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Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
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8

Key Themes and Next Steps

Ann Blanc (Steering Committee Chair, Population Council) introduced the final session, during which the steering committee members reflected upon the highlights and key themes of the workshop. Opportunities that emerged from the workshop for potential future work in this area were also discussed.

Amy Tsui, Johns Hopkins University (emerita)

Tsui commented on the sense of urgency regarding the application of empowerment constructs in the field and juxtaposed that urgency with the fact that the research and science will take time to demonstrate their effects. Tsui said that this workshop presents a unique opportunity to advance conceptualizations of women’s empowerment, consider outliers (as in the presentation by Zeba Sathar), test measurement approaches, and assess different hypotheses about the impact of women’s empowerment as a process. Although rigorous projects that have already generated evidence were shared at the workshop, the evidence remains episodic. A systematic way of testing women’s empowerment could help convince governments and other sponsors that this area deserves investment.

Tsui reiterated that women’s empowerment is a multidimensional process that manifests at different levels of society and across cultural contexts. She outlined three specific gap areas in which research could be conducted. First, research could examine how contraceptive use relates to women’s LFP in terms of quality, duration, and earnings potential. This examination would require longitudinal data that captures work, fertility,

Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×

and contraceptive events over the life course to bypass the potential role of endogeneity (i.e., in cross-sectional research). Second, research could form a knowledge base that encompasses the breadth of the women’s empowerment construct and the multiple actors involved in women’s social and reproductive choices over the course of a lifetime. Tsui emphasized that women’s empowerment is not a one-method intervention, such as contraception, nor simply a policy, such as universal schooling or safe motherhood policies, but is rather a human development process. Third, research may systematically include men and young boys in the process of empowering women’s choices, decisions, and achievements. The influence of these male roles should be based on empirical evidence. Tsui concluded by applauding the strength of female leadership in this field, which was demonstrated during this workshop.

Sunita Kishor, ICF

Kishor reinforced the importance of the context in which women and men live and interact to ensuring the welfare of individual women and girls. The focus on women’s empowerment is rightly placed, but women do not exist in isolation. The importance of context leads to questions about what it really means to make a decision “alone” and about the frequent focus on whether a woman is partnered or unpartnered. Kishor also acknowledged that the field tends to be somewhat prescriptive when discussing SRHR and women’s empowerment. Kishor mentioned the presentation by Anita Raj and said that it is important to determine what women’s needs actually are instead of being prescriptive about those needs; for example, SRHR addresses not only using contraception but also infertility. Empowerment comes in the form of a woman being able to fulfill her own fertility desires and having the access and resources to do so. The focus on unmet need—which Kishor recognized as a research construct that does not necessarily explain why women do not use contraception—must be approached carefully and holistically.

Kishor emphasized the importance of institutions and norms even when examining data collected at the individual level. Many women have to act as pioneers in order to change discriminatory norms, often for the sake of their daughters–-these pioneering women need institutions that actually build on and enable these norm changes. After all, the ability to get an education for your child and have children enjoy their childhood should not be revolutionary and if institutions were supportive, women would not have to be pioneers and face many challenges to meet these goals. Kishor also expressed concern about the difficulty of distinguishing outcome variables from empowerment indicators. This difficulty is another articulation of the endogeneity issue and challenges the field to reflect on how it defines empowerment.

Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×

Kishor concluded by acknowledging that many conceptualizations of women’s empowerment depend on research in Asia, and that as a result many traditional indicators of empowerment or disempowerment may not apply in other contexts. For example, measures of mobility may be less relevant in African contexts than in Asian contexts. These cross-cultural differences are an ongoing challenge in this field of study.

Jocelyn Finlay, Harvard University

Reflecting on Tsui’s call for male inclusion in women’s empowerment research, Finlay noted that women are nested within couples and/or communities and must often negotiate with men. Therefore, inclusion of men in empowerment research and interventions is an inherent aspect of carefully considering a woman’s context. She added that it is also important to recognize that men want to be a part of the process of empowering women.

Finlay commented that this workshop demonstrated recent successes and opportunities in this field. In particular, Finlay highlighted advances in the measurement of empowerment. However, the data currently utilized by many researchers could be reinvigorated by technological advances that render paper surveys outdated. New technologies could enable swifter data collection and longitudinal assessments. Finlay argued that more frequent measurements from smaller studies also offer some advantages compared to broader cross-sectional data collection and may allow researchers to study questions related to mechanisms of empowerment rather than merely its prevalence.

Finlay cited a question from Zeba Sathar regarding the relative adequacy of theoretical frameworks. Finlay’s own work began with research on the demographic dividend, which was discussed at multiple points throughout the workshop. Finlay reasoned that a strong, mathematically based theoretical foundation supports the ongoing push to conduct rights-based research; this foundation will ensure that researchers speak the same language and perform work that can be empirically validated.

Finlay cautioned that researchers must be aware of unintended consequences of interventions when the mechanisms for success are not fully understood. Differences in sample size, context, or timing, for example, can distort an intervention’s expected effect.

Alex Ezeh, Drexel University

Ezeh underscored the importance of generating data and developing measurements of empowerment constructs. In addition, he echoed the calls of his colleagues for more longitudinal data to assess the relationships explored in this workshop, that is, across women’s SRHR, LFP, and empowerment. He also emphasized the importance of measurements at the society

Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×

level. While women’s empowerment is measured largely at the individual level, he said, this workshop has demonstrated the many external factors, such as social norms, that influence these individual measures.

Ezeh suggested that researchers consider the impact of the COVID-19 pandemic on both demographic research and data collection efforts. Much of this work relies on face-to-face interviews and may need to be rearranged in the future to avoid disruptions to data collection. On a related topic, leveraging natural experiments would depend on more careful study design. For example, in some regions very similar populations live in neighboring countries yet experience very different outcomes (e.g., Burundi and Rwanda, Equatorial Guinea and Gabon). This pattern creates an opportunity to conduct national-level research to identify factors that influence divergent outcomes in otherwise similar countries.

One driver of high fertility in African contexts, Ezeh said, is the relatively young age at first marriage and first birth. Although interventional programs exist for adolescents who are in school or are married, he questioned how to reach unmarried adolescents who do not attend school, who represent a large proportion of adolescents in countries such as Niger and Chad. Interventions are particularly effective at transitional stages, such as the progression from primary to secondary school, and Ezeh highlighted the opportunity to understand the circumstances of adolescents who do not make this progression and to assess their relative access to these interventional programs.

Ezeh prioritized a shift from global to local priorities. The DHS Program has existed for nearly 40 years, yet he challenged whether many countries have the institutional capacity to drive change based on the findings of its surveys. Additional support for local institutions would help them drive the ongoing conversation surrounding SRHR and empowerment. Ezeh also pointed out two contrasting demographic patterns that are currently occurring: many high-income countries face large reductions in population over the next few decades, while other countries continue to demonstrate high fertility and rates of population growth. The implications of this change are not well understood, and coping with these trends requires a global perspective, investment, and response.

Mayra Buvinic, United Nations Foundation

Buvinic expressed admiration for the quality of the research progress, especially on determinants and measurements, presented at this workshop. Buvinic also outlined a number of challenges facing future research. First, the measurement of women’s economic empowerment at the group and collective levels, compared to the individual level, remains a challenge. Various domains of empowerment could also be more explicitly recognized

Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×

and delineated to clarify whether a study centers on overall empowerment, economic empowerment, social empowerment, or another domain altogether. These domains may require different forms of measurement and have varying degrees of overlap. Buvinic recognized that measures may need to be adapted or created to capture the processes of disempowerment provoked by the COVID-19 pandemic. Buvinic added that the Center for Global Development and Data2X recently drafted a compendium of empirically derived women’s empowerment–related measures with more than 34 associated methodologies and tools. The volume of data, methodologies, and tools identified and aggregated in the compendium suggests a potential for harmonization within the research community to establish common practices and shared measures. Buvinic stressed the importance of an open data approach to this effort.

Second, insufficient research exists to answer the question of how reproductive health choice relates to empowerment. Buvinic said that although increasingly good evidence is available on this subject, it remains unclear whether agency in reproductive health choices generalizes to economic empowerment and vice versa.

Third, research could grapple more fully with the instrumental aspect of empowerment. Across the realms of reproductive autonomy, economic agency, or other domains entirely, small changes in empowerment can have large instrumental impacts on women’s lives. Buvinic suggested that researchers continue to work toward identifying the triggers for this instrumental aspect of empowerment. Buvinic also supported longitudinal studies of empowerment, particularly to determine the sustainability of empowerment over time, as well as how to make empowerment more sustainable than it currently appears to be.

Buvinic concluded with a call for research on how behavior influences social norms, acknowledging that much work already exists examining the reverse relationship, that is, how social norms influence behavior. Behavior is the trigger for changes in social norms, and thus studies can help to identify the behavioral attributes that drive social transformation.

Nancy Birdsall, Center for Global Development

Birdsall recalled the 1986 NASEM report that Win Brown referenced during the opening of the workshop and observed that a complete reframing of family planning and women’s relationship to it has occurred since that report was published. To encapsulate the current framing, Birdsall posed the following syllogism:

  1. Female autonomy and empowerment are key to a better world for everybody.
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
  1. Reproductive rights are key to female autonomy, because women do not have the same access to sexual intercourse without fear of pregnancy as men and because early pregnancy has long-term implications for women’s empowerment and rights.
  2. Thus, access to reproductive rights, contraception, and justice in these domains is key to a better world.

In keeping with this reasoning, Birdsall emphasized a rights-based conceptual approach to research on reproductive rights and women’s empowerment.

Birdsall suggested that some confusion persists about the relationship between agency and empowerment. To Birdsall, agency is one key dimension of empowerment, but empowerment requires more than agency, as well; for example, it also requires control and resources. Both agency and empowerment could be better measured at the collective and political level. Research at this level also raises the question of the relative importance of social attitudes and norms versus economic development in different societies. While structural aspects of a community, such as economics and education, change slowly, social norms can change quickly. More research would help identify the triggers and mechanisms that underlie these changes and their relationships to each other.

Finally, Birdsall acknowledged that conducting more longitudinal work is not an easy feat, but she suggested a possible role in this effort for the Committee on Population. In the short term, the calendar work from DHS may shed light on questions of empowerment over the life course of women. She also called for more exploitation of natural experiments, citing COVID-19 and the #MeToo movement as recent global starting points for such work.

Ann Blanc, Steering Committee Chair, Population Council

Blanc concluded the workshop by recognizing progress in both the sophistication and nuance in conceptual work on women’s empowerment. To put this work to use, Blanc called for more studies on the pathways that link women’s empowerment to SRH outcomes and posed several questions to guide future research directions:

  • What are the roles of changing attitudes and gender norms on the pathway to better SRH outcomes?
  • What is the mediating effect of caring for children and the elderly on women’s LFP and on empowerment more broadly?
  • What is the potential for working with boys and men to change gender norms?
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
  • What are the ways that the linkages between women’s empowerment and SRH outcomes vary systematically across contexts, and how can that variation be explained?

Blanc commented on the influence of the COVID-19 pandemic on gender equality by sharing an anecdote in which a talented prospective hire recently turned down a job at the Population Council out of concern that the current circumstances (i.e., the pandemic) would diminish her capability to perform her duties; the anecdote, like the pandemic itself, throws the unequal responsibility of caring for children and the elderly into sharp relief. Blanc also noted that the gender-specific implications of climate change were not discussed at this workshop, although they are linked to reproductive health outcomes. This nascent area deserves attention from researchers and donors.

Blanc also joined the chorus of support for longitudinal studies of women’s empowerment. Blanc remarked that she worked on a 1985 report on women’s employment and fertility that outlined the limitations of cross-sectional data, highlighting a long-standing opportunity for donors to support longitudinal work. Although cross-sectional surveys such as those performed by the DHS are valuable and fulfill their intended functions, they will not help overcome the endogeneity problem that obscures causal relationships in the empowerment process. More investment in randomized experimental studies is important, and longer-term studies may also be needed to determine the sustainability of empowerment and whether completed interventions have lasting effects.

Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×

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Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
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Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 78
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 79
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 80
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 81
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 82
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 83
Suggested Citation:"8 Key Themes and Next Steps." National Academies of Sciences, Engineering, and Medicine. 2021. Family Planning, Women's Empowerment, and Population and Societal Impacts: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26023.
×
Page 84
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Over the past several decades, fertility rates have fallen substantially in low- and middle-income countries, and efforts to limit fertility, primarily through the implementation of family planning programs, have become increasingly widespread. Although there is a substantial scholarly literature on the determinants of contraceptive use and other measures to limit fertility and on the resulting differentials in fertility, relatively little is known about the role played by women's empowerment as both a determinant and a consequence of fertility decline. In addition, there continues to be little consensus about the link between fertility decline and broader societal impacts, including economic development.

The National Academies of Sciences, Engineering, and Medicine convened a workshop, "Family Planning, Women's Empowerment, and Population and Societal Impacts," in September 2020. This event brought together experts and stakeholders to discuss conceptual, methodological, and policy issues regarding the relationships among family planning, women's empowerment, fertility decline, and population and societal impacts. The discussion was intended to inform research and policy focused on the issues of women's roles and empowerment and on longstanding questions surrounding the determinants and consequences of fertility reduction behavior. This publication summarizes the presentations and discussion of the workshop.

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