Sexual & Reproductive Healthcare 5 (2014) 9–15

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Sexual & Reproductive Healthcare

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Women’s household decision-making autonomy and contraceptive

behavior among Bangladeshi women
Md. Mosfequr Rahman a,⇑, Md. Golam Mostofa a, Md. Aminul Hoque b
a
Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
b
Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh

a r t i c l e i n f o a b s t r a c t

Article history: Background: Women’s autonomy is a potentially important but less studied indicator of using contracep-
Received 16 July 2013 tion among women as well as ability to control their fertility. This study explores women’s decision-
Revised 3 December 2013 making autonomy as a potential indicator of the use of contraception in Bangladesh.
Accepted 16 December 2013
Methods: This cross-sectional study utilizes data from the Bangladesh Demographic Health Survey
(BDHS) 2007. Information of 8456 currently married and non-pregnant women aged 15–40 years are
analyzed to meet up the objective of this study.
Keywords:
Results: The mean age of the respondents is 27.19 years and majority of the respondents are from rural
Household decision-making autonomy
Contraception
areas (62.7%) and also Muslim (90.2%). A large number of women (26.1%) and their husbands (29.0%) have
Bangladesh no education and 27.2% respondents were working at the time of interview. The mean number of living
children is 2.14. 48.9% of the respondents are currently using a modern method of contraception. More
than one-third women are not involved in their household decision-making. Results of this study indicate
that household decision-making autonomy is significantly associated with current use of modern contra-
ception, future intention to use contraception and discuss contraception with husband. This measure of
women’s autonomy provides additional independent explanatory power of contraceptive behavior net of
some other socio-demographic variables.
Conclusion: This study argues in favor of increasing women’s autonomy to increase contraception using
rate in this population.
Ó 2013 Elsevier B.V. All rights reserved.

Introduction
Increasing contraceptive use is an important development
strategy component in developing countries. Bangladesh has expe-
rienced marked changes in this sector during the past few decades.
The contraceptive prevalence rate (CPR) in Bangladesh had risen
from 8% in 1975 to 55.8% in 2007 [1]. This is a great achievement
in Bangladesh where most people are characterized by many
familial, socio-economic, and cultural (religious) taboos which
are believed to be barrier of use of modern contraception [2].
Adopting target oriented population policies and programs in
mid-70’s by the government of Bangladesh are the primary cause
of such achievement. Overall, 17 percent of currently married wo-
men in Bangladesh have an unmet need for family planning ser-
vices, 7 percent for spacing and 11 percent for limiting births.
The total demand for family planning in Bangladesh is 73 percent.
Seventy-seven percent of family planning demand is satisfied. Un-
met need increased from 15% of currently pregnant women in
⇑ Corresponding author. Tel.: +880 721 750041x4121; fax: +880 721 750064.
E-mail address: mosfeque@gmail.com (M.M. Rahman).
2004 to 17% in 2007 [1]. The Health Population Nutrition Sector
Development Program (HPNSDP) has set a target reducing unmet
need for family planning services to 9% by 2016.
Several studies indicated that the changes in household organi-
zation, socio-economic status of women and women’s involvement
in household decision-making are important factors of using con-
traception as well as long-term fertility reduction in developing
countries [3,4]. To provide empirical evidence for this proposition
researchers have conducted several numbers of studies focusing
on the link between these factors and fertility reductions. In a
developing country like Bangladesh women generally possess infe-
rior positions in household. In effect women are either under col-
lective decision-making with their parents or completely rely on
the male partner’s decisions on issues that affect their reproductive
lives [5]. Hakim et al. [6] suggested that greater gender equality
may encourage women’s autonomy and may facilitate the uptake
of contraception because of increased female participation in deci-
sion-making.
Personal autonomy has been defined as the capacity to manip-
ulate one’s environment through control over resources and infor-
mation for personal interests [7,8]. By having personal autonomy, a
woman is said to be able to improve and maintain her health, and

1877-5756/$ - see front matter Ó 2013 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.srhc.2013.12.003
10 M.M. Rahman et al. / Sexual & Reproductive Healthcare 5 (2014) 9–15
seek necessary health-related resources [9]. The concept of
women’s autonomy, although related to women’s status, is more
closely associated with women’s power and agency. Women’s
autonomy does not imply prestige or position within a social con-
text. It is not necessarily accorded to women as women’s status
generally is, but reflects personal capacities. Measures of women’s
autonomy have included decision-making autonomy, permission
to go out, and financial autonomy [10]. Household decision-mak-
ing is an important and more direct measure of gender relations
and also measure of women’s autonomy within their families,
because it is positively related to women’s empowerment and
women are able to exercise in areas that affects their lives and
environments.
A substantial body of research has examined the role of wo-
men’s autonomy on health and behavioral outcomes such as fertil-
ity [8,11], unintended pregnancy [12], child rearing [13], child
survival [14] and development [15], and pregnancy care [16,17].
Some studies also focus on the relationship between household
decision making and the use of contraception [3,4,18]. During last
two decades, Bangladesh has achieved greater gender equity in
terms of school enrolment, increasing job market participation of
women and also in alleviating poverty, and women’s empower-
ment through the success of microcredit programs [19–21]. Under
these circumstances, this study explores women’s decision-making
autonomy as a potential indicator of the use of contraception in
Bangladesh.
Methods
Sample
This cross-sectional study used data from the 2007 Bangladesh
Demographic Health Survey (BDHS), conducted by the National
Institute for Population Research and Training of the Ministry of
Health and Family Welfare of Bangladesh, from March to August
2007 [1]. The survey was implemented by Mitra and Associates,
a Bangladeshi research firm located in Dhaka. Macro International
Inc., a private research firm located in Calverton, Maryland, USA,
provided technical assistance to the survey as part of its interna-
tional Demographic and Health Surveys program. The U.S. Agency
for International Development (USAID)/Bangladesh provided
financial assistance. The survey used a sample drawn from the to-
tal population of Bangladesh residing in private dwellings. A strat-
ified, multistage cluster sample of 361 primary sampling units, 227
in rural areas and 134 in urban areas, was conducted. A total of
11,178 eligible women aged 15–49 years were identified to partic-
ipate in the survey; 10,996 were interviewed, a response rate of
98.4%. The principal reason for non-response among eligible wo-
men was their absence from home despite repeated visits to the
household. Members of the survey team underwent extensive
training on data collection procedures for 4 weeks prior to the
commencement of the survey. Five well-designed, pre-tested ques-
tionnaires (a Household Questionnaire, a Women’s Questionnaire,
a Men’s Questionnaire, a Community Questionnaire, and a Facility
Questionnaire) were used during the survey. The questionnaires
were pretested on 100 women and 100 men in two rural areas
and two urban areas. Four quality control teams ensured data qual-
ity; each team included one male and one female data quality con-
trol worker. In addition, NIPORT monitored fieldwork with another
set of quality control teams. Data quality was also monitored
through field check tables generated concurrently with data pro-
cessing. This permitted the quality control teams to advise field
teams about problems detected during data entry. Tables were
specifically generated to check various data quality parameters.
Fieldwork was also monitored through visits by representatives
from USAID, Macro International, and NIPORT. Fieldwork was
implemented in five phases and carried out from March 24 to
August 11, 2007. The interviewers went to houses of the respon-
dents’ and collected information from them by asking questions.
Women from selected household were interviewed, whether lit-
erate or illiterate. Questionnaires were drafted in English and then
translated into Bangla, the national language of Bangladesh. All the
people of Bangladesh can speak and understand Bangla very well
so none of the respondents was drop out because of language.
First-hand quantitative and qualitative questions on the surveys
allow for unique and accurate depiction of an entire country’s pop-
ulation. From its inception, the BDHS program has emphasized the
collection of accurate data on demographic events and indicators.
Many steps are required to ensure that the data properly reflect
the situations they intend to describe and that data are comparable
across countries therefore, MEASURE DHS has developed standard
procedures, methodologies, and manuals to guide the survey
process. The Bangladesh Demographic and Health Survey (BDHS)
is one of them and followed the same standard procedure in collec-
tion data. Hence, the findings from this survey are almost accurate
and provide the picture of the whole country. Data collection
procedures for the BDHS were approved by the ORC Macro Institu-
tional Review Board. Details of data collection and management
procedures are described elsewhere [1]. Out of 10,146 married
women of reproductive age interviewed, information of 8456
women aged 15–40 years was analyzed in this present study.
Women over 40 years are less likely at the risk of pregnancy so
they are excluded from the study and the women who are
currently pregnant are also excluded.
Measures
Women’s autonomy
Women’s household decision-making autonomy was measured
based on responses to individual questions regarding who makes
decisions in the (respondent’s) household about: (1) obtaining
health care; (2) large household purchases; (3) household pur-
chases for daily needs; (4) visits to family or relatives; and (5) child
health care. The response options were: (a) respondent alone, (b)
respondent and husband/partner, (c) respondent and other person,
(d) husband/partner alone, (e) someone else, (f) other. For each
question, a value of 1 was assigned if the response was (a), (b),
or (c), and 0 for (d), (e), or (f).The values were then added resulting
in a score from 0 to 5 (Cronbach’s a = 0.9211).
Contraceptive behavior
In this study, contraceptive behavior among women was deter-
mined by current use of contraception, future intention to use and
discussion with husband about contraception. Current use of con-
traception is defined as the proportion of currently married women
who report that they are currently using a family planning method.
Methods of contraception is categorized as modern methods (the
pill, IUD, injectables, implants, condoms, female sterilization, and
male sterilization), traditional methods (periodic abstinence and
withdrawal) (1), and folkloric methods (typically massages or
herbs that may have abortifacient qualities) [22]. Currently mar-
ried women who were not using contraception at the time of sur-
vey—defined as nonusers—were asked about their intention to use
family planning in the future. The 2007 BDHS also assessed couple
communication on family planning among currently married wo-
men who were not sterilized and who knew a contraceptive meth-
od. Interviewers asked how often they had talked with their
husband about family planning in the 3 months preceding the
survey.
 M.M. Rahman et al. / Sexual & Reproductive Healthcare 5 (2014) 9–15 11

Study covariates 27.19 years. Majority of the respondents are from rural areas
All socio-demographic variables were assessed via self-report (62.7%) and also Muslim (90.2%). A large number of women
and the variables include age, respondent’s and husband’s educa- (26.1%) and their husbands (29.0%) have no education and 27.2%
tion, number of living children, respondent’s current work status, respondents were working at the time of interview. The mean
wealth index, place of residence and religion and number of child number of living children is 2.14 and the mean number of child
loss. Education of the respondent and husband was categorized loss is 0.23.
into no education and some education. Religion was categorized Table 2 presents the knowledge about contraception and use
into Muslims and non-Muslims. The wealth index was constructed pattern of the respondents. 99.8% know modern method; among
from data on household assets, including ownership of durable the respondents 48.9% currently using a modern method of
goods (such as televisions, refrigerator, mobile phone, bicycle, contraception.
etc.) and dwelling characteristics (such as source of drinking water, Table 3 displays percentage distributions of the responses to the
sanitation facilities, and construction materials). To create the autonomy related questions. Women’s autonomy in household
wealth index, each asset was assigned a weight (factor score) gen- decision-making among married Bangladeshi women aged
erated through principal component analysis, and the resulting as- 15–40 years is not high. More than one-third women are not
set scores were standardized in relation to a normal distribution involved in decision-making about their own health care (37.3%),
with a mean of zero and standard deviation of one [23]. Each buying major household items (35.8%), buying household daily
household was then assigned a score for each asset, and the scores needs (31.4%), visits to family/relatives (34.1%), or child health care
were summed for each household; individuals were ranked (20.9%).
according to the total score of the household in which they resided. Tables 4–6 show the relationship between several contracep-
The sample was then divided into quintiles with 1 = poorest and tive behaviors and women’s autonomy to make household
5 = wealthiest 20% of household. decisions among married Bangladeshi women. Household deci-
sion-making autonomy is significantly associated with current
Statistical analysis use of modern contraception among the respondents and it is in-
creases with the number of decisions taken (OR = 1.45, 95% CI:
We used bivariate analyses and multiple logistic regressions to 1.51–1.81 for participating in one decision; OR = 1.40, 95% CI:
investigate the relationship between women’s household decision- 1.15–1.70 for participating two decisions; OR = 1.40, OR:
making autonomy and contraceptive behavior, as well as a number 1.21–1.61 for participating three decisions and OR = 1.90, 95% CI:
of other sociodemographic variables. Multiple logistic regression 1.43–1.89 for participating all the five decisions) (Table 4). Again
were used to calculate the maximum likelihood estimates of the educated husband (OR = 1.18, 95% CI: 1.05–1.33) and respondent
odds ratio (OR) and 95% confidence interval (CI), adjusted for (OR = 1.27, 95% CI:1.23–1.44), working women (OR = 1.29, 95%
theoretically relevant variables. All statistical analyses were con- CI: 1.22–1.36), women from urban areas (OR = 1.51, 95% CI:
ducted using SPSS 17.0 for windows (SPSS Inc., Chicago, IL). 1.34–1.69) and richest households (OR = 1.16, 95% CI: 1.01–1.33),
and an increasing number of living children (OR = 1.15, 95% CI:
Results 1.10–1.20) are significantly associated with current contraception
use. Bangladeshi women (Muslim) are also less likely to use cur-
Table 1 displays mean or percentage distributions for the study rent modern contraception (OR = 0.74, 95% CI: 0.63–0.87).
variables of interest. The mean age of the respondents is Table 5 represents the association between future intention to
use contraception and household decision-making autonomy.
Table 1
Household decision-making autonomy is significantly associated
Characteristics of the population (n = 8456).
with future intention to use contraception when women partici-
% N pated in all the five decisions (OR = 1.50, 95% CI: 1.19–1.89). With
Respondent’s age Mean = 27.19 8456 the increment of age, future intention of using contraception
s.d = 6.87 among women decreases significantly (OR = 0.83, 95% CI:
Residence 0.81–0.85). Future intention to use contraception significantly in-
Rural 62.7 5304 creases among educated women (OR = 1.67, 95% CI: 1.30–2.16)
Urban 37.3 3152
and their husband’s (OR = 1.33, 95% CI: 1.03–1.71) and also women
Religion with more number of living children (OR = 1.13, 95% CI: 1.05–1.22).
Non-Muslim 9.8 830
Table 6 presents the odds ratios of the couples having discussed
Muslim 90.2 7626
about the family planning and women’s autonomy and other
Wealth index
variables. Women who make more household decision are signifi-
Poorest 16.2 1369
Poorer 18.7 1581 cantly more likely to discuss family planning with their husbands
Middle 19.2 1624 (from OR = 1.32, 95% CI: 1.09–1.55 for participating two decisions
Richer 19.7 1666
Richest 26.2 2216
Respondent’s level of education Table 2
No education 26.1 2207 Contraception knowledge and use pattern of among currently married Bangladeshi
Some education 73.9 6246 women aged 15–40 years (n = 8456).
Husband’s level of education % N
No education 29.0 2531
Some education 70.0 5916 Knowledge of any method
Knows no or traditional method only 0.2 17
Respondent’s currently working Knows modern method 99.8 8439
No 72.8 6157
Yes 27.2 7797 Current contraceptive method
No. of living children Mean = 2.14 Not using 43.3 3662
s.d. = 1.54 Folkloric method 0.4 34
No. of child loss Mean = 0.23 Traditional method 7.4 629
s.d. = 0.57 Modern method 48.9 4131
12 M.M. Rahman et al. / Sexual & Reproductive Healthcare 5 (2014) 9–15

Table 3
Response to questions about women’s household decision-making autonomy.

Women’s autonomy Percent (number)

Respondent alone decides Jointly decides with family member Respondent not involved in decision
Obtaining health care for herself 14.3 (1206) 48.5 (4099) 37.3 (3150)
Buying major household item 8.9 (754) 55.3 (4676) 35.8 (3024)
Buying household daily needs 31.7 (2684) 36.9 (3119) 31.4 (2653)
Family/relative visits 13.5 (1140) 52.3 (4425) 34.1 (2887)
Child health care 19.2 (11622) 49.2 (4156) 20.9 (1771)

Table 4
Odds ratios of current contraceptive use and measures of women’s autonomy and other characteristics (n = 8456).

b S.E. (b) Odds ratio (95% CI)

Household decision-making autonomy
No decisions taken (Ref. category)
One decision taken 0.368 0.115 1.45** (1.15–1.81)
Two decisions taken 0.333 0.1 1.40** (1.15–1.70)
Three decisions taken 0.125 0.082 1.13 (0.97–1.33)
Four decisions taken 0.335 0.072 1.40*** (1.21–1.61)
All the decisions taken 0.395 0.162 1.90*** (1.43–1.89)
Socio-demographic characteristics
Woman’s age 0.011 0.005 1.01* (1.00–1.02)
Woman’s educational level
No education (Ref. category)
Some education 0.241 0.063 1.27*** (1.23–1.44)
Husband’s educational level
No education (Ref. category)
Some education 0.164 0.06 1.18** (1.05–1.33)
Current work status
Not working (Ref. category)
Currently working 0.253 0.028 1.29*** (1.22–1.36)
Place of residence
Rural (Ref. category)
Urban 0.409 0.059 1.51*** (1.34–1.69)
Religion
Non-muslim(Ref. category)
Muslim 0.299 0.084 0.74*** (0.63–0.87)
Household wealth index
Poorest (Ref. category)
Poorer 0.077 0.081 1.08 (0.92–1.27)
Middle 0.028 0.069 1.03 (0.90–1.18)
Richer 0.008 0.067 1.01 (0.88–1.15)
Richest 0.146 0.069 1.16* (1.01–1.33)
Number of living children 0.139 0.023 1.15*** (1.10–1.20)
Number of child loss 0.003 0.043 1.01 (0.92–1.09)
*
p 6 0.05.
**
p 6 0.01.
***
p 6 0.001.

to OR = 1.42, 95% CI: 1.27–1.77 for participating all the five
decisions). As expected educated women (OR = 1.36, 95% CI:
1.21–1.53) and their husbands (OR = 1.15, 95% CI: 1.03–1.29),
working women (OR = 1.16, 95% CI: 1.10–1.22), richest households
(OR = 1.27, 95% CI: 1.12–1.45) and women having more number of
living children (OR = 1.08, 95% CI: 1.04–1.13) are significantly more
likely to discuss with their husbands about contraception. Also
with the increment of age women are less likely to discuss with
their husband about using contraception (OR = 0.96, 95% CI:
0.95–0.97).
Discussions
This study supports the idea that women’s autonomy to make
household decision is an important factor in the process of fertility
regulation in Bangladesh. The study findings indicate that house-
hold decision-making autonomy is significantly associated with
current use of contraception, future intention to use contraception
and discuss with husbands about contraception among married
women in Bangladesh. These results support that a higher degree
of women’s autonomy in the household as participating in house-
hold decision-making can greatly increase the use of contraception
in Bangladesh. Findings of this study also corroborate the earlier
studies around the world including Bangladesh [3,21,24–30]. This
study reaffirmed the pivotal role of the association between wo-
men’s autonomy and contraceptive use in conservative setting like
Bangladesh. Women’s decision-making power may develop nor-
mative changes in gender relations and rules governing women’s
behavior within the family and the community more broadly
[31]. These changes bring with them attendant changes in men’s
behavior vis-à-vis women, including decisions about fertility regu-
lations. It is obvious that the legacy of male dominance and power
is an important aspect of gender relations in Bangladeshi society. A
lot of initiatives have been taken by the government of Bangladesh
 M.M. Rahman et al. / Sexual & Reproductive Healthcare 5 (2014) 9–15 13

Table 5
Odds ratios of future intention to use contraception and women’s autonomy and other characteristics (n = 3656).

b S.E. (b) Odds ratio (95% CI)

Household decision-making autonomy
No decisions taken (Ref. category)
One decision taken 0.224 0.247 1.25 (0.77–2.03)
Two decisions taken 0.427 0.238 1.53 (0.96–2.44)
Three decisions taken 0.245 0.19 1.28 (0.88–1.86)
Four decisions taken 0.215 0.171 1.24 (0.89–1.74)
All the decisions taken 0.407 0.118 1.50** (1.19–1.89)
Socio-demographic characteristics
Woman’s age 0.189 0.011 0.83*** (0.81–0.85)
Woman’s educational level
No education (Ref. category)
Some education 0.515 0.13 1.67*** (1.30–2.16)
Husband’s educational level
No education (Ref. category)
Some education 0.284 0.129 1.33* (1.03–1.71)
Current work status
Not working (Ref. category)
Currently working 0.028 0.066 1.03 (0.90–1.17)
Place of residence
Rural (Ref. category)
Urban 0.119 0.138 1.13 (0.86–1.48)
Religion
Non-muslim(Ref. category)
Muslim 0.219 0.212 0.80 (0.53–1.22)
Household wealth index
Poorest (Ref. category)
Poorer 0.196 0.174 0.82 (0.58–1.16)
Middle 0.014 0.155 1.01 (0.75–1.73)
Richer 0.069 0.155 0.93 (0.69–1.26)
Richest 0.191 0.166 1.21 (0.88–1.67)
Number of living children 0.12 0.039 1.13** (1.05–1.22)
Number of child loss 0.134 0.08 0.87 (0.75–1.02)
*
p 6 0.05.
**
p 6 0.01.
***
p 6 0.001.

to empower women from last few decades, still both genders seem
to hold traditional views about the roles of men and women. When
it comes to fertility and family planning, husbands are to believe
that they should control the number of children their wives have
[32]. In a study, it is found that some women reported initiating
discussions about contraceptives with their husbands but that
the husbands, being the financial providers, made the final deci-
sions [33]. With the imbalances in power in many marriages,
women may fear of violence due to discussion of family planning
or contraceptive use [32]. Thus, this study finding adds more
knowledge that the decision making power is one of the important
factors of increasing current contraceptive prevalence rate as well
as reducing population growth in Bangladesh.
The relevance of some demographic, socioeconomic and cul-
tural measures (age, education, working status, religion, place of
residence, number of living children, etc.) in fertility regulation
behavior among women in Bangladesh must not be underesti-
mated. Several measures of women’s status (currently working or
not, women’s education) are included in this study to determine
whether these measures predict women’s contraceptive behavior.
Socio-demographic factors such as woman’s age, her husband’s le-
vel of education are also included to serve as predictors of fertility
regulations. Moreover, there may be important differences in con-
traceptive behavior among Bangladeshi women by residence,
number of living children and household wealth. Data of this study
shows that respondent’s age is significantly associated with future
intention to use contraception and discuss family planning with
husbands. With the increase of age the likelihood of future inten-
tion to use contraception and discuss family planning with hus-
band decreases by 17% and 4%, respectively.
Women’s and her husbands’ education are found to have a
significant positive effect on contraceptive behavior among women
in Bangladesh. This means that higher level of education for both
husband and wife is associated with greater acceptance of contra-
ceptive use. Researches done in different parts of the world have
been repeatedly documented the effect of women education in
enhancing contraceptive use [24,27,34–37]. Educated women are
more likely than others to desire smaller families and hence have
a stronger motivation to practice contraception. Education also
improves women’s control over reproductive choices by enhancing
women’s position within the family [38]. This may because, edu-
cated women have greater familiarity with the formal institutions
and health providers and also better informed available contracep-
tive options and sources. Furthermore, once they have made the
decision to regulate fertility, educated women are more likely to
use contraceptives effectively, and they have a lower rate of dis-
continuation and failure [39].
It is also worth noting that women’s current work status, reli-
gion and place of residence are statistically significantly associated
with current use of contraception and discuss contraception with
husband in this study. Currently working women and urban wo-
men are significantly more likely to use contraception and discuss
with husband. Women who are currently working have greater
exposure to mass media and hence have greater knowledge about
contraceptive. Currently working women more likely to use con-
traception and delaying childbirth may be due to the loss of their
earnings [40]. On the other hand, this study reveals that rural wo-
men using less contraception than urban women which is consis-
tent with the study of Hogan et al. [41], who indicates that in the
rural population, lifetime fertility remains high, knowledge about
14 M.M. Rahman et al. / Sexual & Reproductive Healthcare 5 (2014) 9–15

Table 6
Odds ratios of the couples having discussed about the family planning and women’s autonomy and other characteristics (n = 8456).

b S.E. (b) Odds ratio (95% CI)

Household decision-making autonomy
No decisions (Ref. category)
One decision taken 0.214 0.114 1.24 (0.99–1.55)
Two decisions taken 0.277 0.097 1.32** (1.09–1.59)
Three decisions taken 0.187 0.079 1.21* (1.03–1.41)
Four decisions taken 0.244 0.068 1.28*** (1.12–1.46)
All the decisions taken 0.126 0.08 1.42*** (1.27–1.77)
Socio-demographic characteristics
Woman’s age 0.043 0.005 0.96*** (0.95–0.97)
Woman’s educational level
No education (Ref. category)
Some education 0.308 0.061 1.36*** (1.21–1.53)
Husband’s educational level
No education (Ref. category)
Some education 0.141 0.058 1.15* (1.03–1.29)
Current work status
Not working (Ref. category)
Currently working 0.149 0.027 1.16*** (1.10–1.22)
Place of residence
Rural (Ref. category)
Urban 0.109 0.056 1.12 (0.99–1.24)
Religion
Non-muslim(Ref. category)
Muslim 0.103 0.079 0.90 (0.77–1.05)
Household Wealth Index
Poorest (Ref. category)
Poorer 0.048 0.079 1.05 (0.90–1.23)
Middle 0.028 0.068 1.03 (0.90–1.18)
Richer 0.073 0.065 1.08 (0.95–1.22)
Richest 0.239 0.066 1.27*** (1.12–1.45)
Number of living children 0.08 0.022 1.08*** (1.04–1.13)
Number of child loss 0 0.041 1.00 (0.92–1.08)
*
p 6 0.05.
**
p 6 0.01.
***
p 6 0.001.

contraceptives is low, husband-wife discussions about contracep-
tion is relatively rare and only few women want to limit child birth.
In accordance with earlier study among Asian women [42], Ban-
gladeshi women (Muslims) are less likely to use contraception
than other Bangladeshi women (non-Muslims). Number of living
children is also another important predictor of the contraceptive
behavior among currently married Bangladeshi women. Number
of living children is significantly positively associated with current
use of contraception, future intention to use contraception and
discuss about contraception with husband. Contraception use
increases with the more number of living children [43–47].
In conclusion, these findings provide important insights into the
relationship between women’s autonomy in household decision-
making and contraceptive behavior among currently married
women in Bangladesh. Although the relationship is naturally com-
plex, some patterns are discernible as results indicate that autonomy
increases theuse of contraceptionamong womenin Bangladesh.Also,
results show that contraceptive behavior is strongly associated with
the educational status of husband and wife, work status of the
women, religion, place of residence and number of living children.
Increasing the contraceptive prevalence and hence reducing fertility
rates, and improving the health of women and their children in
Bangladesh will therefore need an integrated/holistic approach. This
approach will require the government to increase the legal age for
marriage, promote efficient and effective use of contraceptives, and
elevate women’s position in the household. Women’s household
position can be enhanced by increasing knowledge about their
rights through education and communication, changing social atti-
tudes and norms about women, and encouraging greater participa-
tion of women in household decision-making and other social
activities.
It is important to acknowledge the limitations of this study.
Firstly, women’s autonomy has a multidimensional nature and
we measure women’s autonomy only with some household deci-
sion-making variables and ignored other important factors such
as freedom of movement, and economic freedom. Secondly, wo-
men were only asked about current decision-making patterns,
while most of the childbearing was done in the past, again leading
to issues about the direction of the relationships as well as the is-
sue of whether current patterns of decision-making reflect past
patterns [4]. Thirdly, important limitation of this study is that it
only considers decision-making from the point of view of the wo-
man, not both members of the married couple. Replicating these
results in settings other than Bangladesh will be important in
assessing the generalizability of these findings. Fourthly, because
of the cross-sectional design of the study the analysis can only pro-
vide evidence of statistical association between the variables of
interest and contraceptive behavior and cause-effect relationships
cannot be inferred. We recommend the collection of longitudinal
data to enable future research to comprehensively examine the
role of women’s autonomy on contraceptive behavior. Fifthly, the
different rates of nonresponse to interviews and specific questions
over time could also bias survey estimates. However, the biases are
probably small because the overall nonresponse rates and the non-
response rates for variables used in the analysis are low. Finally,
DHS operation may suffer from a lack of quality data for validation,
since by definition DHS implemented in locations where that lack
of data is a primary problem. Despite these limitations, the study
strengths are significant. It is a large, population-based study with
national coverage. In addition, data of the DHS are widely per-
ceived to be of high quality, as they were based on sound sampling
methodology with high response rate. The survey was approved by
 M.M. Rahman et al. / Sexual & Reproductive Healthcare 5 (2014) 9–15
the Ethics Committee of the ORC Macro at Calverton in the USA and
by the National Ethics Committee in Bangladesh. All study partici-
pants gave informed consent before participation and all informa-
tion was collected confidentially.
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