Agency in Family Planning: A Scoping Review of the Measurement of Agency in Low- and Middle-Income Countries

Abstract

Improving women's agency in family planning is an integral component of empowerment, requiring culturally relevant, reliable, and valid measures. Measuring agency-action towards the achievement of self-determined goals-is key to tracking progress as highlighted by its inclusion in the Sustainable Development Goals. Yet, agency measurement within low- and middle-income contexts has all too often involved applying measures developed and tested in high-income contexts, and conceptual confusion has also led to both overlapping measures and those that omit key facets of agency. To examine the construction and application of agency measures in family planning research and programs, we conducted a scoping review of studies in low-and middle-income countries. Of 9,289 articles and abstracts screened, 72 met our inclusion criteria and included family planning outcomes. We identified 58 unique measures. Most measures were summative and described psychometric testing. Measures often included family planning-specific items, generally focused on contraceptive use with less attention to areas such as communication, access to services, or fertility timing. While increased interest in measuring family planning agency is evident, inconsistencies in measurement hinder cross-contextual comparisons. As family planning research and programs adopt empowerment-focused benchmarks, validated measures of agency are needed to accurately assess impact.

FIGURE 1

PRISMA flowchart of study selection and extraction

FIGURE 2

Venn diagram of measures of agency and related constructs within the unique measures (n = 58)