Women's autonomy, education and contraception use in Pakistan: a national study

BACKGROUND: It has been proposed that the autonomy of women is one of the mechanisms of how education influences contraceptive use in developing countries. We tested this hypothesis in a national sample of women in Pakistan. METHODS: We used the 2000 Pakistan Reproductive Health and Family Planning Survey, which interviewed a national sample of ever married women aged 15-49 years (n = 6579). Women's decision autonomy was estimated from 9 questions on who makes decisions at home; movement autonomy was based on 6 questions on whether women need permission to visit places outside home. A number of socio-demographic variables were used in multivariate analysis to investigate the independent association between autonomy and lifetime and current contraception use and to assess the extent to which autonomy mediates the association between education and contraception use. RESULTS: Decision autonomy was significantly associated with both lifetime and current contraception use; after controlling for covariates, the odds ratios for the highest vs. the lowest quintile were 1.8 (1.4-2.4) and 2.0 (1.4-2.8), respectively. Movement autonomy was not consistently associated with contraceptive use. Contraceptive use was strongly associated with women's education but this relation was not mediated by women's autonomy. CONCLUSION: Women's decision autonomy is significantly associated with contraceptive use but it does not appear to mediate the link between woman's education and contraception.