Women's empowerment positively impacts family planning in sub-Saharan Africa, but little is known about its relationship with contraceptive method mix. Considering that contraceptive needs vary across life stages, we aimed to explore the intersectional differences in contraceptive method mix according to age and level of empowerment in sub-Saharan Africa. We analyzed data from Demographic and Health Surveys conducted since 2015 across 28 countries in West & Central and Eastern & Southern Africa. Within each region, we calculated pooled estimates of demand for family planning satisfied by any method (DFPS) and contraceptive method mix, stratifying by women's age and empowerment level using the survey-based women's empowerment index (SWPER). Our sample included 138,374 married women of reproductive age. Across both regions, more empowered women achieved higher DFPS, especially those older than 19. Among adolescents, we found a substantial increase only in the decision-making domain. Injectables and implants dominated the method mix, but their shares dropped as empowerment increased. This trend appeared across all age groups and empowerment domains, with the largest declines observed for social independence. High-empowered women had a more diversified method mix, with adolescents and young women with increased use of condoms, pills, and fertility-awareness methods, while women over 34 relied more on IUDs and sterilization. Our findings reveal that age, empowerment, and contraceptive method mix intersect in diverse ways. Tailoring family planning policies and counseling while addressing empowerment drivers could enhance informed contraceptive choices and better meet women's reproductive health goals. The evidence generated in this study emphasizes the importance of designing family planning programs that address age-specific reproductive needs and empowerment-related barriers, providing insights to guide more tailored interventions in sub-Saharan Africa.

Traditional measures of success in family planning research focus on contraceptive uptake and use. Scholars have increasingly challenged these outcomes, calling for rights-based, person-centered measures that capture whether individuals can fulfill their reproductive preferences or desires. We sought to evaluate a family planning program using a novel, person-centered measure of perceived pressure to adopt contraception. We use secondary data collected as part of the Postpartum Intrauterine Device (PPIUD) Study, a step-wedged, cluster-randomized trial of a provider-focused PPIUD intervention conducted in Sri Lanka from 2015 to 2018. We used logistic regression to assess the association between the PPIUD intervention and perceived pressure to adopt contraception at 18-month follow-up and converted estimates into risk differences. About 18 months following the PPIUD intervention, 13% of participants were not using contraception, most (82%) were using contraception and did not report feeling pressured to adopt their method, and 5% were using contraception and did report feeling pressured. While the PPIUD intervention was associated with increased contraceptive use, it was also associated with increased perceived pressure to adopt contraception (risk difference comparing intervention and control group: 4.5%; 95% confidence interval: -2.7%, 11.7%). Perceived pressure to adopt contraception was higher among IUD users compared to users of other contraceptive methods. While expanding access to contraceptive methods - including the IUD - is imperative to promote choice in contraceptive decision-making, our findings highlight the importance of evaluating interventions not just based on use or uptake of specific contraceptive methods, but also using person-centered outcomes that capture reproductive autonomy. Evaluating family planning programs solely on contraceptive use overlooks critical aspects of reproductive autonomy. We find that a postpartum IUD intervention in Sri Lanka was associated with increased contraceptive use but also increased perceived pressure to adopt contraception. Our findings emphasize the importance of assessing programs using rights-based, person-centered measures.