproductive health and reproductive rights in development. Despite significant progress on many aspects...The ICPD Programme of Action and the Sustainable Development Goals both underscore the essential role of sexual and reproductive health and reproductive rights in development. Despite significant progress on many aspects of sexual and reproductive health and rights (SRHR), challenges remain, and they are exacerbated by rising anti-rights movements in many countries. At a time when SRHR is under threat, it is important to surface evidence that speaks to its critical role in development and its inextricable connections to multiple global goals. In this commentary, we argue that investing in SRHR is strategic because it yields substantial benefits to individuals, economies, societies, the environment, and peace and security, and thus contributes to progress on related goals. We encourage SRHR advocates to leverage the broad array of arguments to bolster decision-makers' and other stakeholders' support of SRHR, alongside the well-established arguments grounded in cost-effectiveness, and returns on health and human rights. With the world falling short of achieving the Sustainable Development Goals and conservative forces threatening to undo the progress that has been made, urgent and collective action on multiple fronts is needed. By recognizing that many development priorities are interconnected, we can accelerate progress through cross-movement advocacy and mobilization.
With the growing prevalence of dual-earner families in China, fertility decisions are increasingly influenced by experiences in the work domain. While previous research has explored the relationship between static occupa...With the growing prevalence of dual-earner families in China, fertility decisions are increasingly influenced by experiences in the work domain. While previous research has explored the relationship between static occupational status and fertility intentions, it has largely overlooked how career development affects these dynamics. Changes in occupational status alter both the material resources available for childbearing and the balance between work and family life. Using diagonal reference models on pooled data from the Chinese General Social Survey, this study investigates the impact of intragenerational occupational mobility on fertility intentions. The findings reveal that this impact varies by parity and gender. Intragenerational upward mobility is positively associated with men's first birth intentions but negatively associated with women's first birth intentions. However, intragenerational downward mobility is negatively associated with first birth intentions for both men and women. For additional children, the impact of upward mobility is not significant, but the negative impact of downward mobility is still prominent. Overall, while upward mobility enhances fertility intentions for men by providing greater resources and stability, for women, the pursuit of career advancement often results in reduced fertility intentions. These findings highlight a gendered trade-off between professional success and family formation.
Bearak JM, Leong E, Gausman J
… +6 more, Rosenberg J, Menanno M, Sackietey S, Mulhern O, Kantorová V, Molitoris J
Stud Fam Plann
· 2025 Jun · PMID 40394867
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The Programme of Action adopted after the International Conference on Population and Development (ICPD), and later the Beijing Declaration, affirmed commitments to the human right to decide on the number and spacing of o...The Programme of Action adopted after the International Conference on Population and Development (ICPD), and later the Beijing Declaration, affirmed commitments to the human right to decide on the number and spacing of one's children and have the information and means to do so. In this study, we estimate trends related to this component of reproductive agency-undesired births per thousand women who want to avoid pregnancy, the conditional undesired birth rate-with annual rates for five-year periods from 1975 to 2024. Worldwide, 36 million undesired births occurred annually in 2020-2024 compared to 45 million annually in 1990-1994, corresponding to a decrease in rate from 61 to 32. Had it not been for increases in contraceptive use since 1990-1994, the global average rate in 2020-2024 would have been 36 percent higher than it actually was. Had it not been for increasing proportions of pregnancies aborted, the rate would have been 58 percent higher. Comparing regional averages, excepting Sub-Saharan Africa and Oceania, the pace of decline in conditional undesired birth rates slowed by the 2000s; hence, the global average rate decreased by 22 percent in the latter half of the post-ICPD period after declining by 31 percent and 33 percent during the 15-year periods immediately before and after ICPD.
Stud Fam Plann
· 2025 Jun · PMID 40376891
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The world is grappling with a huge array of demographic challenges-ranging from rapid population growth in sub-Saharan Africa to rapid aging and decline elsewhere-with profound implications for social systems, economic s...The world is grappling with a huge array of demographic challenges-ranging from rapid population growth in sub-Saharan Africa to rapid aging and decline elsewhere-with profound implications for social systems, economic stability, and environmental sustainability. We examine the complex interplay of demographic diversity and other global megatrends, emphasizing the urgent need for policies that prioritize human rights and sustainable development. The legacy of the 1994 International Conference on Population and Development (ICPD) is re-evaluated, highlighting the principles that advocate for individual reproductive rights over numerical targets. Rather than solely focusing on population numbers, we underscore the necessity of addressing root causes of apparent demographic challenges and inequalities, especially relating to gender equality, access to quality health care (including sexual and reproductive health services), and education. By integrating insights on aging populations, migration, and climate change, we call for a shift toward inclusive, rights-based policies that harness the potential of all individuals, in which sexual and reproductive health and rights are central. Ultimately, we suggest that progress toward the Sustainable Development Goals and implementation of the ICPD Programme of Action can only be achieved through tailored demographic policies that reflect the unique contexts of each country, fostering resilience and well-being in a demographically diverse world.
Brander C, McKenna C, Gerdts C
… +6 more, Palanisamy B, Jain A, Jacobson L, Key K, Chandrasekaran S, Jayaweera R
Stud Fam Plann
· 2025 Dec · PMID 40369701
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While the incidence of self-managed abortion (SMA) in India is well-documented, why the majority of abortions in India are self-managed remains largely unanswered. This qualitative study explores factors that contribute...While the incidence of self-managed abortion (SMA) in India is well-documented, why the majority of abortions in India are self-managed remains largely unanswered. This qualitative study explores factors that contribute to decision-making about SMA in India. Between January and August 2022, we conducted 43 in-depth interviews with people who self-managed abortions across six Indian states, recruiting via accredited social health activists, clinic sampling frames, and social media posts. Underpinned by the Coast et al. framework, we coded and analyzed transcripts using thematic analysis and then organized factors that contributed to people's decision-making around SMA versus facility-based care. Contributing factors to people's decisions not to seek facility-based abortion care included concerns about poor treatment by providers, the unaffordability of private facility care, and fear of procedural abortion methods. Factors contributing to people's decision to seek SMA included having prior SMA experience, access to information about SMA, affordability, privacy, accessibility, and convenience. SMA is a valued option for abortion seekers in India due to perceived benefits and a desire to avoid facility-based care. Our findings highlight the need for improved person-centered abortion care at facilities and offer potential avenues for developing supportive resources for people who self-manage abortion in India.
Stud Fam Plann
· 2025 Jun · PMID 40344228
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Since the International Conference on Population and Development in 1994, global policies, and agenda-setting milestones have emphasized that universal sexual and reproductive health and rights (SRHR) are unattainable wi...Since the International Conference on Population and Development in 1994, global policies, and agenda-setting milestones have emphasized that universal sexual and reproductive health and rights (SRHR) are unattainable without the meaningful engagement and inclusion of men. Despite this, the field of SRHR continues to struggle with how and in what ways men can and should be included in research, programs, and policies. In this commentary, we argue that the programmatic focus of SRHR limits the capacity to produce the data and evidence needed to inform gender transformational change. For men to be meaningfully engaged with by SRHR, researchers need an analytic lens that can capture the manifestations and outcomes of gender and power. We consider the conceptual complementarities between two theoretical frameworks: hegemonic masculinities and Reproductive Justice. We contend that bringing together these conceptual approaches to men and SRHR offers an analytic framework to iterate and innovate approaches to research. Such changes will allow for a greater interrogation of gender and power and the production of data and evidence necessary to grapple with the ongoing injustices that curtail people's sexual and reproductive freedoms.
Stud Fam Plann
· 2025 Jun · PMID 40325850
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Fertility research in sub-Saharan Africa regularly indicates the need to increase women's reproductive autonomy. However, individual, female-focused conceptualizations of reproductive autonomy tend to neglect the power d...Fertility research in sub-Saharan Africa regularly indicates the need to increase women's reproductive autonomy. However, individual, female-focused conceptualizations of reproductive autonomy tend to neglect the power dynamics both internal and external to couples and other intimate relationships that shape a woman's reproductive autonomy. Furthermore, they disregard the reproductive autonomy of men and other subpopulations and partners in intimate relationships. To identify gaps and evaluate the applicability of the concept, this scoping review clarifies how reproductive autonomy has been assessed and applied in fertility research in sub-Saharan Africa. Eligible for inclusion were empirical peer-reviewed publications, including quantitative, qualitative, and mixed-methods research, published since 1994. Out of 1568 articles screened, 18 met the inclusion criteria. Most publications were quantitative in nature and focused mainly on the reproductive autonomy of women. Our key finding is that the reproductive autonomy of partners in intimate relationships, and of women in particular, is restricted at the community level in order to preserve the status quo of social power structures in society. In line with a reproductive justice approach, more research should focus on the reproductive autonomy of vulnerable and understudied populations as well as on the interpersonal and contextual dynamics that suppress reproductive autonomy in communal settings.
Big data and artificial intelligence (AI) have the potential to transform sexual and reproductive health (SRH), offering new avenues to enhance access, efficiency, and personalization in healthcare. AI-driven tools can p...Big data and artificial intelligence (AI) have the potential to transform sexual and reproductive health (SRH), offering new avenues to enhance access, efficiency, and personalization in healthcare. AI-driven tools can provide opportunities to improve service delivery and optimize resource allocation. Through data-driven insights, healthcare providers can better understand population trends, predict health risks, and tailor interventions for diverse communities, ultimately advancing gender equality and empowerment. However, the integration of AI into SRH also presents significant challenges. Ethical concerns such as informed consent, data privacy, and transparency are critical to ensuring that AI applications do not violate individual autonomy and rights. The digital divide-disparities in technology access between different regions and populations-further risks exacerbating inequalities in SRH services and the provision of care. Moreover, there is a need for robust governance frameworks and global data protection laws to regulate the use of AI in SRH, and in healthcare more broadly. Programs and policies must focus on bridging these gaps, emphasizing equity and ethical considerations while leveraging AI's potential to enhance SRH services and support the vision of SRH and rights for all.
Wilkins E, Herrmann M, Boydell V
… +2 more, Light B, Idele P
Stud Fam Plann
· 2025 Jun · PMID 40322933
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This commentary discusses the issue of low and declining fertility and the enduring relevance of the 1994 International Conference on Population and Development (ICPD) Programme of Action (PoA) in this new demographic co...This commentary discusses the issue of low and declining fertility and the enduring relevance of the 1994 International Conference on Population and Development (ICPD) Programme of Action (PoA) in this new demographic context. We explore low-fertility trends, patterns, and determinants; fertility in the context of the ICPD PoA; and the recent pushback against sexual and reproductive health, rights, and gender equality. We conclude with various actions that can be taken to future-proof the ICPD PoA in low-fertility contexts looking forward to the next 30 years.
Stud Fam Plann
· 2025 Jun · PMID 40322932
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The climate crisis will have an impact on everyone, everywhere, affecting both present and future generations, but there are unique ways in which the crisis is impacting the lives of women and girls. This commentary revi...The climate crisis will have an impact on everyone, everywhere, affecting both present and future generations, but there are unique ways in which the crisis is impacting the lives of women and girls. This commentary reviews growing evidence on the effects of climate change on sexual and reproductive health and rights (SRHR) and gender-based violence (GBV), illustrating how the crisis is augmenting preexisting gender inequalities. Far greater attention to SRHR and GBV is needed within climate actions to ensure the fulfillment of the International Conference on Population and Development Programme of Action and a sustainable future for women and girls.
Since the 1994 International Conference on Population and Development (ICPD), there have been notable improvements in reproductive health and rights. However, these overall gains obscure deep inequalities, and recent set...Since the 1994 International Conference on Population and Development (ICPD), there have been notable improvements in reproductive health and rights. However, these overall gains obscure deep inequalities, and recent setbacks during and after the COVID-19 pandemic highlight the fragility of this progress. The reproductive health agenda is extensive yet remains underfunded and underperforming. Careful thought is needed on how to retain reproductive health and rights as a priority in the global development framework that will replace the Sustainable Development Goals in 2030. This paper examines the evolution of reproductive health, drawing lessons and recommendations for revitalizing and future-proofing its agenda and enhancing progress. Key recommendations include encouraging bolder thinking in research engaging with the field's multiple challenges, including nontechnical aspects; improving dissemination and utilization of policy-relevant research; presenting a stronger business case to influence policymakers; and employing broader, inclusive rights-based arguments that emphasize social justice and equity. Additionally, reevaluating the global reproductive health architecture is necessary, particularly the influential yet inconsistent role of the USA. Relevant lessons from maternal and child health and HIV efforts are distilled to further assist in this process of developing a more effective path forward, ensuring the ICPD's vision is achieved beyond 2030.
Corker J, Weinberger M, Dasgupta ANZ
… +1 more, Sully EA
Stud Fam Plann
· 2025 Jun · PMID 40269552
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The 1994 International Conference on Population and Development transformed the family planning (FP) field. Yet, three decades later, global FP monitoring remains anchored in the same core indicators: contraceptive use,...The 1994 International Conference on Population and Development transformed the family planning (FP) field. Yet, three decades later, global FP monitoring remains anchored in the same core indicators: contraceptive use, unmet need, and demand satisfied. Despite decades of well-established critique, these measures have seen little substantive revision. As the global community looks to 2030 and beyond, a coordinated effort is urgently needed to develop a revised set of easily interpretable, top-line FP indicators. Leveraging recent momentum around advances in FP and contraceptive measurement, this effort must be intentional and focused-ensuring that new indicators better reflect the values and priorities of the field-and should be guided by principles of simplicity, validity, directionality, and universal applicability. Without action, the FP community risks continued reliance on outdated measures or the adoption of impractical, unvalidated indicators, weakening future accountability for rights-based FP. We call on key stakeholders-FP advocates, donors, and global organizations-to prioritize and invest in the development and validation of robust new top-line FP indicators over the next three years, to ensure their integration into post-2030 global agenda setting.
Odwe G, Kisaakye P, Obare F
… +5 more, Wado YD, Wandera B, Küng S, Rich C, Giorgio M
Stud Fam Plann
· 2025 Dec · PMID 40269527
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Estimates of the incidence of induced abortion and unintended pregnancies in refugee settings are lacking, limiting efforts to improve sexual and reproductive health services. We adapted the abortion incidence complicati...Estimates of the incidence of induced abortion and unintended pregnancies in refugee settings are lacking, limiting efforts to improve sexual and reproductive health services. We adapted the abortion incidence complications method to estimate the incidence of induced abortion and unintended pregnancy among women aged 15-49 years in refugee settlements in Uganda. We draw data from a survey of 102 health facilities providing postabortion care (PAC) services to women and girls across 13 refugee settlements in Uganda and a knowledgeable informant survey of 59 individuals familiar with induced abortion among the refugee population in Uganda. An estimated 4131 PAC cases were due to induced abortion among women in refugee settings. The overall induced abortion incidence rate among women living in refugee settlements in Uganda was 37.3 per 1000 women aged 15-49. Of the 31,189 live births, 25,023 pregnancies were unintended, translating to an unintended pregnancy rate of 73.7 per 1000 women of reproductive age. Of all pregnancies to women living in refugee settlements, 25 percent were estimated at end in induced abortion, 24 percent in unplanned birth, 37 percent in planned birth, and 15 percent in miscarriage. The findings suggest a need to improve access to contraceptives, safe abortion, and PAC services in refugee settlements in Uganda.
Depression and anxiety symptoms are associated with increased unmet need for family planning (FP) postpartum, yet solutions promoting the integration of mental health into FP service settings remain scarce. The aims of t...Depression and anxiety symptoms are associated with increased unmet need for family planning (FP) postpartum, yet solutions promoting the integration of mental health into FP service settings remain scarce. The aims of this study were to quantitatively examine the immediate and longer term effects of participation in a group-based cognitive behavioral therapy (CBT) intervention called Mothers Time on (1) symptoms of depression and anxiety, (2) the use of a modern family planning method, and (3) intermediate FP-related factors among postpartum women in Ethiopia. Building from lessons learned during a feasibility study, we implemented a cluster randomized controlled design, with structured interviews delivered before (baseline), immediately following (endline), and fourxst months after implementation of the intervention (follow-up). A total of 302 postpartum women were recruited from 10 health clusters in northwest Ethiopia. In comparison to control clusters where participants received standard of care, intervention clusters showed significantly greater reductions in symptoms for both depression and anxiety from baseline to follow-up. Modern FP use also increased significantly more in intervention clusters as compared to control clusters from baseline to follow-up. Results suggest that more holistic FP services that consider postpartum mental health can both reduce postpartum depression and anxiety and support women in fulfilling their reproductive intentions.
Measurement of reproductive empowerment (RE) is necessary to understand and address barriers to RE and to evaluate the impact of policies and practices that increase RE as a pathway to improving reproductive health. This...Measurement of reproductive empowerment (RE) is necessary to understand and address barriers to RE and to evaluate the impact of policies and practices that increase RE as a pathway to improving reproductive health. This study validated an existing RE scale, developed in 2016 for sub-Saharan African (SSA) contexts, using longitudinal survey data from a cohort of women in Plateau State, Nigeria. Psychometric properties were assessed through confirmatory factor analysis, and invariance tests evaluated the scale's consistency across baseline and endline. Longitudinal logistic regression models examined whether changes in RE levels predicted family planning outcomes. The results demonstrate the final RE scale is a valid and predictive tool, comprising 24 items across five subscales that measure empowerment at individual, immediate relational, and distant relational levels. The RE scale also predicts the use of family planning and intention to use modern contraception in the future. This is one of the few RE scales designed specifically for SSA contexts and the only one known to be validated longitudinally. The RE scale provides a robust framework for measuring RE across levels and over time and can be used in SSA contexts to measure RE as a dynamic process and as an outcome.
In sub-Saharan Africa, child out-fostering is a traditional social practice, and research suggests stable levels of out-fostering over time, yet the underlying demographic and socioeconomic factors driving this stability...In sub-Saharan Africa, child out-fostering is a traditional social practice, and research suggests stable levels of out-fostering over time, yet the underlying demographic and socioeconomic factors driving this stability have remained largely unexplored. To gain insight into the prevalence and associations of child out-fostering and mothers' individual and household characteristics, we analyzed nine rounds of Demographic and Health Survey (DHS) data of Senegalese mothers of children aged 0-14, collected between 1986 and 2019. Child out-fostering has remained stable, with nearly one-third of mothers of children aged 0-14 living apart from at least one child. Our findings indicate that at the macro-level, counteracting fertility and child mortality dynamics contribute to this stability. At the micro-level, out-fostering is influenced by a complex interplay of maternal demographic, socioeconomic, and household characteristics. The role of demographic macro-level factors demands further research attention in the context of persisting child fostering across sub-Saharan Africa. The results further suggest that changes, such as postponement of motherhood, as well as further declines in fertility and infant mortality, could affect fostering arrangements in the future.
Over the past six decades, significant demographic and familial changes, including rapid fertility decline, have occurred in Latin America and the Caribbean (LAC), impacting household structure and formation. We document...Over the past six decades, significant demographic and familial changes, including rapid fertility decline, have occurred in Latin America and the Caribbean (LAC), impacting household structure and formation. We document trends in and changes to household size and composition in the region, leveraging 144 country-year samples from census and survey microdata across 27 LAC countries. We measure changes in average household size, household composition by member relationship to the household head, and the evolution of female headship. Our findings show a general reduction in household size that mirrors the trend in fertility decline, albeit with subregional variations. An analysis of changes in members' relationships over time reveals that children are the main drivers of household shrinkage. The analysis also unveils the enduring complexity of household composition, namely of extended family structures. Female-headed households, which are characterized by more complex household structures than their male-headed counterparts, significantly increased over time. This trend partly explains the persistence of extended households in LAC. In addition, we document a gradual convergence in the average number of children per household between male- and female-headed households. These results challenge theories positing a global convergence towards nuclear family structures. Overall, LAC's demographic and familial transformations underscore the interplay between shrinking household size and persistent household complexity.