Reproductive empowerment and contraceptive self-care: a systematic review

Figures & data

Figure 1. ICRW conceptual model of reproductive empowerment

Figure 2. Flow diagram

Table 1. Characteristics of included studies (n=37)

	n (%) or Mean
Region
North America (Canada, United States)	13 (35.1)
Asia (Bangladesh, China, India, Nepal, Pakistan, Vietnam)	9 (24.3)
Europe (Italy, Portugal, Spain, United Kingdom)	7 (18.9)
Africa (Ghana, Namibia, Nigeria, South Africa, Uganda, Zambia)	5 (13.5)
South America (Brazil)	1 (2.7)
Oceania (Fiji)	1 (2.7)
Global (Web survey, participants from 112 countries)	1 (2.7)
Gender
Women only	18 (48.6)
Men and women	16 (43.2)
Men only	3 (8.1)
Age
Mean age (n=23 studies)	21.4
Adolescents (10–19 years) and youth (15–24 years)*	17 (45.9)
Adults (25+ years)	14 (37.8)
University students, age range not reported	6 (16.2)
Type of contraceptive self-care (Multiple responses possible)
Male condoms	30 (81.1)
Client-facing digital technology	4 (10.8)
Oral contraceptives	4 (10.8)
Withdrawal	3 (8.1)
Emergency contraception	3 (8.1)
Other**	3 (8.1)
Study design
Cross-sectional study	21 (56.8)
Qualitative research	7 (18.9)
Randomized controlled trial (RCT)	6 (16.2)
Single-group pre-test post-test study	2 (5.4)
Nonrandomized experimental study	1 (2.7)
Risk of bias, studies with quantitative data (n=31)***
High risk of bias	27 (87.1)
Low risk of bias	4 (12.9)
Methodological quality, studies with qualitative data (n=7)***
Good quality	6 (85.7)
Poor quality	1 (14.3)

*One study included young people 13–26 years, one study included young people 21–30 years, one study included young people 15–30 years, and one study included young people 18–26 years.

**Other methods were the patch, vaginal ring, DMPA-SC self-injection, diaphragm, foam, jelly, lactational amenorrhea method (LAM), periodic abstinence, and rhythm method.

***One study reported both quantitative and qualitative data and is represented in both sections. Studies reporting quantitative data were determined to have low risk of bias if they possessed five or more of the eight items. Studies reporting qualitative data were determined to have good methodological quality if they possessed seven or more of the nine items.

Table 2. Results

Study ID	Study Design; Population; Setting	Contraceptive Self-care Type; Contraceptive Self-care Outcome(s)	Reproductive Empowerment	Direction of Relationship; Data Type	Results
Individual Agency
Escribano, et al.^Citation20	RCT; Male and female youth ages 14–16 living in Spain; High schools	Male condoms; (1) Intention to use condoms; (2) consistent condom use	General self-efficacy (General Self-Efficacy Scale with Spanish adolescents), 10-item measure with 10-point Likert-type response options assessing general self-efficacy with high internal consistency (α=0.90)	Crossec.; Quant.	Statistically significant positive direct effect within structural equation modeling of self-efficacy on intention to use condoms (β = .005, SE = 0.002, p = 0.048, n = 435), controlling for intervention effects; within this model, condom use intention significantly influenced consistent condom use (β = 1.70, SE = 0.33, p < 0.001, n = 435).
Espada, et al.^Citation21	Cross-sectional study; Male and female youth ages 13–18 living in Spain; High schools	Male condoms; (1) Intention to use condoms: single item with five-point Likert-type response option indicating level of certainty of using condoms in the future; (2) Frequency of using condoms	Condom use self-efficacy (Condom use self-efficacy subscale from the HIV Attitudes Scale), three-item measure with four-point Likert-type response options assessing participant confidence to negotiate and use condoms with acceptable internal consistency (α= 0.76)	Crossec.; Quant.	No statistically significant direct or indirect associations between condom use self-efficacy and intention to use condoms, nor between condom use self-efficacy and frequency of condom use (coefficients NR, p > 0.05, n = 410).
Ghobadzadeh, et al.^Citation22	Cross-sectional study; Sexually active girls ages 13–17 living in the United States; Primary care clinics	Male condoms; Condom use consistency: proportion of months using condoms every or most of the time	Self-esteem: four-item measure adapted from Minnesota Student Survey with four-point Likert-type response options assessing self-esteem with good internal consistency (α=0.89)	Crossec.; Quant.	No statistically significant relationship between self-esteem and condom use consistency (OR = 1.09, p = 0.5, n = 253).
Appleton^Citation23	Qualitative research; Women ages 20–40 living in India; Community-based	EC; Hypothetical use of emergency contraception	Bodily autonomy and empowerment	CSC→RE; Qual.	Participants described that EC pills could be a way for women to exact agency, gain control over their bodies, and feel empowered.
Dehlendorf, et al.^Citation24	Cluster RCT; Women living in the United States ages 15–45 planning to start or change contraception method; Health care facilities	Client-facing digital technology*; Randomised to My Birth Control decision support tool vs. standard of care	Decision quality (Decisional Conflict Scale): 16-item measure with five subscales and five-point Likert-type response options assessing awareness of available options and perceived ability to make an informed choice, with lower scores indicating better satisfaction with making an informed decision (example items include “I am clear about which benefits matter most to me,” “I am choosing without pressure from others,” and “My decision shows what is important to me”)	CSC→RE; Quant.	No statistically significant difference between intervention and control arms in odds of selecting best-informed response options for the total scale (OR = 1.18, 95% CI 0.80–1.74, p = 0.41). Intervention arm was statistically significantly more likely to select the best-informed response options for the Uncertainty subscale (vs control), indicating more decision certainty in the intervention arm (OR = 1.45, 95% CI 1.03–2.05, p = 0.03). No statistically significant differences within the Informed decision (OR 1.34, 95% CI 1.00–1.80, p = 0.05), Effective decision (OR = 1.13, 95% CI 0.80–1.59, p = 0.50), Values clarity (OR = 1.17, 95% CI 0.86-1.59, p = 0.31), and Support (OR = 1.06, 95% CI 0.76–1.49, p = 0.41) subscales.
Stephenson, et al.^Citation25	RCT; Women 15–30 years living in the United Kingdom; Health facilities in urban area	Client-facing digital technology**; Randomised to Contraception Choices decision support tool vs. standard of care	(1) Feeling empowered to speak to health professionals; (2) feeling more prepared before clinic appointments	CSC→RE; Qual.	Intervention participants described feeling empowered to talk to providers about their preferred contraceptive method. Intervention participants also described that they felt more prepared to discuss contraception in these appointments.
Sundstrom^Citation26	Qualitative research; Women 18–44 years living in the United States; Community-based	OCPs; Hypothetical access to OCPs over the counter	Autonomy and control over fertility	Crossec.; Qual.	Participants described that having access to OCPs over the counter could improve their control over their fertility and their “bodily autonomy,” noting that this would be critical to enable them to make appropriate and desired life choices, such as motherhood, without being at risk of unintended pregnancy.
WHO^Citation27	Cross-sectional study; HCPs and LP from 112 countries; Global survey	OCPs, EC, patch, VR, DMPA-SC self-injection, diaphragm, client-facing digital technology; Hypothetical use	(1) Perceiving empowerment to be a top reason for using family planning method; (2) perceiving empowerment as a benefit of method	Crossec.; Quant.	Proportion HCPs and LP that felt empowerment was a top reason for using the method: OCP: 31.3% HCP (n = 320), 24.9% LP (n = 193) EC: 27.1% HCP (n = 292), 20.6% LP (n = 175) Patch: 27.3% HCP (n = 267), 25.2% LP (n = 155) VR: 24.2% HCP (n = 264), 23.7% LP (n = 156) DMPA-SC SI: 23.5% HCP (n = 268), 27% LP (n = 152) Diaphragm: 22.8% HCP (n = 254), 24.3% LP (n = 148) Client-facing digital intervention (Internet): 31.2% HCP (n = 276), 24.4% LP (n = 156) Client-facing digital intervention (App): 31.1% HCP (n = 355), 24.8% LP (n = 420) Proportion of HCPs perceiving empowerment as a benefit of method: OCs: 49.8%, EC: 49.2%, patch: 46.5%, VR: 46.7%, DMPA-SC SI: 48.2%, diaphragm: 44.6%, client-facing digital intervention (Internet): 57.3%, client-facing digital intervention (app): 58.3%.
Immediate Relational Agency –Partner Negotiation
Asante, et al.^Citation28	Cross-sectional study; Male and female university students living in Ghana; Private university in urban area	Male condoms; Condom use at last sex	Condom use self-efficacy (CUSES): total score and assertive subscale	Crossec.; Quant.	Statistically significant positive relationships between total condom use self-efficacy score and condom use at last sex (ρ = 0.730, p < 0.01, n = 426), and between Assertive subscale score and condom use at last sex (ρ = 0.550, p < 0.01, n = 426).
Buston, et al.^Citation29	Qualitative research; Men ages 16–21 living in the United Kingdom at a young offender institution; Prison	Male condoms; Condom use Condom use	Contraceptive decision-making	RE→CSC; Qual.	Men with consistent condom use described feeling responsible for carrying condoms with them and would use condoms to protect themselves from their partners becoming pregnant. Men with infrequent condom use did not describe being in control of condom use and stated that their partners would ask for condoms to be used if needed.
Chirinda, et al.^Citation30	Cross-sectional study; Sexually active male and female youth ages 18–24 living in South Africa; Population-based household survey	Male condoms; Inconsistent condom use with most recent sex partner	(1) Partner risk reduction self-efficacy: four-item measure with four-point Likert-type response options to assess perceived ability to change sex behaviour within partnership, such as “Would you be able to avoid sex any time you didn’t want it?”, with moderate internal consistency (α = 0.73); (2) relationship control:	Crossec.; Quant.	Among women, there was a statistically significant negative relationship between partner risk reduction self-efficacy and inconsistent condom use, adjusting for talking with partner about condoms, difficulty of getting condoms, lack of relationship control, sex with much older partner, ever having a transactional sex partner, and hazardous or harmful alcohol use (aOR = 0.74, 95% CI 0.61–0.97, p < 0.05, n = 1009). No statistically significant relationship between lack of relationship control and inconsistent condom use (aOR = 1.05, 0.94–1.22, p > 0.05, n = 1009), adjusting for partner risk reduction
Chirinda, et al.^Citation30	Cross-sectional study; Sexually active male and female youth ages 18–24 living in South Africa; Population-based household survey	Male condoms; Inconsistent condom use with most recent sex partner	four-item measure with four-point Likert-type response options to assess perceived control in relationship, such as “Your partner has more control than you do in important decisions that affect your relationship,” with good internal consistency (α = 0.81)	Crossec.; Quant.	self-efficacy, talking with partner about condoms, difficulty of getting condoms, sex with much older partner, ever having a transactional sex partner, and hazardous or harmful alcohol use. Among men, there were no statistically significant relationships between partner risk reduction self-efficacy and inconsistent condom use (OR = 0.92, 95% CI 0.79–1.06, p > 0.05, n = 1129) or between lack of relationship control and inconsistent condom use (OR = 1.01, 95% CI 0.88–1.17, p > 0.05, n = 1129).
Do, et al.^Citation31	Cross-sectional study; Married women living in Vietnam; Population-based survey	Male condoms; (1) Condom use at last sex; (2) consistent condom use in past 12 months	Condom and sex negotiation self-efficacy: two-item measure with dichotomous response options assessing perceived ability to refuse sex and ask partner to use a condom	Crossec.; Quant.	Statistically significant positive associations between condom and sex negation self-efficacy and odds of condom use at last sex (OR = 1.60, p < 0.001, n = 4632) and consistent condom use (OR = 1.56, p < 0.001, n = 4632).
Folayan, et al.^Citation32	Cross-sectional study; Adolescents ages 10–19 living in Nigeria at HIV treatment centres and youth centres; Geographically representative survey	Male condoms; Condom use at last sex	(1) Confidence in discussing condom use: single-item, yes/no question assessing confidence to discuss condom use; (2) confidence in negotiating condom use: single-item, yes/no question assessing confidence to negotiate condom use	Crossec.; Quant.	Statistically significant positive relationship between confidence in discussing condom use and odds of condom use at last sex (82.1% vs 7.9%, OR = 141.01, 95% CI 14.99–1326.36, n = 173). No statistically significant relationships between confidence in negotiating condom use and condom use at last sex (91.3% vs. 8.7%, OR = 2.87, 95% CI 0.72–11.42, p = 0.14, n = 173).
Gesselman, et al.^Citation33	Single group pre-test post-test study; Couples ages 18–24 attending a university in the United States; University	Male condoms; Condom nonuse: proportion of times a couple engaged in unprotected sex in past month	Condom use self-efficacy (modified CUSES): four-item measure with five-point Likert-type response options measuring self-efficacy to use condoms	Crossec.; Quant.	Unprotected sex at Time 1 was statistically significantly negatively correlated with condom use self-efficacy at Time 1 but not at Time 2 (T1: ρ = −0.47, p < 0.01; T2: ρ = −0.32, p > 0.05). Unprotected sex at Time 2 was not statistically significantly correlated with condom use self-efficacy at either time point (T1: ρ = −0.30, p > 0.05; T2: ρ = −0.24, p > 0.05).
Krugu, et al.^Citation34	Qualitative research; Adolescent girls ages 14–19 living in Ghana; Community-based	Male condoms; Using condoms with sex partners	Negotiating condom use with partners	Crossec.; Qual.	All sexually active participants stated that they used condoms during sex and that they felt empowered to negotiate and insist upon condom use prior to sexual intercourse. Participants gave example phrases such as “No condoms, no sex” to ensure partners complied, and indicated strong self-efficacy towards negotiating condom use.
Long, et al.^Citation35	Cross-sectional study; Sexually active male and female college students living in China; Universities	Male condoms; Condom use at last sex	Contraceptive responsibility: single item asking, “During your most recent sexual intercourse, who ended up being responsible for ‘taking care’ of contraception?”; response options were “the man,” “the woman,” and “both the man and the woman”	Crossec.; Quant.	Among males with a casual partner, there was a statistically significant negative relationship between condom use at last sex and having the man alone or the woman alone be responsible for contraception, compared to the man and woman together (man took responsibility vs. both: aOR = 0.15, 95% CI 0.08–0.50, n = 114; woman took responsibility vs. both: aOR = 0.19, 95% CI 0.07–0.67, n = 114). Among females with a steady partner, there was a statistically significant negative relationship between condom use at last sex and having the man take responsibility for contraception at last sex, compared to the man and woman together (Man took responsibility vs. both:
					aOR = 0.11, 95% CI 0.04–0.78, n = 212), but not with having the woman take responsibility for contraception at last sex (woman took responsibility vs. both: aOR = 0.17, 95% CI 0.08–1.00, n = 212). There were no statistically significant relationships among males with a steady partner (man took responsibility vs. both: aOR = 1.09, 95% CI 0.69–2.11, n = 445; woman took responsibility vs. both: aOR = 0.87, 95% CI 0.50–2.22, n = 445) nor among females who recently had sex with a casual partner (man took responsibility vs both: aOR = 0.77, 95% CI 0.25–2.66, n = 55; woman took responsibility vs both: aOR = 0.07, 95% CI 0.01–2.39, n = 55). All analyses adjusted for age, spending, and major.
Ritchwood, et al.^Citation36	Cross-sectional study; Sexually active African American females ages 14–20 living in the United States; Sexual health clinics	Male condoms; (1) Condom use at last sex; (2) proportion of times condoms used in past six months	Partner communication self-efficacy: six-item measure with five-point Likert-type response options assessing perceived difficulty of talking with their male sexual partners about condom use and other sexual risk behaviours	Crossec.; Quant.	No statistically significant relationships between partner communication self-efficacy and condom use at last sex (OR = 0.95, p = 0.66, n = 546) or with the proportion of times condoms were used in the past six months (β = 0.11, p = 0.52, n = 546), adjusting for partner age, sex enjoyment, sexual sensation seeking, sexual happiness, and interaction terms.
Santos, et al.^Citation37	Cross-sectional study; Undergraduate university students ages 18–29 living in Portugal; University	Male condoms; Condom use	Condom use self-efficacy (CUSES-R): Portuguese version of CUSES, 15-item measure with five-point Likert-type response options assessing self-efficacy in using condoms with good internal consistency (α=0.86)	Crossec.; Quant.	Among both genders, condom use self-efficacy scores were statistically significantly higher among participants that used condoms vs. no contraception (48.90 vs. 46.56, p < 0.001, n = 1946). This difference remained statistically significant among males (50.31 vs. 44.24, p < 0.001, n = 700), but was not statistically significant among females (47.81 vs. 47.40, p = 0.318, n = 1246).
Shih, et al.^Citation38	Cross-sectional study; Sexually active women 14–45 years living in the United States; Health facilities	Male condoms; Inconsistent condom use: Number of unprotected sex acts	(1) Perceived control over condom use: single item asking who in the relationship has more say in condom use (response options: partner, participant, equal say, don’t talk about it); (2) condom use self-efficacy: five-item Confidence in Safer Sex scale assessing confidence to successfully negotiate condom use with a partner	Crossec.; Quant.	Women in the lowest condom use self-efficacy quartiles had statistically significantly higher risk of having more unprotected sex acts (lowest quartile vs. highest quartile: aRR = 2.50, 95%CI 1.81–3.47, n = 2087; second-lowest quartile vs. highest quartile: aRR = 1.59, 95% CI 1.16, 2.17, n = 2087). There were no significant differences in risk of having more unprotected sex acts comparing women in the second highest to the highest self-efficacy quartiles (aRR = 1.17, 95%CI 0.84–1.63, n = 2087). No statistically significant associations between perceived control over condom use and number of unprotected sex acts (partner has more say vs. equal say: aRR = 1.16, 95% CI 0.73–1.85, n = 2087; woman has more say vs. equal say: aRR = 1.11, 95% CI 0.91–1.35, n = 2087; don’t talk about it vs. equal say: aRR = 0.88, 95% CI 0.45–1.74, n = 2087). All analyses adjusted for race, ethnicity, age, marital status, education level, socioeconomic status, and sexual behaviours.
Smylie, et al.^Citation39	Cross-sectional study; Young men and women ages 16–24 living in Canada; Community organisations, youth service organisations, drop-in centres, health clinics, shopping malls, and universities	Male condoms; Condom use at last sex	Protection self-efficacy: eight-item measure with five-point Likert-type response options assessing confidence in ability to negotiate safer sex with a partner, with good internal consistency (α= 0.883)	Crossec.; Quant.	Participants who used condoms in the past 12 months had statistically significantly higher mean protection self-efficacy scores vs. those who did not (mean score 24.00, SD NR vs 22.13, SD NR, p < 0.001, n = 1185).
Sousa, et al.^Citation40	Cross-sectional study; Adolescent and young adult students ages 13–26 living in Brazil; School affiliated with state education network	Male condoms; Condom use: Single item with 5-point Likert-type response option indicating frequency of using condom with a fixed partner	Condom use self-efficacy (Adapted CUSES in Portuguese) 14-item measure with three sub-scales, five-point Likert-type response options indicating self-efficacy to use condoms. Communication subscale assessed self-efficacy in discussing condom use with a partner (e.g. “I could talk about using condoms with any sexual partner” and “I could say no to sex if my partner refused to use a condom.”	Crossec.; Quant.	Statistically significant differences in overall condom use self-efficacy score by frequency of using condoms with a fixed partner (mean [SD] score by condom use frequency: never 57.1 [25.2], hardly 67.5 [21.3], sometimes 64.1 [22.1], in most relations 72.2 [19.5], in all relations 75.2 [17.3], p = 0.036, n = 123). No statistically significant differences in mean communication domain scores by frequency of using condoms with a fixed partner (mean [SD] score by condom use frequency: never 66.6 [28.3], hardly 66.2 [23.9], sometimes 69.8 [20.6], in most relations 74.2 [27.1], in all relations 82.6 [19.8]; p = 0.077, n = 123).
Tafuri, et al.^Citation41	Cross-sectional study; Freshman university students living in Italy; University	Male condoms; Condom use at last sex	Items in the Condom Use Skill Measure, a 13-item measure assessing attitudes, self-efficacy, and skills related to condom use with three-point Likert-type response options. No aggregate score reported. Relevant items are: “If I suggest to my partner we use a condom he/she might end the relationship,”	Crossec.; Quant.	Statistically significantly higher odds of condom nonuse among participants responding affirmatively to the question, “If I suggest to my partner we use a condom he/she might end the relationship,” compared to those who did not (OR = 3.0, 95% CI 1.1–8.8, p < 0.05, n = 1091); responding affirmatively to the question, “If I suggested we use a condom my partner would think I do not trust him/her,” compared to those who did not (OR = 4.9, 95% CI 2.3–11.1, p < 0.0001, n = 1091); responding affirmatively to the question, “If I suggested we use a condom my partner would think I am accusing him/her of cheating,”
			“If I suggested we use a condom my partner would think I do not trust him/her,” “If I suggested we use a condom my partner would think I am accusing him/her of cheating,” “If I suggested we use a condom my partner might think I am cheating on him/her.” Other items included attitudes toward condoms, perceptions of condom comfort, and perceived need for condoms.		compared to those who did not (OR = 2.5, 95% CI 0.9–7.3, p = 0.06, n = 1091); and responding affirmatively to the question, “If I suggested we use a condom my partner might think I am cheating on him/her,” compared to those who did not (OR = 4.9, 95% CI 1.5–17.2, p < 0.001, n = 1091).
Thomas, et al.^Citation42	Cross-sectional study; Community-based sample living in the United Kingdom; Health facilities and condom trial participants	Male condoms; (1) Mostly/usually used condoms in past 3 mo.; (2) Intention to mostly/usually use condoms in future	Condom use self-efficacy (CUSES): Assertiveness subscale; total score NR	Crossec.; Quant.	No statistically significant differences in mean assertiveness scores between participants who mostly or usually used condoms vs. those who did not (13.7 vs 13.3, p = 0.16) and comparing participants who intended to mostly or usually use condoms in the future vs. those who did not (13.6 vs. 13.4, p = 0.53).
Tingey, et al.^Citation43	Cluster RCT; American Indian adolescents ages 13–19 living in the United States; Day camp	Male condoms; Intention to use condoms: Single question asking if participants would use a condom if they had sex in the next six	(1) Condom use self-efficacy: single item with five-point response option, lower score indicating greater self-efficacy; (2) partner negotiation self-efficacy:	Crossec.; Quant.	Decreasing condom use self-efficacy associated with statistically significant decrease in condom use intention (aIRR = 0.82, 95% CI 0.73–0.92, n = 251), adjusting for age, HIV knowledge, general self-efficacy, response efficacy, extrinsic reward, severity, and sex in the past six months.
		months (response options: Yes, maybe, don’t know, probably not, no)	single item with five-point response option, lower scores indicating greater self-efficacy		No statistically significant differences in partner negotiation self-efficacy comparing those who intended to use condoms vs. those who did not (Mean [SD]: 2.56 [0.10] vs. 2.41 [0.11]; AMD = 0.14, p = 0.285, n = 240).
Tsay, et al.^Citation44	Single-group pre-test post-test study; Adolescents ages 13–18 living in the United States in youth detention centres; Juvenile detention facilities	Male condoms; Intention to use condoms after leaving detention centre	Condom self-efficacy: 15-item unidimensional measure with five-point Likert-type response options, similar in structure to Brafford and Beck Condom Use Self-Efficacy Scale (mechanics and assertive sub-scales) with good internal consistency (α=0.84)	Crossec.; Quant.	Statistically significant positive relationship between intention to use condoms and condom use self-efficacy (β = 0.655, p < 0.001, n = 662), controlling for HVI/STI knowledge and condom use knowledge. Unclear if these were pre- or post-intervention data.
Xiao^Citation45	Cross-sectional study; Unmarried junior and senior college students ages 18 + living in China; University	Male condoms; Condom use: assessed as a latent construct using two indicators: condom use at last sex (yes/no) and frequency of using condoms in past 12 months (five-point Likert-type response options, higher scores indicating higher frequency)	Partner communication about condom use: single question assessing frequency of telling partner they wanted to use a condom during sex in past three months with five-point Likert-type response option, higher scores indicate higher frequency	Crossec.; Quant.	Statistically significant positive relationship between partner communication and condom use (β = 0.317, SE = 0.038, p < 0.001) in a structural equation model accounting for peer communication, self-efficacy to use condoms in various situations, subjective norms, and attitudes towards condoms.
Agha^Citation46	Cross-sectional study; Men living in Pakistan married to women ages 15–49; Nationally representative survey	Male condoms, withdrawal; (1) Intention to use withdrawal in next 12 months; (2) intention to use condoms in next 12 months	Inability to discuss family planning with spouse or convince spouse to use family planning (single item)	Crossec.; Quant.	Statistically significant negative relationship between reported inability to discuss family planning with spouse or convince them to use family planning and intention to use condoms (OR = 0.82, 95% CI 0.70–0.96, p < 0.05, n = 1805), and statistically significantly positive relationship with intention to use withdrawal (OR = 1.51, 95% CI 1.23, 1.84).
Bui, et al.^Citation47	Cross-sectional study; Third-year female undergraduate students living in Vietnam; Universities	Male condoms, emergency contraception, withdrawal, rhythm method; (1) Using contraception at first sex; (2) using condoms at first sex	Sexual communication self-efficacy: five-item unidimensional scale assessing confidence in starting conversations with partner about safer sex, contraception, and negotiating condom use with moderate internal consistency (α=0.68)	Crossec.; Quant.	Statistically significant positive relationship between sexual communication self-efficacy and using contraception at first sex (OR = 1.13, p = 0.039, n = 111). Contraception methods used at first sex were condoms, EC, withdrawal, and rhythm method. No statistically significant relationship between safer sex communication self-efficacy and using condoms vs. other contraception methods (EC, withdrawal, rhythm method) at first sex (OR = 1.15, p = 0.092, n = 71).
Do, et al.^Citation48	Cross-sectional study; Women ages 15–49 currently married or cohabitating with a partner living in Namibia, Zambia, Ghana, or Uganda; Nationally representative surveys	Male condoms, withdrawal, diaphragm, foam, jelly, LAM, periodic abstinence, female condom; Use of couple methods (male and female condoms, diaphragm, foam, jelly, withdrawal, LAM, and periodic abstinence)	(1) Economic empowerment: five-item index with three-point Likert-type response options to assess decision-making balance in how income would be used between a woman and her husband, with higher scores indicating greater empowerment; (2) sociocultural activities: single-item	Crossec.; Quant.	In Namibia, higher aggregated empowerment scores were associated with greater likelihood of using couple contraception methods vs. no contraception (aRR = 1.24, SE = 0.05, p < 0.001, n = 3235). There were no statistically significant associations between the following empowerment measures and use of couple contraceptive methods vs.no contraceptive methods: economic empowerment (aRRR = 1.05, SE = 0.06, p > 0.05, n = 3235), sociocultural activity decision-making (aRRR = 0.96,
			measure asking who decided whether women could visit their family and relatives (woman alone or joint decision vs. other); (3) health-seeking behaviour: single-item measure asking who made decisions about the woman’s health care (woman alone or joint decision vs. other); (4) agreement on fertility preferences: single-item measure asking whether the woman and her partner wanted the same number of children (yes vs. no or don’t know); (5) sexual activity negotiation: six-item index with dichotomous response options to assess woman’s ability to negotiate sexual activity (such as refuse sex, ask partner to use condoms), higher scores indicating higher negotiation power among women		SE = 0.18, p > 0.05, n = 3235), health-seeking behaviour decision-making (aRRR = 0.89, SE = 0.19, p > 0.05, n = 3235), agreement on fertility preference (ARRR = 1.02, SE = 0.15, p > 0.05, n = 3235), and sexual activity negotiation (aRRR = 1.02, SE = 0.05, p > 0.05, n = 3235). In Zambia, there were statistically significant positive associations between agreement on fertility preferences and use of couple contraceptive methods vs. no contraceptive methods (aRR = 1.31, SE = 0.15, p < 0.05, n = 4241); and between sexual activity negotiation and use of couple contraceptive methods vs. no contraceptive methods (aRR = 1.08, SE = 0.03, p < 0.05, n = 4241). There were no statistically significant relationships between the following empowerment measures and use of couple contraceptive methods vs. no contraceptive methods: economic empowerment (ARR = 1.02, SE = 0.03, p > 0.05, n = 4241), sociocultural activity decision-making (ARR = 0.97, SE = 0.12, p > 0.05, n = 4241), and health-seeking behaviour decision-making (ARR = 0.95, SE = 0.11, p > 0.05, n = 4241). In Ghana, there were statistically significant positive associations between sexual activity negotiation and use of couple contraceptive methods vs. no contraceptive methods (aRRR = 1.13, SE = 0.05, p < 0.05, n = 2902). There were no statistically significant relationships between the following empowerment measures and use of couple contraceptive methods vs. no contraceptive methods: economic empowerment (aRRR = 1.02, SE = 0.09, p > 0.05, n = 2902),
					sociocultural activity decision-making (aRRR = 0.97, SE = 0.18, p > 0.05, n = 2902), health-seeking behaviour decision-making (aRRR = 0.82, SE = 0.15, p > 0.05, n = 2902), and agreement on fertility preferences (aRRR = 1.06, SE = 0.14, p > 0.05, n = 2902). In Uganda, there were statistically significant positive associations between economic empowerment and use of couple contraceptive methods vs. no contraceptive methods (aRRR = 1.09, SE = 0.04, p < 0.05, n = 5193) and between agreement on fertility preferences and use of couple contraceptive methods vs. no contraceptive methods (aRRR = 1.60, SE = 0.18, p < 0.001, n = 5193). There were no statistically significant relationships between the following empowerment measures and use of couple contraceptive methods vs. no contraceptive methods: sociocultural activity decision-making (aRRR = 1.11, SE = 0.17, p > 0.05, n = 5193), health-seeking behaviour decision-making (ARRR = 1.13, SE = 0.16, p > 0.05, n = 5193), and sexual activity negotiation (ARRR = 1.02, SE = 0.05, p > 0.05, n = 5193). All analyses adjusted for age, education, household wealth, religion, number of living children, exposure to family planning messages in mass media, number of methods known, and rural or urban community. Aggregate measures not reported for Zambia, Ghana, and Uganda because they were not statistically significant in unadjusted analyses.
Nelson, et al.^Citation49	Nonrandomised experimental study; Women ages 18–40 living in the United States selected from a health insurance cohort to participate in an RCT, using OCPs as primary contraceptive method; Insurance coverage cohort	OCPs; (1) Self-reported adherence in past three months: single item asking number of days missed a dose of OCPs in past three months; results categorised as high (three or fewer missed days) or low (more than three missed days); (2) Proportion of days covered in past 90 days: used pharmacy claims data to calculate proportion of days covered in past 90 days	Contraceptive self-efficacy: eight-item scale (response structure NR) assessing confidence in preventing pregnancy and talking to partners about contraception with moderate internal consistency (α = 0.71). For analysis, scores were dichotomised at the mean into high or low self-efficacy.	Crossec.; Quant.	Participants with high contraceptive self-efficacy were statistically significantly more likely to have high adherence to OCPs by self-report compared to those with low contraceptive self-efficacy (aOR = 1.99, 95%CI 1.18–3.37, n = 281), adjusting for age, relationship status, education level, household income, race/ethnicity, religion, future pregnancy intention, self-reported importance of avoiding pregnancy, and length of pill supply. Participants with high contraceptive self-efficacy were statistically significantly more likely to have high adherence to OCPs by self-report and pharmacy claims data together, compared to those with low contraceptive self-efficacy (aOR = 1.63, 95%CI 1.03–2.58, n = 202), adjusting for age, relationship status, education level, household income, race/ethnicity, religion, future pregnancy intention, self-reported importance of avoiding pregnancy, and length of pill supply. There were no statistically significant differences in OCP adherence by contraceptive self-efficacy score when measuring adherence using pharmacy claims data alone (aOR = 1.16, 95% CI 0.72–1.87, n = 253), adjusting for age, relationship status, education level, household income, race/ethnicity, religion, future pregnancy intention, self-reported importance of avoiding pregnancy, and length of pill supply.
Immediate Relational Agency – Intimate Partner Violence
Chiodo, et al.^Citation50	RCT; Ninth grade adolescent girls living in Canada who participated in a school-based cluster RCT and reported having a partner in the past 12 months at follow-up; High schools	Male condoms; Condom use at last sex	Actual and threatened physical dating violence (none, victim only, perpetrator only, mutually violent)	Crossec.; Quant.	Girls in different dating violence profiles had statistically significantly different proportions of condom nonuse (proportion of participants with condom nonuse by violence profile: 34.2% no violence (n = 367), 37.0% victim only (n = 39), 33.3% perpetrator only (n = 32), 60.7% mutual (n = 81); χ^23 df = 13.28, p < 0.01).
Davis^Citation51	Cross-sectional study; Men 21–30 years living in the United States interested in sexual activity with women and had 1 or more instances of unprotected sex with a woman in past 12 mo.; Urban area	Male condoms; Nonconsensual condom removal: Number of times since age 14 obtained condomless sex when female sex partner wanted to use a condom	(1) Sexual aggression severity (adapted from Sexual Experiences Survey): number of items and scoring NR, assessed frequency of attempted and completed sexual assault; (2) condom use self-efficacy (CUSES)	Crossec.; Quant.	zStatistically significant positive association with sexual aggression severity and nonconsensual condom removal (aOR = 1.063, 95% CI 1.032–1.095, p < 0.001, n = 626), adjusting for age and condom use self-efficacy. No statistically significant relationship between condom use self-efficacy and nonconsensual condom removal (OR = 0.931, 95% CI 0.509–1.703, p = 0.817, n = 626).
Mitchell, et al.^Citation52	Qualitative research; Female university students ages 18–26 living in Fiji; University	Male condoms; Condom use	Reproductive coercion	RE→CSC; Qual.	Almost half of participants described experiencing reproductive coercion in the form of being “pressured, manipulated, or deceived” into having condomless sex. Male partners coerced participants into having sex without a condom through questioning participants’ love, trust, or commitment to the relationship, making statements such as, “If you love me, if you like me, then don’t use a condom.”
Sharma, et al.^Citation53	Qualitative research; Women living in India who recently injected drugs or used drugs through non-injecting routes; Community-based drop in centres	Male condoms; Condom use	Fear of partners and power dynamics within paid partnerships	Crossec.; Qual.	Within paid partnerships, women reported not using condoms due to fear of violence from paying partners and due to the power dynamics involved in transactional sex.
Yamamoto, et al.^Citation54	Cross-sectional study; Married women ages 15–49 living in Nepal using contraception; Nationally representative survey	Male condoms; Currently using condoms	Fear of partner: single item asking whether women were afraid of their partner with three-point Likert-type response options indicating, most of the time, some of the time, or never	Crossec.; Quant.	40% of pill users and 33.3% of condom users reported fear of their partner (no statistical test conducted, n = 336). Women who feared their partner were statistically significantly less likely to use condoms vs. female sterilisation (Marginal effect: −0.070, SE: 0.288, p < 0.05, n = 616), adjusting for years of schooling, age, literacy, husband’s education, wealth quintile, and region.
Reiss, et al.^Citation55	RCT; Women ages 18–49 living in Bangladesh receiving a menstrual regulation procedure; Public and private health clinics	Client-facing digital technology;*** Receiving client-facing digital technology intervention	Experiencing intimate partner violence	CSC→RE; Quant.	Participants randomised to the client-facing digital technology intervention had statistically significantly higher odds of experiencing physical intimate partner violence as a result of being in the study (aOR = 1.97, 95% CI 1.12–3.46) but no higher odds of experiencing sexual intimate partner violence (12% intervention vs. 10% control, OR NR). Adjusted for age, socioeconomic status, experiences of violence during the study period not due to study participation, and experiences of violence before the study.
Thiel de Bocanegra, et al.^Citation56	Qualitative research; Women ages 18 and older living in the United States at participating domestic violence shelters; Domestic violence shelters in urban area	OCPs, male condoms; (1) Use of oral contraceptives; (2) use of male condoms	Experiencing abuse within a relationship	RE→CSC; Quant.	19% of women described that their abusive partners prevented them from using oral contraception by barring them from getting refills. 87% of women reported consistently using condoms with their abusive partner, with about half of these participants reporting that their partner refused to use a condom when asked.

Note: Crossec. = Cross-sectional; CSC = Contraceptive self-care; EC = Emergency contraception pills; OCP = Oral contraception pills; RE = Reproductive Empowerment.

*My Birth Control, tablet-based interactive decision support tool to provide contraceptive education, elicit preferences for contraception attributes, and provide recommendations for methods matching patient preferences. Tool provider printout with patient preferences and questions to be shared with provider during visit.

**“Contraception Choices” website provides information about contraception and an interactive decision tool that queries women’s priorities for a contraceptive method and provides a list of the three methods that most closely fit women’s preferences.

***Interactive voice-recorded messages providing tailored information about contraception and linking participants to a counsellor at a call centre for additional information.

Figure 3. Summary of the relationships between contraceptive self-care and reproductive empowerment constructs

Table 3. Measures of reproductive empowerment and related constructs

Measure	Description	Number of Items (Number and Names of Subscales)	Response Options	Example Item	Internal Consistency*	Studies	Reference for Original Measure
Condom Use Self-Efficacy Scale (CUSES)	Asses self-efficacy to use condoms and negotiate condom use with partners	Original: 14 (4: Assertiveness, Partner’s Disapproval, Mechanics, Intoxicants) Gesselman, et al. abbreviated version: 4, unidimensional Sousa, et al. adaptation for Brazilian context: 14 (3: Communication, Consistent Use, Correct Use) Santos, et al. adaptation for Brazilian context: 15 (NR)	Five-point Likert-type	“If I were unsure of my partner’s feelings about using condoms, I would not suggest using one.”	Original scale: Excellent for overall scale (Thomas, et al.: α = 0.90); excellent to good for each subscale (Asante: α = 0.81–0.90) Adaptations for Brazilian context: Good (Santos, et al.: α = 0.86; Sousa, et al: α = 0.85)	Original version: Thomas et al.^Citation42; Davis^Citation51; Asante et al.^Citation28. Adaptations for Brazilian context: Santos, et al.^Citation37; Sousa, et al.^Citation40 Abbreviated version: Gesselman, et al.^Citation33	^Citation59
Decisional Conflict Scale	Assesses awareness of available options and perceived ability to make an informed choice	16 (5: Informed Decision, Uncertainty, Effective Decision, Values Clarity, Support)	Five-point Likert-type	“I am clear about which benefits matter most to me.”	NR	Dehlendorf, et al.^Citation24	^Citation58
Condom Self-Efficacy	Assess confidence in using condoms, similar to CUSES Mechanics and Assertiveness subscales	15	Five-point Likert-type	NR	Good (α = 0.84)	Tsay, et al.^Citation44	NA
Partner Risk Reduction Self-Efficacy	Assess perceived ability to change sex behaviour within relationship	4	Five-point Likert-type	“Would you be able to avoid sex any time you didn’t want it?”	Acceptable (α = 0.73)	Chirinda, et al.^Citation30	^Citation60
Relationship Control	Assess perceived control in relationship	4	Four-point Likert-type	“Your partner has more control than you do in important decisions that affect your relationship.”	Good (α = 0.81)	Chirinda, et al.^Citation30	^Citation61
HIV Attitudes Scale, condom use self-efficacy subscale	Assess confidence to negotiate and use condoms	Three-item subscale	Four-point Likert-type response	“If my partner would want to have sex without a condom, I would try to convince her/him to use it.”	Acceptable (α =  0.76)	Espada, et al.^Citation21	^Citation62
Minnesota Student Survey, self-esteem subscale	Assess self-esteem	Four-item subscale	Four-point Likert-type	“I usually feel good about myself.”	Good (α = 0.89)	Ghobadzadeh, et al.^Citation22	NA
Partner Communication Self-Efficacy	Assess perceived difficulty of talking with sexual partner about condom use and other risk behaviours	6	Five-point Likert-type	“How hard is it for you to refuse to have sex if he won’t wear a condom?”	Good (α = 0.82)	Ritchwood, et al.^Citation36	^Citation63
General Self-Efficacy Scale	Assess general self-efficacy among adolescents	10	10-point Likert-type	“I am confident that I could handle unexpected events effectively.”	Excellent (α = 0.90)	Escribano, et al.^Citation20	^Citation64
Confidence in Safer Sex Scale (Adapted)	Assess confidence to successfully negotiate condom use with a partner	5	Five-point Likert-type	“How sure are you that you would use condoms when your partner gets annoyed about using condoms?”	NR	Shih, et al.^Citation38	^Citation65
Sexual Communication Self-efficacy (adapted and abbreviated)	Assess confidence in discussing safer sex, contraception, and negotiating condom use with partner	5	Eight-point Likert-type	“I can easily initiate and conduct a conversation about safer sex with my boyfriend.”	Questionable (α = 0.68)	Bui, et al.^Citation47	NA
Contraceptive Self-Efficacy	Assess confidence in preventing pregnancy and talking to partner about contraception	8	NR	NR	Acceptable (α = 0.71)	Nelson, et al.^Citation49	NA, influenced by existing measure^Citation66

*Excellent: α ≥ 0.9, Good: 0.8 ≤ α < 0.9; Acceptable: 0.7 ≤ α < 0.8; Questionable: 0.6 ≤ α < 0.7.

Appendix 2. Risk of bias and quality assessments assessment

Risk of Bias Assessment, Studies with Quantitative Data
ID	Cohort Design	Control or Comparison Group	Pre/post Intervention Data	Random Assignment of Participants to the Intervention	Random Selection of Participants for Assessment	Follow-up Rate of 80% or More	Comparison Groups Equivalent on Socio-demographics	Comparison Groups Equivalent at Baseline on Outcome Measures	Other Issues
Agha^Citation46	No	No	No	NA	Yes	NA	NA	NA
Asante, et al.^Citation28	No	No	No	NA	No	Yes	NA	NA
Bui, et al.^Citation47	No	No	No	NA	No	NA	NA	NA
Chiodo, et al.^Citation50	No	Yes	Yes	Yes	No	Yes	NR	NR
Chirinda, et al.^Citation30	No	No	No	NA	Yes	NA	NA	NA
Davis^Citation51	No	No	No	NA	No	NA	NA	NA
Dehlendorf, et al., ^Citation24	No	Yes	Yes	Yes	No	Yes	Yes	Yes
Do, et al.^Citation31	No	No	No	NA	Yes	NA	NA	NA
Do, et al.^Citation48	No	No	No	NA	No	NA	NA	NA
Escribano, et al.^Citation20	No	Yes	Yes	Yes	No	No	No	No
Espada, et al.^Citation21	No	No	No	NA	Yes	NA	NA	NA	Statistical power not discussed, but potentially small sample size for structural equation modeling
Folayan, et al.,^Citation32	No	No	No	NA	No	NA	NA	NA	Imprecise estimates due to large standard errors
Gesselman, et al.^Citation33	No	No	No	NA	No	NR	NA	NA
Ghobadzadeh, et al.^Citation22	No	Yes	Yes	Yes	No	NR	NR	NR
Long, et al.^Citation35	No	No	No	NA	Yes	NA	NA	NA
Nelson, et al.^Citation49	No	Yes	No	Yes	No	NR	NR	NR
Reiss, et al.^Citation55	No	Yes	Yes	Yes	No	Yes	Yes	Yes
Ritchwood, et al.^Citation36	No	No	No	NA	No	NA	NA	NA
Santos, et al.^Citation37	No	No	No	NA	Yes	NA	NA	NA
Shih, et al.^Citation38	No	No	No	NA	No	NA	NA	NA
Smylie, et al.^Citation39	No	No	No	NA	No	NA	NA	NA
Sousa, et al.^Citation40	No	No	No	NA	No	NA	NA	NA
Stephenson, et al.^Citation25	No	Yes	Yes	Yes	No	No	Yes	Yes
Tafuri, et al.^Citation41	No	No	No	NA	No	NA	NA	NA
Thiel de Bocanegra, et al.,^Citation56	No	No	No	NA	No	NA	NA	NA	Methodology unclear, no statistical testing conducted
Thomas, et al.^Citation42	No	No	No	NA	No	NA	NA	NA
Tingey, et al.^Citation43	No	Yes	Yes	Yes	No	Yes	NR	Yes
Tsay, et al.^Citation44	No	No	Yes	No	No	NR	NA	NA
WHO^Citation27	No	No	NA	NR	NA	NA	NA	NA
Xiao^Citation45	No	No	No	NA	Yes	No	NA	NA
Yamamoto, et al.^Citation54	No	No	No	NA	Yes	NA	NA	NA
Quality assessment, studies with qualitative data
ID	Clear Statement of Research Aims	Qualitative Methodology Appropriate	Research Design Appropriate to Address Aims of the Research	Recruitment Strategy Appropriate for Aims of the Research	Data Collected in a Way That Addressed Research Issue	Relationship Between Researcher and Participant Adequately Considered	Ethical Issues Taken into Consideration	Data Analysis Sufficiently Rigorous	Clear Statement of Findings
Appleton^Citation23	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
Buston et al.^Citation29	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Krugu, et al.^Citation34	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
Mitchell, et al.^Citation52	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes
Sharma, et al.^Citation53	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Stephenson, et al.^Citation25	Yes	Yes	Yes	Yes	No	No	Yes	No	Yes
Sundstrom, et al.^Citation26	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes

Appendix 3. Additional information about studies included in the review

ID	Aim	Study years	Population description	Demographics
Individual Agency
Escribano, et al.^Citation20	Describe relationship between consistent condom use among sexual and reproductive health intervention recipients	2012–2014	Male and female youth ages 14–16 (n = 1121)	Mean (SD) age: 14.8 (0.8); SES: 33.4% low, 58.4% middle, 8.2% high
Espada, et al.^Citation21	Assess factors associated with condom use frequency	2012	Male and female youth ages 13–18 (n = 410)	Mean (SD) age: 15.6 (NR) SES: 3.2% low, 54.9% middle, 41.9% high
Ghobadzadeh, et al.^Citation22	Examine associations between protective factors and consistent family planning use	2007–2008	Sexually active girls ages 13–17 (n = 253)	Mean (SD) age: 15.6 (NR)
Appleton^Citation23	Explore perceptions of emergency contraception (EC)	2008–2011	Women ages 20–40 (n = 15)	NR
Dehlendorf, et al.^Citation24	Evaluate effects of tablet-based contraception decision support tool on family planning continuation, decision quality, and experiences with family planning care	2014–2016	Women ages 15–45 planning to start or change contraceptive method (n = 758)	32% parous
Stephenson, et al.^Citation25	Assess efficacy of “Contraception Choices” website on women’s informed choice of family planning	2017–2018	Women ages 15–30 (n = 927)	Mean (SD) age: 24 (NR)
Sundstrom, et al.^Citation26	Assess attitudes toward availability of OCPs without a prescription	2015	Women 18–44 years (n = 52)	Mean (SD) age: 33.2 (7.9); low household income: 56%; 100% rural
WHO^Citation27	Explore values and preferences of health care providers (HCPs) and laypeople (LP) around self-care	2018	HCPs and LP ages 18–70+ (n = 837; 360 HCPs, 465 LP)	NR
Immediate Relational Agency –Partner Negotiation
Asante, et al.^Citation28	Assess psychometric properties of Condom Use Self-Efficacy Scale	NR	Male and female university students (n = 511)	Mean (SD) age: 21.6 (NR); 88% married; 60% living in affluent area
Buston, et al.^Citation29	Explore attitudes and experiences with contraception and sexual and reproductive health (SRH)	2008	Males ages 16–21 at a young offender institution (n = 31)	Mean (SD) age: 18.3 (NR)
Chirinda, et al.^Citation30	Identify factors associated with inconsistent condom use	NR	Sexually active male and female youth ages 18–24 (n = 2138)	Poverty index (SD), range 6-22: 8.1 (NR)
Do, et al.^Citation31	Examine relationships between demographics, self-efficacy, and condom use	2005	Married women (n = 4632)	Household wealth: 38.6% low, 40.7% middle, 20.7% high; 80.9% rural, 19.1% urban
Folayan, et al.^Citation32	Assess factors related to contraceptive knowledge and condom use	2012	Male and female adolescents ages 10–19 at HIV treatment centres and youth centres (n = 1555)	62.7% could afford three meals/day, 22.8% could afford two, 6.7% could afford one, 7.8% NR
Gesselman, et al.^Citation33	Assess feasibility and acceptability of a condom promotion intervention	NR	Couples ages 18–24 attending university (n = 118, 59 couples)	0% married
Krugu, et al.^Citation34	Assess factors related to sexual decision-making among adolescent girls	NR	Adolescent girls ages 14–19 (n = 20)	Mean (SD) age: 17.3 (1.6); 0% married; mean (SD) parity: 0 (0)
Long, et al.^Citation35	Explore perceptions related to who should be responsible for family planning	2016	Sexually active male and female college students (n = 826)	Mean (SD) age: 20.9 (1.5)
Ritchwood, et al.^Citation36	Assess relationships between sexual sensation seeking and antecedents of unprotected sex and number of sex partners	2005–2007	Sexually active African American women ages 14–20 (n = 701)	Mean (SD) age: 17.6 (1.7)
Santos, et al.^Citation37	Explore factors contributing to family planning use	2012–2013	Undergraduate university students ages 18–29 (n = 1946)	Mean (SD) age: 20.7 (2.3); 57% low-income; 40% urban, 60% rural
Shih, et al.^Citation38	Assess factors related to inconsistent and incorrect condom use	2007–2009	Sexually active women ages 14–45 (n = 2087)	32% married
Smylie, et al.^Citation39	Develop and validate sexual health indicators	2010	Young men and women ages 16–24 (n = 1185)	Mean (SD) age: 19.7 (NR); 68.4% urban, 27.6% rural
Sousa, et al.^Citation40	Assess an adapted measure of condom use self-efficacy and relationship with associated factors	2014	Male and female students ages 13–26 (n = 209)	NR
Tafuri, et al.^Citation41	Assess factors related to condom use	2008	Freshman university students (n = 1,091)	Mean (SD) age: 19.6 (1.7)
Thomas, et al.^Citation42	Assess determinants of condom use	NR	Community-based sample (n = 311)	Mean (SD) age: 27.0 (8.6)
Tingey, et al.^Citation43	Evaluate impact of an SRH intervention on predictors of condom use intentions	2011–2012	Male and female American Indian adolescents ages 13–19 (n = 267)	Mean (SD) age: 15.1 (1.7)
Tsay, et al.^Citation44	Implement and evaluate an HIV/STI prevention programme		Male and female adolescents ages 13–18 in youth detention centres (n = 662)	Mean (SD) age: 15.6 (NR)
Xiao^Citation45	Assess a theoretical framework for condom use	2007	Unmarried male and female college students ages 18+ (n = 1875)	Median age: 20
Agha^Citation46	Identify factors motivating and deterring uptake of family planning	2007	Men married to women ages 15–49 (n = 4062; 1788 women, 1805 men)	32.9% urban residence (women), 34.4% urban residence (men)
Bui, et al.^Citation47	Assess relationships between relationship inequality, sexual communication, and family planning use	2009	Female undergraduate students (n = 1181)	Mean (SD) age: 21.6 (1.0); 66.1% rural, 26.3% urban
Do, et al.^Citation48	Examine relationships between women’s empowerment and use of female-only or couple family planning	2006–2008	Women ages 15–49 currently married or cohabitating (n = 15,571; 3235 Namibia, 4241 Zambia, 2902 Ghana, 5193 Uganda)	SES: Poorest: 33.1% Namibia, 40.9% Zambia, 31.9% Ghana, 35.7% Uganda Middle: 30.4% Namibia, 31.5% Zambia, 34.0% Ghana, 36.9% Uganda Richest: 36.5% Namibia, 27.6% Zambia, 34.0% Ghana, 27.4% Uganda Rural: 52.1% Namibia, 65.6% Zambia, 57.9% Ghana, 87.0% Uganda Urban: 47.9% Namibia, 34.4% Zambia, 42.2% Ghana, 13% Uganda
Nelson, et al.^Citation49	Compare prescription claims data to self-report to assess oral contraceptive pill (OCP) adherence	2014	Women ages 18–40 using OCPs (n = 384)	Household income: 16% lowest, 23% second lowest, 27% second highest, 34% highest
Immediate Relational Agency – Intimate Partner Violence
Chiodo, et al.^Citation50	Assess risk factors for dating violence	2004–2007	Ninth grade adolescent girls (n = 519)	Mean (SD) age: 13.8 (0.5)
Davis^Citation51	Assess rates of nonconsensual condom removal and related predictors and risk factors	Not reported (NR)	Men ages 21–30 (n = 626)	Mean (SD) age 25.5 (3.5); 100% urban
Mitchell, et al.^Citation52	Explore experiences of reproductive coercion	2011–2012	Female university students ages 18–26 (n = 17)	0% married
Sharma, et al.^Citation53	Assess factors related to sexual and reproductive health outcomes specific to women who use drugs	NR	Women with history of drug use (n = 48)	100% low-income, 100% urban
Yamamoto, et al.^Citation54	Assess relationships between demographic factors and family planning method choice	2011	Married women ages 15–49 (n = 4172)	Mean (SD) age: 33.8 (7.8); 100% married
Reiss, et al.^Citation55	Assess impact of automated interactive voice messages on family planning use	2015–2016	Women ages 18–49 receiving a menstrual regulation procedure (n = 969; 485 intervention, 484 control)	Mean (SD) age: 28 (6); 99% married (intervention), 98% married (control)
Thiel de Bocanegra, et al.^Citation56	Describe experiences of birth control sabotage and forced sex	2007	Women ages 18 + in domestic violence shelters (n = 53)	Mean (SD) age: 33.7 (NR)

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