This study is focused on the relationship between women’s power, spousal interactions and reproductive decision-making. It examines the nature of Reproductive Decision-Making Processes (RDMP) and the effect of spousal interactions and power relations on women’s capacity to make autonomous reproductive decisions or to negotiate desired reproductive outcomes. The study questions whether or not women’s empowerment and spousal communication really matters for the spread of family planning in Malawi? The major findings of the study show that social dynamics at the national, the community, the lineage and the family levels affect the nature of RDMP and their outcomes. A number of indices are identified as having a significant impact on women’s power to participate in RDMP and influence their outcomes. These factors include non-egalitarian lineage or marriage system, women’s perceived autonomy, spousal communication about family planning and exposure to modern ideas and lifestyles. This study demonstrates that changes in the social context, particularly in the lineage power structures and relationships, influence women’s capacity to participate in deciding to space births, stop child bearing and use family planning methods. For example, the social change that has been taking place in Malawian societies has had an impact on family dynamics and structures. Urbanisation has continuously attracted men and women to migrate to cities leading to the fragmentation of lineages. De facto female-headed households have been on the increase. This has allowed married women to consider making autonomous reproductive decisions to space births using modern contraceptive methods. The reproductive decision-making power of lineage heads has been weakened. Nevertheless, married women are still not able to make autonomous decisions or convince their husbands to use modern contraceptive methods for the purpose of limiting family sizes. The empirical findings of the study provide a paradox for research and public policies. Contrary to theoretical beliefs and the ‘Cairo Model’, less gender egalitarian lineage and marriage systems permit married women to make autonomous reproductive decisions, whereas more gender egalitarian lineage and marriage systems enable married women to negotiate desired reproductive behaviours and outcomes. In order to meet the needs of these categories of married women, public policies will require analyses that would provide in-depth understanding of the relationship between social change, spousal power relations, reproductive decision-making and family planning. The few reproductive decision-making power variables identified in this study: lineage, type of union, perceived autonomy, perceived negotiating power, spousal communication and exposure to modern ideas, have only measured the degree of women’s reproductive decision-making power. A more in-depth understanding of why most married women do not have the capacity to make autonomous decisions or to influence their husbands to use modem family planning methods for limiting family sizes is essential. This thesis has partially brought about that understanding. But more in-depth analyses of the impact of men’s power, women’s power, couple power, higher levels of spousal communication and levels of socio-economic development on the nature and outcomes of reproductive decision-making processes is called for. There is need to develop more cultural and socio-economic-based women’s power measures that would allow for more gender and cultural-sensitive research, analyses and policy planning and implementation.