Determinants of fertility in Malawi: Does women autonomy dimension matter?

Background: Power inequality within the household and sexual relationships is linked to poor reproductive health. Malawi Government through National Sexual and Reproductive Health and Rights policy is committed to women empowerment as well fertility reduction. However, there is limited evidence in Malawi regarding whether women's autonomy in the household is an independent determinant of fertility. With this background, the aim of this study is to investigate whether women's autonomy in the household is a determinant of fertility in a poor socioeconomic and cultural setting.

Methods: This study used Malawi Demographic and Health Survey, 2015-2016. A multivariable Poisson regression model was used to investigate if women's autonomy in the household in Malawi determines fertility. The outcome measure, children ever born, was used as a measure of fertility. Women's autonomy was measured with two dimensions, such as women's household related decision makings and women's sexual autonomy. The individual recode and household recode were merged for the analysis. The final study sample was 15,952 women who were cohabiting or married at the time of the survey.

Results: The level of autonomy among women in the household related decisions and sexual autonomy was 49.1% and 64.0% respectively. Controlling for covariates, the study found no significant association between women's autonomy dimensions in the household and number of children ever born. On the other hand, living in urban area (IRR = 0.91, CI 0.88-0.93); having less than tertiary education thus, no education (IRR = 1.83, CI 1.67-1.99) or primary education (IRR = 1.55, CI 1.42-1.69) or secondary education (IRR = 1.23, CI 1.13-1.33); poor households (IRR = 1.05, CI 1.01-1.09), starting cohabiting at the age of 19 years or less (AIRR = 1.15, CI 1.13-1.18) and not using modern contraceptive methods (AIRR = 1.17, CI 1.15-1.19) were significantly associated with fertility.

Conclusions And Recommendations: Though women's autonomy does not have independent effect on fertility, it may be interacting with other sociocultural norms prevailing in the society. The study recommends that the Government of Malawi should come up with economic hardship emancipation policy for poor households. The government should also come up with a girl-child secondary school completion policy. Furthermore, the government should accelerate the implementation, monitoring and evaluation of National Gender Policy to ensure the women empowerment/autonomy is having positive effect at all level including the household.