Women’s empowerment has become a focal point for development efforts worldwide and there is a need for an updated, critical assessment of the existing evidence on women’s empowerment and fertility. We conducted a literature review on studies examining the relationships between women’s empowerment and several fertility-related topics. Among the 60 studies identified for this review, the majority were conducted in South Asia (n = 35) and used household decision-making as a measure of empowerment (n = 37). Overall, the vast majority of studies found some positive associations between women’s empowerment and lower fertility, longer birth intervals, and lower rates of unintended pregnancy, but there was some variation in results. In many studies, results differed based on the measure of empowerment used, sociopolitical or gender environment, or sub-population studied. This article is one of the first evaluations of the literature assessing the relationships between women’s empowerment and fertility. We identify several key issues that merit further investigation.

In this study, compared with having an abortion, being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes. Psychological well-being improved over time so that both groups of women eventually converged. These findings do not support policies that restrict women's access to abortion on the basis that abortion harms women's mental health.

This valid and reliable scale can be used in research examining abortion stigma and related outcomes (e.g., women's health, relationships and behavior). The scale can also be used to evaluate programs and interventions that aim to reduce the stigma experienced by women who have abortions.

No validated measures are currently available to assess women's ability to achieve their reproductive intentions, also referred to as "reproductive autonomy." We developed and validated a multidimensional instrument that can measure reproductive autonomy. We generated a pool of 26 items and included them in a survey that was conducted among 1,892 women at 13 family planning and 6 abortion facilities in the United States. Fourteen items were selected through factor analysis and grouped into 3 subscales to form a Reproductive Autonomy Scale: freedom from coercion; communication; and decision-making. Construct validity was demonstrated by a mixed-effects model in which the freedom from coercion subscale and the communication subscale were inversely associated with unprotected sex in the past three months. This new Reproductive Autonomy Scale offers researchers a reliable instrument with which to assess a woman's power to control matters regarding contraceptive use, pregnancy, and childbearing, and to evaluate interventions to increase women's autonomy domestically and globally.

The literature on women's empowerment has defined and conceptualized "empowerment" using different and often interchangeable terms, including "autonomy," "status" and "agency." 1,2 According to one definition, empowerment is "the expansion of people's ability to make strategic life choices in a context where this ability was previously denied to them." 3 Two central components of empowerment are the agency and the resources needed to exercise life choices. 2,3 In addition, the construct of women's empowerment encompasses many dimensions, including reproductive, economic, social and cultural, familial and interpersonal, legal, political and psychological, 2 which leads to wide variation in conceptualization. Given this wide variation, women's empowerment is difficult to measure consistently. Studies often assess women's autonomy with an index measuring participation in decision making about various household issues, which represents women's degree of control over their environment. Some researchers include both major decisions (e.g., large household purchases) and minor decisions (e.g., what food to cook) in the index, 4 whereas others exclude day-to-day household choices and those that are traditionally within the woman's domain. 5 Other measures of women's empowerment assess freedom of movement, 6,7 differences in age and education between marital partners, 8,9 and the process of spouse selection. 10Even with a clear definition and conceptualization, these constructs are difficult to quantify in a standardized way within a given population. To measure empowerment at an individual level, researchers must translate the amorphous construct into a set of specific questions that population-based surveys can ask; ideally, those questions would be applicable to individual respondents with a diverse set of social and demographic characteristics. For example, young women who have not had sex would not have the experience needed to answer questions about sexual power. In such a case, hypothetical situations could be used to ascertain attitudes and beliefs, but such situations are often difficult for people to fully understand and respond to realistically. 11Another challenge is the variation in cultural contexts that affect the measurement of women's empowerment. A measure that captures empowerment in one context may have limited relevance in another, as is the case with measures of mobility in communities where free movement is the norm for women. Thus, for the validity of cross-national comparisons, it is important to identify universally applicable measures, regardless of the gender equity environment. (beta coefficients, -0.5 and -0.3, respectively