Women's Autonomy, Education and Employment in Oman and their Influence on Contraceptive Use

Abstract: Since 1970 political and economic changes have brought about great improvements inhealth and education in Oman, and since 1994 the government has provided free contraceptives toall married couples in primary health care centres. Despite rapid socio-economic development, thefertility rate was 4.2 in 2001. The aim of this study was to define baseline data on ever-marriedwomen’s empowerment in Oman from a national study in 2000, analyse the correlates of women’sempowerment and the effect of empowerment on unmet need for contraception. Two indicators ofempowerment were used: women’s involvement in decision-making and freedom of movement.Bivariate analysis was used to link these measures and their proxies, education and employmentstatus, with use of a family planning method. Education was a key indicator of women’s status.Unmet contraceptive need for women exposed to pregnancy was nearly 25%, but decreasedsignificantly with educational level and paid employment. While empowered women were morelikely to use contraception, women’s education was a better predictor of ‘‘met need’’ than autonomy,as traditional factors and community influence remain strong. For nearly half the 1,830 women inthe study, the husband decided whether contraception was used. Fewer than 1% were usingcontraception before their first child as women are expected to have a child within the first year ofmarriage. A 2004 Reproductive Health Matters. All rights reserved.

Keywords: education, women’s empowerment, autonomy, family planning use, unmet need, Oman

THE 1994 International Conference on Pop-ulation and Development found that thesingle most important component a nation

can invest in to improve its health is theeducation of girls and women.1 The conferencereflected the now commonly understood link-ages between education, women’s empower-ment and demographic indicators.

Since the ascension of His Majesty, SultanQaboos bin Said in Oman in 1970, political andeconomic changes have brought about greatimprovements in health and education.2 In 2002,infant mortality was 16.2 per 1000 live birthscompared to 103 in 1975 and life expectancyrates for the same years were 73.8 years com-pared to 52.7.3 A universal education policy for

both boys and girls was introduced in 1970.Thirty years later, Oman is beginning to see thebenefits of this policy in a higher percentage ofeducated women in Oman. Among women aged60 and over, less than 1% had 12 or more yearsof education compared to men (4.4%) but forwomen aged 20–29, nearly half (47%) had com-pleted secondary school (12 years of education)as had 46.5% of men in the same age cohort.4

Despite rapid socio-economic development,15% of adolescent girls aged 15–20 are married.4

The fertility rate, 4.2 in 2001, remains high3 andlarge families are common. Compared to a totalfertility rate of 7.84 in 1990,5 4.2 represents adramatic drop. Although similar to othercountries of the region (4.12 in Kuwait, 4.24

Women’s Autonomy, Education and Employment inOman and their Influence on Contraceptive Use

Asya Al Riyami,a Mustafa Afifi,b Ruth M Mabryc

a Director, Department of Research and Studies, Ministry of Health, Oman. E-mail: [email protected]

b Medical Officer, Department of Research and Studies, Directorate General of Planning, Ministry of Health, Oman

c Public Health Officer, Directorate General of Health Affairs, Ministry of Health, Oman

www.rhmjournal.org.ukwww.rhm-elsevier.com

A 2004 Reproductive Health Matters.All rights reserved.

Reproductive Health Matters 2004;12(23):144–1540968-8080/04 $ – see front matterPII: S0968-8080 (04 )23113-5

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in United Arab Emirates and 3.11 in Bahrain)the rate is high compared to Europe and NorthAmerica. Upward rises in educational levels foryounger women in these same Gulf countriesin 1995 demonstrate the rapid rise in access toeducation for girls across the region.6–8

Because of the high fertility rate, the Ministryof Health initiated a birth spacing programmein 1994. Prior to 1994, women could obtainmodern methods of contraception in only a fewprivate clinics in the capital. Since the pro-gramme’s inception more than eight years ago,efforts have been made to provide contraceptivesfree to all married couples in primary health carecentres which are readily accessible to a majorityof the population.

Education, autonomy andcontraceptive useEducation has been shown to be more sus-ceptible to improvement through policy inter-

vention than more deeply rooted culturalconventions regarding family size.9 The inverserelationship between women’s educational leveland fertility has been universally acknowl-edged,9–15 a trend also seen in the Arabworld.16–22 Martin’s comprehensive review of26 Demographic and Health Surveys (DHS)identified this as an important link.9

There is also a common assumption thateducation leads to autonomy as it helps womento stand up to their husbands and provides thema forum to learn about fertility control and makeeffective use of the health care system.10

Dyson and Moore defined autonomy as thetechnical, social and psychological ability to ob-tain information and to use it as the basis formaking decisions about one’s private concernsand close relations.11 Jejeebhoy identified fiveinterdependent aspects of women’s autonomywhich are important in the education–autonomylink: autonomy of knowledge (educated womenhave a wider world view), decision-making

REN

EBURRI/MAGNUM

PHOTOS

Oman 1975

A Al Riyami et al / Reproductive Health Matters 2004;12(23):144–154

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autonomy (education strengthens women’s sayin decisions that affects their own lives), phys-ical autonomy (educated women have morecontact with the outside world), emotionalautonomy (educated women shift loyaltiesfrom extended kin to the conjugal family)and economic and social autonomy and self-reliance (education increases a woman’s self-reliance in economic matters and her ability torely on herself rather than on her children orhusband for social status).12

The Women’s Global Network for Repro-ductive Rights calls for women’s right to self-determination, including socio-economic andpolitical rights, so that they can make choicesregarding their reproductive health.23 Most of thepublished data, however, including in the mostrecent DHS, focus only on certain aspects ofwomen’s autonomy, such as decision-makingand freedom of movement. This paper will alsolimit itself to these two indicators.

As regards fertility control, Ravindran expand-ed the concept of ‘‘unmet need’’ to refer towomen’s ability to achieve their reproductiveintentions in good health and the ability ofreproductive health services to meet thoseneeds.24 However, this broader definition hasnot yet been incorporated into many fertility-related surveys. For the purposes of this paper,the definition of ‘‘met need’’ is restricted to‘‘using contraception’’ and ‘‘unmet need’’ to‘‘wants to use contraception’’ because of limita-tions in the available data. Although empower-ment and autonomy have different connotations,they are often used interchangeably in the litera-ture and similarly in this paper.

A search of the Demographic and HealthSurveys (DHS) website was done for publishedarticles on secondary analysis of data forcountries that used the DHS status of womenmodule questionnaire. Although the women’sstatus module of the DHS has been used in atleast seven countries, Egypt, the first country touse it, is the only country in the region forwhich secondary analysis of DHS data has beenpublished.25 Secondary analysis of this datafound that the mean level of both empowermentindices (a decision-making index and a freedomof movement index) for Egyptian women in-creased steadily and significantly with educa-tion. They concluded that the relationship of theempowerment indicators for contraceptive need

and use, in combination with education, pro-vided a clearer picture on contraceptive needand use than education alone.16 In a similarstudy of Egyptian women, it was found thatmore empowered women had fewer children andthat education was the most important factorrelated to women’s autonomy.17 Thus, althoughAngin and Shorter have questioned the relation-ship between education, empowerment and theuse of family planning,26 greater evidence seemsto confirm the relationship.

The Child Health Survey, 19905 Oman FamilyHealth Survey, 199527 and National Health Sur-vey, 20004 measured fertility and contraceptiveuse in Oman. Ever-use of modern contraceptivemethods increased in that decade from 16.3% to35.3% to 50.3% and current use increased from8.6% to 23.7% to 31.7%, respectively.

Oman has not had baseline data on wom-en’s empowerment nor its relationship to con-traceptive use. The National Health Survey,2000 (NHS 2000) was the first to allow thelink between the two to be studied. Our aimin doing this study was to define baselinedata on ever-married women’s empowermentin Oman, study the correlates of women’sempowerment and examine the effect ofwomen’s empowerment on the unmet needfor modern contraception among currentlymarried Omani women.

MethodologyNHS 2000, a community-based survey under-taken by the Department of Research and Stud-ies in the Omani Ministry of Health, had twoparts. The first covered lifestyle risk factors andthe second reproductive health. The surveysample was selected to be representative ofthe nation as a whole, using a multi-stage,stratified probability-sampling design. All sub-jects aged 20 years and above in the selectedhouseholds were invited to participate. The totalnumber of households selected was 1,968 witha total of 7,011 subjects fulfilling the selectioncriteria. The reproductive health section includ-ed several modules, with questions* coveringwomen’s background, reproductive health, ma-ternal health, family planning, HIV/AIDS and

*The study questionnaire can be requested from the

corresponding author.


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women’s status. Of the 2,037 ever-marriedwomen aged 15–49 who responded to the sur-vey, 1,830 were currently married and had heardabout family planning methods, answered thequestions related to contraceptive use and all theother modules.*

Two indicators of empowerment were devel-oped from the women’s status module to mea-sure women’s involvement in decision-makingand freedom of movement. To understand thedecision-making process, married women wereasked ‘‘Who has the final say on...’’ eight deci-sions: what foods to cook, household expendi-ture, children’s clothes, children’s medicine andhealth care, problem solving, family planning,having another baby and visiting relatives. Tomeasure decision-making power, an index wascreated (0 to 8) where 0=no responsibility forany of the eight decisions and 1–8=responsi-bility for 1–8 decisions. Similarly, marriedwomen were asked ‘‘Does your husband allowyou to go alone or accompanied by yourchildren** to...’’ six places: shopping, hospital/health centre, children’s schools, visit relatives,visit friends and go for a walk. Again, an indexwas used with a range from 0 to 6 (0 = no freedomand 1–6 = 1–6 places women can go). Cronbach-acoefficient was used to measure the reliability ofboth indices, and showed satisfactory results.Since these two indices did not provide a cleardifferentiation between autonomy and met andunmet need for contraception, the two indiceswere computed together to get the women’s em-powerment scale, ranging from 0 (very low em-powerment) to 14 (very empowered).

As regards met and unmet need for contra-ception, women who were pregnant, infecundor post-menopausal were defined as ‘‘not ex-posed to pregnancy’’,y while women with po-tential contraceptive need were those who didnot want a child within the next two years whowere ‘‘exposed to pregnancy’’. Women exposedto pregnancy were either currently using a

modern contraceptive method (met need) ornot (unmet need). The reproductive health sec-tion of NHS 2000 focused on obtaining infor-mation related to the birth spacing programmewith questions focusing on modern family plan-ning methods.

Bivariate analysis was used to link the directmeasures of women’s empowerment, decision-making and freedom of movement indices, andtheir proxies, education and employment sta-tus, with women’s use of family planningmethods. Due to the multi-dimensional natureof the variables examined, multivariate anal-ysis was used to control for variables thatare known to affect both empowerment andcontraceptive use, in order to identify andhighlight their relationship, namely age, num-ber of living children and place of residence.Multivariate analysis was conducted for theeffect of the empowerment index and women’seducation and employment on both poten-tial contraceptive need status and use sta-tus. Several logistic regressions were run to

**Women often do not have someone to look after their

children when they go out.y Women who were pregnant were not asked whether or

not they wanted to be.

*Asking fertility related questions to unmarried women is

considered culturally inappropriate; thus, unmarried

women were not asked fertility-related questions.


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investigate the effects of the different empower-ment variables.

ResultsEmpowerment indicatorsEducation is one of the key indicators in deter-mining women’s status in Oman. There was aclear difference when data on education weredisaggregated by age: 38.7% of women aged25–29 had had secondary education or above

compared to only 1.5% of those aged 45–49.Again, in the cohort aged 25–29, a much higherpercentage had paid employment (30.3%) thanin the cohort aged 45–49, where only 5.3% hadpaid employment. The difference between thesetwo cohorts in educational level and paid em-ployment is statistically significant (p<0.05, datanot shown).

The mean women’s empowerment scale forever-married women was 8.4 (Table 1). There


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was a significant difference between differenteducational levels and the reference category(those with university grades). Similarly, thosein paid employment had a higher mean on theempowerment scale.

Indicators and family planning useIn-depth analysis of these empowerment indi-cators with women’s unmet family planningstatus in relation to contraceptive use was thencarried out (see Table 2). Unmet need was quitehigh for women exposed to pregnancy, nearlyone in four women, but decreased significantlywith educational level from 34% for non-literatewomen to only 10% for those with universityeducation. More than half the women in paidemployment were using contraception, anothersignificant relationship.

Nearly 29% of the women who were respon-sible for only one decision had an unmet needfor contraception compared to about 21% of

those who were responsible for all eight deci-sions. Nearly 58% of the women responsible forall eight decisions were using contraceptioncompared to 37.8% involved with only onedecision (p<0.05), although the relationship isnot as strong as with education.

Of the women who were not allowed to goout alone, almost 30% were not using contra-ception while a similar percentage were using it.In contrast, only 22% of women who wereallowed to go to all six places alone were notusing contraception while nearly 48% wereusing it. Thus, although the more empoweredwomen were more likely to use contraception, itwas not a clear-cut linear relationship.

Regression analysis on need and use ofcontraceptionThe age of the woman and her number ofchildren significantly predicted use of contracep-tion (Table 3); thus, both have been controlled


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for in the models. Educational level and em-ployment status clearly show their influencein distinguishing those who were exposedto pregnancy from those who were not. Theempowerment scale alone predicted those whowere exposed to pregnancy compared to thosewho were not. However, the significance ofeducation and employment status was muchstronger than the empowerment scale. In otherwords, the empowerment scale was no longersignificant in predicting who was exposed topregnancy when combined with education andemployment status.

In Table 4, a similar analysis was done todetermine the effects of the empowerment scaleand its proxies, education and employmentstatus, on the probability of a woman’s contra-ceptive needs being met. Women’s education

had the strongest effect on their use of contra-ception. Empowered women were more likely touse contraception even after controlling foreducation and employment status, but women’seducation seemed to be a much better predictorof ‘‘met need’’ than the autonomy index.

DiscussionThe results clearly demonstrate the influence ofeducation on the need for and use of familyplanning and are likely to be the result ofinfluences such as socio-economic developmentand government policy of universal education.This confirms previous findings.9–22

A paper by Kishor et al using results from thewomen’s empowerment module of the EgyptianDHS 1995,16 an earlier paper using data from the


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Egyptian DHS 1989 and national surveys17 areamong the few studies on this issue that arereadily available from the region. Kishor et alfound that mean decision-making of Egyptianwomen in 1995 on a seven-point scale was 4.7.They were asked ‘‘Who has the final say in yourfamily on.. .’’: what foods to cook, the use ofcontraception, having another child, children’smedicine, children’s education, budget and visitsto friends and family. Around 3% of Egyptianwomen were not responsible for any of thesedecisions but nearly 21% were involved in allseven. Regarding freedom of movement, thewomen were asked ‘‘Are you usually allowed togo to...on your own, only with children, onlywith another adult, or not at all?’’ The five placesincluded just outside the home, local market,homes of friends and family, local health centreand recreation. The number of places womenwere allowed to go alone ranged from 3.6% forwomen not allowed to go to any of the placesalone to as high as 35% able to go all five places.The study concluded that Egyptian women’sparticipation in decision-making had the mostinfluence on the need for contraception whilefreedom of movement was significantly asso-ciated with met need for contraception; addingeducation and employment enhanced the signifi-cance of the association.16

Another article by Kishor focused on women’sdecision-making within the family and employ-ment in the work force. The three autonomyindices she used were: customary (making deci-sions related to procreation and childrearing),non-customary (making decisions outside thesetraditional areas) and realised (actual autonomysuch as having freedom of movement). Themean level of autonomy in this study was 1.8out of 5 and education was the most importantfactor related to women’s autonomy. The con-clusion was that variables related to modernisa-tion, such as education and socio-economicstatus, affect women’s autonomy. Most interest-ing was that changes in non-customary auto-nomy affected the other indices of autonomyand were most closely related to the use ofcontraception compared to the other indices.22

These and other studies point to the relation-ship between women’s autonomy and contra-ceptive use,11,12,18,21 andwewould have expectedthat relationship to exist in Oman as well. What isinteresting, however, is the relatively weak rela-

tionship between women’s autonomy, as mea-sured by their decision-making influence in thehousehold and their freedom of movement, andfamily planning use, and that education has amuch stronger influence.

Oman has a well-established health caresystem with nearly universal access (97%) toprimary health care.3 Unmet need for contra-ception has declined remarkably since the startof the birth spacing programme. Even withthe low level of women’s autonomy, the wideaccessibility of family planning services in allprimary health care centres and the ability ofthe majority of women to visit a health centreon their own (76.0%)4 provide some explana-tion of the education–contraceptive use link,similar to that in Bangladesh.9,13

Oman is new to the development and modern-isation process. In contrast, Egypt became amodern state much earlier, including the estab-lishment of schools for girls before the turn of the20th century. Oman has only had one generationof adults who have been educated, particularlythose under the age of 30. Since cultural andattitudinal changes take time, there could be agenerational lag in attitudes towards contracep-tion and fertility. Like other countries in the Gulf,Oman has a mean desired fertility of 5.5 (rangingfrom 6.2 for non-literate women to 4.7 for uni-versity-educated women or higher).4 Similarly,mean desired fertility is 4.7 in Bahrain,6 5.3 inKuwait,7 and 5.7 in the United Arab Emirates.8

The wealth from the oil industry has led to rapidmodernisation in these Gulf states, but there hasnot been a dramatic concomitant change incultural views on desired family size.

Although educated women are more likelyto need and use family planning, this is notdirectly linked to autonomy since, for 43.6% ofthe women in the current study, it is the husbandwho decides they should use family planning(from 38.5% of non-literate women to 50.4% ofuniversity-educated women). Oman is a verygender stratified society, which places limits onthe decisions educated women can make (datanot shown). As Jejeebhoy has noted, it takeswomen in highly gender-stratified societies‘‘considerably more education before [they can]overcome these cultural constraints and areinvolved in decisions seen as major to thehousehold’’.12 In short, education and employ-ment do not necessarily enhance autonomy if


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traditional factors remain strong. Jejeebhoyand Sathar noted that traditional forms ofauthority (such as age) can have a strong effecton women’s autonomy in communities withwide gender disparities.28

An ethnographic study in a working classcommunity in Istanbul, Turkey, questioned thewhole idea that education leads to womenbeing empowered and wanting fewer births.26

Although a study in Pakistan found four waysthat education affects fertility (it leads to latermarriage, to women marrying men with higherincome, to women entering the formal employ-ment sector and to unspecified changes inwomen’s values and interests), it found thatdomestic autonomy failed to predict fertility.14

In Kuwait, the government provides free edu-cation through secondary school (and beyondfor those who qualify), free health care, housingsubsidies and a monthly allowance for eachchild. Domestic workers are brought in fromabroad, which reduces the stress associated withraising a large family. Finally, childbearingremains an essential social role for women.29

Oman is very similar apart from the child allow-ance. Like Kuwait, Oman is a tribal society inwhich members of the same tribe are expected tohelp one another in many different ways, and afamily-oriented society in which extended fam-ilies support each other in raising children.

In highly stratified settings, autonomy maybe shaped by traditional factors such as co-res-idence with mothers-in-law and dowry, as foundin a comparative study of India and Pakistan.28 Inother communities, however, education and eco-nomic development raise most indicators ofwomen’s autonomy. In other words, autonomyindices need to be more culture-specific.

The effect of culture on women’s autonomy isoften attributed to community-level influ-ences.15,28,30–32 Morsund et al found weak linksbetween individual autonomy and fertility indi-cators when analysing National Family HealthSurvey data in India. On the other hand, theysuggested that literacy among women in acommunity can generally influence an indi-vidual woman’s reproductive behaviour beyondthat of her own education.30 Morgan et al,in comparing Muslim and non-Muslim commu-nities in four Asian countries, found no rela-tionship between individual autonomy andfertility. One possible explanation was political

disadvantage, leading Muslim communities tohave higher fertility.31

It would be interesting to create an indexincorporating more dimensions of women’sautonomy, as Nawar did. Her five-point indexcovered self-choice of spouse, current participa-tion in the workforce, employment as importantto women’s personal fulfilment, looking afterone’s own health, and insisting on one’s ownopinion or trying to convince or reconcile incase of disagreement. The mean autonomy levelon this scale was 1.2 out of 5 with little varia-tion except in relation to women’s education(0.9 for non-literate women and 2.3 out of 5 forthose with a secondary school or higher educa-tion). She also found that more autonomouswomen were more able to control their fertilityand ended up with fewer children at the end oftheir reproductive years.17

Although the cultural lag in Oman may par-tially explain the weak link between women’sautonomy and fertility indicators, a more com-prehensive and culturally-specific index mightdemonstrate a clearer link between education,autonomy and fertility measures. Several of theitems on Nawar’s five-point index could be usedto measure modernising influences on women’sautonomy in Oman, such as self-choice ofspouse and participation in the workforce. Thewording of the questions on the index items isalso key. For example, asking ‘‘Does your hus-band allow you... .’’ demonstrates very limitedautonomy and if kept, could be re-worded.Markers of autonomy introduced by Jejeebhoy,12

such as knowledge and physical autonomy,could also be incorporated, and further analysiscould be done to measure community influenceson autonomy and fertility.

Finally, future demographic and health sur-veys should obtain information to measurewhether women are able to achieve their repro-ductive intentions in good health,24 as sug-gested by Ravindran. This would provide avaluable measure of women’s autonomy inOman, as well as measure the success of thebirth spacing programme.

AcknowledgementsThe authors would like to thank the Ministry ofHealth, UNICEF and UNFPA for their financialsupport to conduct the National Health Survey.They would also like to thank His Excellency the


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Minister of Health, their Excellencies the Under-secretaries of Planning, Health Affairs andFinancial Affairs, Director Generals at the

Ministry of Health, HQ as well as in the regionsand a large number of other people within theMinistry of Health for their support.

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32. Underwood C. WHO ConsultantReport on Reproductive Healthin Oman, 1998. (Unpublished)

ResumeDepuis 1970, des changements politiques eteconomiques ont nettement ameliore la sante etl’education a Oman, et depuis 1994 les centres desoins de sante primaires fournissent gratuitementdes contraceptifs a tous les couples maries.Malgre un developpement socio-economiquerapide, le taux de fecondite etait de 4,2 en 2001.Cette etude cherchait a definir des donnees dereference sur l’autonomisation des femmesmariees a Oman a partir d’une etude nationalede 2000, pour examiner les correlats del’autonomisation des femmes, et pour analyserl’effet de l’autonomisation sur le besoininsatisfait de contraception. On a utilise deuxindicateurs de l’autonomisation : la participationdes femmes a la prise de decision et leur libertede mouvement. Une analyse bivariee a lie cesmesures et leurs mesures suppletives, l’educationet le statut de l’emploi, avec l’emploi d’unemethode de planification familiale. L’educationetait un indicateur cle de la condition desfemmes. Le besoin insatisfait de contraceptifspour les femmes exposees a une grossesse etaitd’environ 25%, mais diminuait sensiblementavec le niveau d’instruction et l’emploi remunere.Alors que les femmes autonomes avaient plusde probabilites d’utiliser une contraception,l’education des femmes etait un moyen plussur de predire un « besoin satisfait » quel’autonomie, puisque les facteurs traditionnelset l’influence communautaire demeurent forts.Pour pres de la moitie des 1830 femmesde l’etude, le mari decidait d’utiliser lacontraception, et moins de 1% utilisaient unecontraception avant la premiere naissance,puisqu’on attend des femmes qu’elles aientun enfant dans la premiere annee de mariage.

ResumenDesde 1970, los cambios polıticos y economicosen Oman han producido mejoras notables en lasalud y la educacion, y desde 1994, el gobierno hasuministrado anticonceptivos gratis a parejascasadas en centros de salud primaria. A pesardel rapido desarrollo socioeconomico, la tasa defecundidad fue 4.2 en 2001. El objetivo de esteestudio fue definir datos de lınea de base sobre elempoderamiento de mujeres alguna vez casadasen Oman de un estudio nacional en 2000, estudiarlos correlatos del empoderamiento de la mujer, yanalizar el efecto del empoderamiento sobre lanecesidad no satisfecha de la anticoncepcion.Se usaron dos indicadores de empoderamiento:la participacion de la mujer en la toma dedecisiones y la libertad de movimiento. Seaplico un analisis bivaria para vincular estosindicadores y sus sustitutos – la escolaridad y elnivel de empleo – con el uso de un metodo deplanificacion familiar. La escolaridad fue unindicador clave de la condicion de la mujer. Lanecesidad no satisfecha de la anticoncepcionen mujeres expuestas al embarazo fue casi un25%, pero bajo significativamente con el nivelde escolaridad y el empleo remunerado. Si bienera mas probable que las mujeres empoderadasusaran un anticonceptivo, la escolaridad delas mujeres pronosticaba mejor la ‘‘necesidadsatisfecha’’ que la autonomıa, ya que los factorestradicionales y la influencia comunitaria semantenıan fuertes. Para casi la mitad de las1,830 mujeres estudiadas, el esposo decidıasi usaban o no un metodo anticonceptivo, ymenos del 1% usaron un anticonceptivo antesde tener su primero hijo ya que se espera quelas mujeres tengan un hijo durante el primer anode matrimonio.


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Women's Autonomy, Education and Employment in Oman and their Influence on Contraceptive Use

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