Reproductive autonomy: Adapting a scale to account for religious influences on women’s contraceptive use
Awarded 2013
Complex Family Planning Fellowship Research
Chava Kahn, MD
University of Michigan

Background: Reproductive autonomy (RA) means having control over one’s own fertility desires. Identification in a religious community may impact women’s decision-making abilities surrounding family planning. Upadhyay et al. developed a scale consisting of three domains that measure RA as it applies to a woman and her partner: freedom from coercion, communication, and decision-making. However, little is known about how religious norms influence RA.
Objectives: We aimed to expand a validated RA scale to capture religious influences.
Methods: We performed interviews and focus groups with married women from religious communities to identify items that capture religious influences on RA. We generated 27 items and included them and the current RA scale in a survey, which we administered to a sample of religious married women. We recruited using snowball sampling via Facebook. We performed exploratory factor analysis and assessed construct validity using logistic regression to measure how each of the subscales is associated with unprotected sex. We calculated Pearson’s correlations to measure the strength and direction of the association between the old and new RA scales.
Results: Factor analysis revealed 13 items grouped into two factors: agency (alpha=0.92) and judgment (alpha=0.85). Factor analysis on the current RA scale demonstrated high internal consistency: 1) freedom from coercion (alpha=0.96); 2) communication (alpha=0.82); 3) decision-making (alpha=0.78). Pearson’s correlations between old and new subscales revealed a strong positive association.
Conclusions: The current RA scale is a valid measure of RA among religious women. RA among religious women is influenced by a complex interaction of agency, perceived judgment and partnership dynamics.