“It was my own decision”: The transformational shift that influences a woman’s decision to use contraceptives covertly

This study examines the decision-making process through which women in sub-Saharan Africa choose to use contraceptives covertly, often due to socio-cultural barriers and unbalanced gender relations that limit their autonomy. Using qualitative data from 400 participants across Benin, Kenya, Malawi, and Uganda, the research explores how women, despite lacking overt decision-making power, engage in covert contraceptive use (CCU) as a way to achieve their reproductive goals. Women recognized the negative consequences of frequent pregnancies and large families but felt their husbands were either unaware of or unsympathetic to their suffering. They used CCU as a way to assert control over their fertility when overt contraceptive use was not an option. The study highlights that CCU is an important shift in women’s perception of decision-making power, empowering them to act according to their reproductive preferences despite societal constraints.