Social independence and reproductive health inequalities among married women in Türkiye

Objective: Women's empowerment is a key determinant of reproductive health outcomes. In Türkiye, persistent gender gaps in education, labor force participation, and decision-making autonomy may shape reproductive behaviors and outcomes. This study examines the association between women’s social independence and reproductive health outcomes using nationally representative data.Methods: We conducted a secondary analysis of 5,156 married women aged 15-49 from the 2018 Türkiye Demographic and Health Survey. Women’s social independence was assessed using a modified version of the SWPER Global Index, adapted to the Turkish context by excluding items not locally applicable. Eight reproductive outcomes were examined: total births, ideal number of children, having more children than the desired number, unplanned births, demand for family planning satisfied with modern methods, contraceptive use (female-only vs. couple methods), induced abortion, and miscarriage. Robust Poisson regression models, adjusted for demographic and socioeconomic factors, estimated prevalence ratios.Results: Higher social independence was consistently linked to more favorable reproductive outcomes. Women in the lowest quintile had a higher prevalence of four or more births (16-fold), desiring four or more children (1.9-fold), having more children than the desired number (5.7-fold), unplanned births (2.3-fold), induced abortions (1.9-fold), and miscarriages (1.7-fold) compared with the highest quintile. Lower social independence was also associated with greater use of female-only contraceptive methods.Conclusion: Social independence strongly influences reproductive health in Türkiye. Integrating gender empowerment into reproductive health policies-through improved education, enhanced mobility, and support for decision-making autonomy-is crucial to reduce inequalities and advance progress toward Sustainable Development Goal 5.