Sexual and reproductive health rights have gained importance over the last three decades. Despite the growing availability of reproductive health services, the uptake of these services remains inadequate among women in low-income countries. One of the main causes of the inadequate uptake of reproductive health services is women's weak control over pregnancy-related decisions. When and how many children to have, and whether and where to seek pre-natal, delivery and post-natal care, are crucial decisions that may shape an important pathway into or out of extreme poverty. To identify policy initiatives that can break the vicious circle between women's low empowerment, poor reproductive health and poverty, this project studies the decision-making processes around the use of reproductive health services. For this, it collected data in Burkina Faso and Tanzania on the uptake of reproductive health services as well as the decision-making process by married or co-habiting couples.The proposed research will contribute to answering the first overarching question of this call "What factors shape pathways into and out of poverty and people's experience of these, and how can policy create sustained routes out of extreme poverty in ways that can be replicated and scaled up?" The project will do so by focusing on the low or inadequate uptake of reproductive health services in sub-Saharan Africa which directly influences the health and survival prospects of women and their children, as well as their economic participation and poverty. Despite the growing availability of reproductive health services, the uptake of these services remains inadequate among the poorest in society. The research is timely because achieving 'universal access to reproductive health' was one of the Millennium Development Goals on which least progress was made in sub-Saharan Africa. The new Social Development Goals which will form the basis of the post-2015 development agenda have recognized this slow progress and have included updated reproductive health targets.

In both countries, we used a multistage cluster sampling approach to obtain a representative sample of co-habiting or married couples, in which the woman was younger than 40 years old, and had at least one birth. Of each selected couple, both spouses were interviewed individually and in private. To maximize rapport, we used same-sex enumerator-interviewee pairs. As study regions, we selected Misungwi district in the Mwanza region in Tanzania, and the Province of Houet in Burkina Faso. In Tanzania, we selected 32 rural hamlets through multistage cluster sampling at the different administrative levels. More specifically, we first randomly selected eight rural wards. In each selected ward, two villages were then randomly selected and within each selected village, two hamlets were randomly chosen. In all selected hamlets, a census of all married or co-habiting couples was conducted. From all couples that fulfilled the selection criteria we randomly selected 40 of them in each selected hamlet. If less than 40 couples were available in a hamlet, we selected all of them. In total, 892 couples were interviewed. We used a similar multi-stage cluster approach in Burkina Faso. In a first stage, we randomly selected six rural ‘communes’ out of the 13 rural communes of the province and within each selected rural commune, we randomly selected five villages. We then conducted a census of all married or co-habiting couples living in the 30 selected villages. In each selected village, we identified all married or co-habiting couples. In total, 1137 couples were interviewed that fulfilled the selection criteria, selected from the villages in proportion to village size.