New Study Puts a Number on Women’s Power to Decide on Sex and Contraception in Burkina Faso

In the broad landscape of global health research, few concepts have proven as stubbornly difficult to measure as women’s empowerment. Now, a team of researchers working in Burkina Faso has taken a significant step toward solving one of the field’s most persistent measurement problems, validating a multidimensional scale designed to capture women’s agency specifically in the domains of family planning and sexual intercourse. The study, published in Social Indicators Research, draws on data from the Performance Monitoring for Action (PMA) research platform and offers both a practical tool for researchers and a sobering portrait of the social forces that continue to constrain reproductive decision-making in the West African nation.

The research, led by Fiacre Bazié of the Institut Supérieur des Sciences de la Population at Université Joseph Ki-Zerbo in Ouagadougou, together with colleagues at Johns Hopkins Bloomberg School of Public Health and Université Joseph Ki-Zerbo’s sociology department, addresses a conceptual gap that has long frustrated the field. Empowerment, as theorists such as Naila Kabeer have argued, is a broad process encompassing resources, agency, and achievements. Agency itself—sometimes described as autonomy or the capacity to define goals and act on them—has been operationalized in many different ways across studies, with instruments often developed in high-income settings or generic contexts that translate poorly to the lived realities of women in sub-Saharan Africa. The new work argues that reproductive empowerment deserves to be treated as a distinct process that both reflects and shapes broader empowerment dynamics, rather than as a simple subset of a general construct.

At the heart of the validated measure are two key dimensions: motivation, defined as the ability to define one’s own reproductive goals, and self-efficacy, the ability to act on those goals. The concept of self-efficacy traces back to Albert Bandura’s foundational work in psychological theory, which holds that beliefs about one’s own capability are critical determinants of behavior change. In the reproductive sphere, this translates into questions of whether a woman feels able to negotiate contraceptive use with a partner, to refuse sexual intercourse, or to seek out family planning services on her own initiative. Motivation, by contrast, captures whether a woman has internalized her own reproductive preferences at all—a precondition for action that is far from universal in contexts where fertility expectations are strongly socially scripted.

The measure was applied across two areas of reproductive health that the researchers describe as key: family planning and sexual intercourse. This dual focus is analytically important. Many existing instruments concentrate exclusively on contraceptive decision-making, treating reproductive autonomy as a question of clinic attendance and method choice. But the negotiation of sexual activity itself—who decides when sex happens, and whether a woman can decline—represents a more fundamental locus of power within relationships. Prior scholarship, including work on sexual relationship power and sexual assertiveness, has established that women’s capacity to navigate sexual negotiation is closely tied to outcomes ranging from contraceptive use to vulnerability to HIV and other sexually transmitted infections.

Methodologically, the validation followed the established conventions of psychometric research. The authors assessed whether the multi-item subdimensions of the measure demonstrated acceptable psychometric properties—reliability and structural validity—for use in the Burkinabe context. Their conclusion was cautiously positive: three of the multi-item subdimensions performed adequately and can be deployed with confidence in future surveys in Burkina Faso. One subdimension, a two-item index of contraceptive self-efficacy, was judged to be more fragile, and the researchers recommend that it be treated as preliminary until further evidence accumulates. This kind of transparency about the limits of a scale is notable in a literature often criticized for adopting measures wholesale without local testing.

Beyond internal validation, the team examined external validity—the question of whether scores on the measure actually predict reproductive outcomes in theoretically expected ways. The results were instructive. Across each domain of agency, the motivation dimension showed more consistent associations with reproductive outcomes than self-efficacy did. In practical terms, this suggests that whether a woman has defined her own reproductive goals may matter more for observed behaviors, such as modern contraceptive use, than her confidence in acting on those goals. For program designers, the implication is that interventions aimed solely at building skills or confidence may miss a critical upstream step: helping women articulate and claim their own fertility preferences in the first place.

Perhaps the most striking findings concern the social architecture of constraint that the study documents. The researchers identify a constellation of factors that limit women’s autonomy in reproductive decision-making in Burkina Faso. Social expectations regarding fertility exert powerful pressure, shaping what women believe they are permitted to want. Fear of infertility—long documented in West African contexts as a consequential concern—discourages behavior perceived to jeopardize future childbearing, including the adoption of certain contraceptive methods. Stigma surrounding female sexuality restrains women from openly discussing or negotiating sexual matters, while perceptions of men’s sexual rights within marriage and partnerships legitimize male authority over the timing and occurrence of intercourse. Finally, fear of relational sanctions—the anticipation of conflict, abandonment, or violence—hangs over women’s calculations in ways that formal measures of household decision-making often fail to capture.

These constraints have direct public health consequences. Burkina Faso, like much of sub-Saharan Africa, continues to grapple with unmet need for family planning, high adolescent fertility, and elevated maternal mortality risks. A substantial body of evidence links women’s agency to contraceptive use, birth spacing, use of obstetric services, and even child health outcomes such as birth weight. Yet the field’s measurement practices have lagged behind this evidence, with systematic reviews repeatedly noting that studies use heterogeneous, weakly validated indicators that make comparison across countries and programs nearly impossible. The PMA platform, which conducts rapid-turnaround household surveys to monitor family planning service and practice across multiple countries, provided the population-based data infrastructure that made a rigorous local validation feasible.

The study’s practical contributions extend beyond Burkina Faso. Because the instrument is grounded in a conceptual framework that distinguishes motivation from self-efficacy, and because it spans both contraceptive and sexual negotiation domains, it offers a template for adaptation elsewhere in the region. The authors note that the datasets supporting the study are available upon request through the PMA data portal, enabling other researchers to extend the validation work. Careful context-specific validation of empowerment measures has become a growing priority in the literature, with previous national validation efforts in settings such as Egypt demonstrating both the feasibility and the necessity of the approach. The Burkina Faso study joins that lineage, and its finding that motivation outperforms self-efficacy as a correlate of outcomes gives other teams a concrete hypothesis to test.

What emerges from the analysis is a picture of reproductive agency not as an individual psychological attribute but as a negotiated social position, continuously shaped by norms, fears, and relationship dynamics. Women in the study population operate within a web of expectations in which fertility is prized, infertility is feared, female sexuality is stigmatized, and male sexual entitlement is widely assumed. Within that web, agency is exercised cautiously and often indirectly. Measures that capture this complexity—distinguishing what women want from what they feel able to do, and distinguishing contraceptive decisions from the negotiation of sex itself—are essential if research and policy are to meet women where they actually are. The validated scale represents a technical achievement, but its deeper significance lies in what it reveals: that expanding reproductive autonomy requires confronting the social expectations, stigmas, and relationship risks that quietly determine the boundaries of what women in Burkina Faso can choose.

Subject of Research: Validation of a multidimensional measure of women's reproductive agency in family planning and sexual decision-making in Burkina Faso

Article Title: Reproductive Agency: Validation of a Measure for Women's Autonomy in Family Planning and Sexual Intercourse in Burkina Faso

Article References: Bazié, F., Onadja, Y., Soura, A. B., Byrne, M. E., & Bationo, F. B. (2026). Reproductive Agency: Validation of a Measure for Women's Autonomy in Family Planning and Sexual Intercourse in Burkina Faso. Social Indicators Research, 184(2), Article 44. https://doi.org/10.1007/s11205-026-03932-7

Image Credits: AI Generated

DOI: 10.1007/s11205-026-03932-7

Keywords: reproductive agency, women's empowerment, family planning, self-efficacy, measurement validation, Burkina Faso, sexual autonomy, psychometrics, contraception, PMA survey, gender norms, fertility expectations