By Melinda Young

Evidence has found that education and family planning provide long-term benefits to maternal and child health outcomes and the largest returns on investment. But there are fewer data on how much family planning contributes to women’s empowerment and greater agency.¹ “Our goal and interest was in this idea that family planning use empowers women and also that family planning and empowerment are [closely] linked,” says Nadia Diamond-Smith, PhD, MSc, an associate professor in the department of epidemiology and biostatistics at the University of California San Francisco and Institute of Global Health Sciences in San Francisco.

“It’s intuitive, and we think we know that [link] as people of the world, but when we look at the literature, there is not as much out there to provide strong evidence,” she adds. “It doesn’t tell us which came first — empowerment or family planning.” Diamond-Smith and co-investigators wanted to know whether family planning had longer-term effects on their lives, including retirement, and whether women have more empowerment if they can space their pregnancies or have pregnancies when they want to have them.

“We took a different perspective that looked at empowerment as a process of multiple domains, including some of the things we rely on such as labor force participation, and those are a great measure of women’s empowerment,” Diamond-Smith says. “But it’s only one piece of a process, and maybe they are relied on because they’re easier to measure: Are you in school? Do you have a job?”

The more complicated measures to collect involve decision-making capability, agency, and feelings of aspiration or confidence, she adds. Access to acting on one’s knowledge is another facet of empowerment. For instance, if a woman is well-educated on contraception, family planning, and reproductive health but has limited access to prenatal supplements, contraception, and reproductive healthcare, then she lacks full empowerment.

Researchers speak with women who say they know about contraception, but they are not able to do it. This suggests that clinicians and researchers are not fully managing women’s empowerment if they just make certain they are knowledgeable about existing contraceptive options and reproductive healthcare actions they might take, Diamond-Smith notes.

This division between what a woman knows is possible and what is available to her also is seen in places where governmental laws and regulations limit a woman’s options for family planning. This division can be seen in U.S. states and in nations where women’s right to end a pregnancy is prohibited or made too difficult for most to access. Economic barriers to contraception also can affect access and empowerment, research shows.¹

Cultural or geographic barriers are another factor that cannot be studied globally. “What we mean by empowerment in Bangladesh vs. Ethiopia vs. the United States varies,” Diamond-Smith says.

“How can we compare empowerment and what empowerment might mean across countries?” she explains. “I work mostly in South Asia, and there is mobility [as a measure of empowerment]. Women being able to leave their home and go somewhere alone is a huge thing there.”

But in Africa, mobility is not an issue for most women, she notes. This means that adding mobility as a measure of empowerment might produce useful data in one country but not in another. “The people interested in empowerment try to measure across these domains, and we go back and forth about whether it is even possible to think about one measure that can be used as a global concept,” she adds.

One of the reasons researchers often use income and education as measures of empowerment is because they are easy to measure and they also are more universal than other measures, she says. “If you’re doing a multisite study of family planning, it’s much easier to say women have more income and compare,” Diamond-Smith says. “What we’re pushing people to think about is to not stop there. Even if a woman has more family income, she may not have decision-making over how the income is used, so it’s not really a marker of empowerment.” Someone could have resources without having agency to act on her hopes and plans.

Other factors related to empowerment and autonomy involve individual circumstances, such as a person’s marriage, intimate partner violence, and household size. Women in some homes in the United States have very little empowerment because of patriarchal family systems or violence that prevents them from being able to act on their family planning desires.¹

From a clinician’s perspective, the chief objective is to counsel patients on their options and include information that could help them overcome access barriers related to cost, transportation, confidentiality, and clinic visit time. But they have to be careful they provide information to patients in a way that is noncoercive, Diamond-Smith says. “Remember family planning has so many long-term benefits in helping women to have reproductive autonomy and to plan their families as they wish,” she adds.

More broadly, there is evidence that access to family planning has huge effects on women’s lives in the areas of education, labor participation, income, and intimate partner violence, she says. “This gives women more decision-making power, and they’re able to meet their aspirations and long-term impacts on society,” Diamond-Smith explains. “By limiting [family planning options], it could have wide-ranging impacts on women.”

It also affects society since women’s labor force participation is important to a society’s economy, she adds. “This message that family planning has such broad long-term impacts on women’s and families’ lives, and think about empowerment across the range of domains,” Diamond-Smith says.

“And that it’s not only concrete, measurably economic framing of things; there are social and emotional, familial and other ways to measure empowerment and how women are able to interact and meet their goals in their lives,” she says.

Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.

Reference

1. Diamond-Smith NG, Gopalakrishnan L, Wawire S, et al. Does family planning use empower women? A systematic review of the evidence. Reprod Health. 2025;22(1):230.