Validation of Reproductive Autonomy and Contraceptive Autonomy Scales Among Egyptian Women
Validation of Reproductive Autonomy and Contraceptive Autonomy Scales Among Egyptian Women
This study aims to:

 1. To validate Arabic version of the reproductive autonomy scale among married women in
 reproductive age group (15-49 year) in Assiut.

 2. To validate Arabic version of the contraceptive autonomy scale among married women in
 reproductive age group in Assiut
In October 2011, the global population was estimated to be 7 billion. With a growth rate
 1.05% per year, the world's population is expected to increase by 2 billion persons in the
 next 30 years, from 7.7 billion currently to 9.7 billion in 2050 and could peak at nearly 11
 billion around 2100 (1). Nearly all of this growth is occurring in developing nations, where
 fertility rates remain relatively high(2) .

 There is an inverse relationship between contraceptive use and fertility. Countries with high
 proportions of women using contraception generally have lower levels of fertility (3).
 Globally, 62 percent of married women ages 15 to 49 use a method of family planning and 56
 percent use a modern method. These rates are twice as high among women living in high-income
 countries (67 percent and 60 percent, respectively) compared to women living in low-income
 countries (34 percent and 29 percent, respectively)(4).

 Currently, many more women of reproductive age are using some form of contraception than in
 1990. The growing use of contraceptive methods in recent decades has resulted not only in
 improvements in health-related outcomes such as reduced unintended pregnancies, high-risk
 pregnancies, maternal mortality, and infant mortality, but also in improvements in schooling
 and economic outcomes, especially for girls and women. Beyond the impacts of contraceptive
 use at the individual level, there are benefits at the population level. From a macroeconomic
 perspective, reductions in fertility enhance economic growth as a result of reduced youth
 dependency and an increased number of women participating in paid labour(3).

 In recognition of the 25th anniversary of the International Conference on Population and
 Development (ICPD) in 1994, governments reaffirmed the importance of the Program of Action
 and its further implementation for achieving the Sustainable Development Goals (SDG). The
 emphasis on universal access to a full range of safe and reliable family planning methods,
 which help couples and individuals to realize their right to decide freely and responsibly on
 the number, spacing and timing of births, remains as critical today as it did in 1994(3).

 The primary outcome of interest to the family planning community has been contraceptive use
 (often modern method use), which has traditionally been measured and interpreted in a fairly
 straightforward way. Generally, a person using a (modern) method is considered a positive
 outcome, while someone not using a (modern) method is considered a negative outcome (5). Most
 studies of individual determinants of contraceptive use focus on cognitive, demographic, and
 contextual variables. However, these models assume that individuals have personal control
 over their contraceptive behavior(6) .As with other sexual risk outcomes, a woman's capacity
 to act upon her intention to use contraception may be contingent upon the wishes and actions
 of her partner or other members of her family or community(7).

 Autonomy is defined as the ability of subject to make his/her own decisions without being
 controlled by anyone else (8). Reproductive autonomy means the women has the power to decide
 when, if at all, to have children; also, many-but not all-of the choices relevant to
 reproduction. It means focusing on decisions about whether and when to have children. Women
 should also generally determine how their pregnancy will be carried out and how the birth
 will happen(9).

 Reproductive autonomy is central to women's welfare both because childbearing takes place in
 women's bodies and because they are generally expected to take primary responsibility for
 child rearing(9). It is one of the main reproductive rights. Unfortunately, such autonomy is
 a low priority for most societies, or is anathema to their belief systems altogether. This
 situation is doubly sad because women's reproductive autonomy is intrinsically valuable for
 women and also instrumentally valuable for the welfare of humankind(9).

 Recent American study has developed and validated an English multidimensional quantitative
 instrument that can measure reproductive autonomy. Fourteen items were selected through
 factor analysis and grouped into three subscales under the construct of reproductive
 autonomy, labeled "freedom from coercion,""communication," and " decision-making". The scale
 is considered a reliable instrument 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(6).

 Reproductive autonomy cannot exist without attention to context to supports, to barriers, to
 social policy, to social norms(10).

 A cross-sectional study of reproductive-age, sexually active women was conducted in Vietnam.
 It aimed to validate the Reproductive Autonomy Scale among Vietnamese females. Subscales had
 moderate to high internal consistency (Cronbach's alpha: decision-making power 0.65, freedom
 from coercion 0.85, and communication ability 0.87). However, the study highlight the need to
 develop and validate a new measure for reproductive autonomy for populations outside the
 United States or to adapt the existing measure for these contexts(7).

 Although countless approaches to measuring the success of family planning programs exist and
 novel measures are being continuously introduced, the most widely measured indicators in
 global family planning continue to be: 1) the total fertility rate; 2) the contraceptive
 prevalence rate; and 3) unmet need for contraception. These three population-based indicators
 have the advantage of being routinely measured within nationally representative surveys such
 as the Demographic and Health Surveys (DHS) around the world without the need for a dedicated
 study in any given context. In the absence of more nuanced data, we routinely summarize TFR,
 CPR, and unmet need to paint a picture of the overall family planning context. However, none
 of these indicators is a measure of health, quality, access, or rights(5).

 Clinicians and others show respect to autonomous persons by giving "weight to their
 considered opinions and choices" and by "refraining from obstructing their actions unless
 they are clearly detrimental to others(10).

 A Novel Family Planning Indicator is the contraceptive autonomy. It is defined as factors
 necessary for a person to decide for themself what they want in relation to contraception and
 then to realize that decision, this indicator divides the contraceptive autonomy construct
 into subdomains of informed choice, full choice and free choice. It aimed to promote
 reproductive health and right. By acknowledging that autonomous nonuse is a positive outcome,
 aiming to maximize contraceptive autonomy rather than use could help shift incentives for
 family planning programs and reduce some common forms of contraceptive coercion, as this
 measurement approach is realigned with a focus on high-quality rights-based care (6).

 Improvements in the status and empowerment of women is central to progress in global
 development efforts and, perhaps more importantly, to the achievement of equitable treatment
 and representation of the 3.5 billion women in the world (11). Women's autonomy is an
 important determinant of women's health and well-being, (12). Review of literature reported
 the positive associations between women's empowerment and modern contraceptive use and access
 to maternal interventions such as antenatal care and skilled birth attendance(13), lower
 fertility, longer birth intervals, and lower rates of unintended pregnancy (11).

 Analysis of Pakistani Reproductive Health and Family Planning Survey, 2000 which interviewed
 a national sample of ever married women aged 15-49 years showed that decision autonomy was
 significantly associated with both lifetime and current contraception use. On other hand,
 movement autonomy was not consistently associated with contraceptive use(14).

 Omani study analyzed the correlates of women's empowerment and the effect of empowerment on
 unmet need for contraception. Two indicators of empowerment were used: women's involvement in
 decision-making and freedom of movement. The results reveled that empowered women were more
 likely to use contraception(15).

 Egypt situation In 2021, the estimated Egypt total population is 101,6 million.(16) Between
 2011 and 2018, 11 million people were added to the Egyptian population.(17) Unless the
 fertility rate of 3.47 changes, by 2030, Egypt's population is expected to grow to 128
 million.(18) High fertility contributes to rapid population growth, which threatens the
 health and well-being of the Egyptian people. In addition, It is likely to impose a costly
 burden for Egypt by hindering economic development, limiting access to education, food,
 employment, and potable water, and increasing health risks for women and children.(19) EDHS
 2014 findings revealed that 58.5 percent of currently married women in Egypt are currently
 using a contraceptive method and in Upper Egypt was 50%, modern methods 56.9%, traditional
 methods 1.6%, total unmet need 12.6%, and not using 41.5%.(20) Women's autonomy over time is
 a product not only of their individual characteristics, but also of the household and
 community environment in which they live. Secondary analysis study used the 2006 and 2012
 Egyptian Labor Market Panel Survey (ELMPS) and multilevel models. It showed that There are
 large and consistent variations in women's autonomy by household region of residence and
 wealth. women in the rural and urban Upper Egypt region are less autonomous than women in the
 Cairo region, and women in wealthier households are less autonomous compared to the poorest
 households.(12) The ELMPS measures of autonomy include a set of questions on: (a)
 participation in household decision-making, (b) woman's ability to move around on her own
 (mobility), and (c) access to financial resources. (12) Attitudinal measures like attitudes
 towards gender norms and tolerance of Intimate partner violence are also commonly used as
 measures of women's empowerment globally(21) A secondary analysis of EDHS 2008 data aimed to
 assess women's autonomy on modern contraceptive use and its associated factors among Egyptian
 women. The study revealed that women's autonomy influences their use of modern contraception
 methods, where household decision-making autonomy was significantly associated with current
 modern contraceptive use. Women with intermediate and high autonomy were 1.19 (95%CI
 1.04-1.35) and 1.32 (95% CI 1.18-1.49) more likely to use modern contraception methods
 compared to women with low autonomy.(22)
Inclusion Criteria:

 -  Currently married women within reproductive age group (15-49 years)

 Exclusion Criteria:

 -  Current pregnant women, breast feed women (till 6 months), intension to get pregnant
 within the next 12 months and husband is traveler.