Scientists measure reproductive agency in Burkina Faso

Researchers working in Burkina Faso have built and tested a new way to measure something that matters a great deal for sexual health but has proved hard to pin down: a woman's power to make her own reproductive choices. The validated scale captures reproductive agency across two areas, family planning and sexual intercourse, using survey data collected through the Performance Monitoring for Action platform in the West African nation.

The study, published in the journal Social Indicators Research, was led by Fiacre Bazié of the Institut Supérieur des Sciences de la Population at Université Joseph Ki-Zerbo in Ouagadougou, with colleagues at the Johns Hopkins Bloomberg School of Public Health. The team set out to fix a long-running measurement problem in global health research, where empowerment is often treated as one broad process even though reproductive autonomy behaves as something distinct, the authors argue. Many existing tools were designed in high-income settings or for generic contexts, and they translate poorly to the lived realities of women in sub-Saharan Africa, according to the study.

Two parts of agency

The scale rests on two dimensions. Motivation means the ability to define one's own reproductive goals. Self-efficacy, a concept drawn from Albert Bandura's foundational work in psychology, means the ability to act on those goals. The distinction separates a question like whether a woman has her own view on childbearing from whether she feels able to negotiate contraceptive use with a partner, refuse sexual intercourse, or visit a family planning service on her own initiative.

The dual focus is deliberate, the team reports. Plenty of existing instruments concentrate on contraceptive decision-making alone, treating reproductive autonomy as a question of clinic attendance and method choice. But the negotiation of sexual activity itself, who decides when sex happens and whether a woman can decline, is where power sits most directly inside relationships. Earlier scholarship on sexual relationship power and sexual assertiveness has connected a woman's capacity to navigate that negotiation with outcomes ranging from contraceptive use to vulnerability to HIV and other infections, which is why the new scale treats the two domains separately.

What gets in the way

Beyond the technical work of validating the instrument, the researchers documented the social architecture that constrains women's reproductive choices in Burkina Faso. Social expectations around fertility exert heavy pressure, shaping what women believe they are permitted to want. Fear of infertility, long documented in West African contexts, discourages behaviors seen as a threat to future childbearing, including the adoption of certain contraceptive methods. Stigma surrounding female sexuality keeps women from openly discussing or negotiating sexual matters, while widespread assumptions about men's sexual rights within marriage legitimize male authority over when intercourse occurs. And fear of relational sanctions, the anticipation of conflict, abandonment, or violence, hangs over women's calculations in ways that formal household decision-making measures often miss.

Those constraints have direct public health consequences. Burkina Faso, like much of sub-Saharan Africa, continues to face unmet need for family planning, high adolescent fertility, and elevated maternal mortality risks. A large body of evidence already connects women's agency to contraceptive use, birth spacing, use of obstetric services, and even child health outcomes such as birth weight, according to the study.

Wanting matters more than confidence

A striking finding concerns which dimension of agency tracks real outcomes more closely. When the team tested external validity, meaning whether scale scores predict reproductive behaviors in theoretically expected ways, motivation showed more consistent associations with outcomes than self-efficacy did. Whether a woman had defined her own reproductive goals mattered more for observed behaviors like modern contraceptive use than her confidence in acting on them. The implication for program designers is that interventions focused only on building skills or confidence may skip a critical upstream step, which is helping women articulate and claim their own fertility preferences in the first place.

Methodologically, the validation followed standard psychometric practice. The authors checked whether the multi-item subdimensions showed acceptable reliability and structural validity in the Burkinabe context, and their conclusion was cautiously positive: three of the multi-item subdimensions held up well enough to use in future surveys, while a two-item contraceptive self-efficacy index was judged more fragile and should be treated as preliminary until more evidence accumulates. That kind of transparency about a scale's limits stands out in a literature that has often adopted measures wholesale without local testing, according to the research summary.

The datasets behind the study are available upon request through the PMA data portal, which the authors say should let other research teams extend the validation work. Because the instrument distinguishes motivation from self-efficacy and spans both contraceptive and sexual negotiation domains, it offers a template for adaptation elsewhere in the region. Careful local validation of empowerment measures has become a growing priority in the field, and the Burkina Faso study now joins a lineage that includes earlier national efforts in settings such as Egypt. The finding that motivation outperforms self-efficacy as a correlate of outcomes gives those teams a concrete hypothesis to test next.

The full study, titled "Reproductive Agency: Validation of a Measure for Women's Autonomy in Family Planning and Sexual Intercourse in Burkina Faso," is available at https://doi.org/10.1007/s11205-026-03932-7.