Reconceptualizing Empowerment for Women’s and Girls’ Sexual and Reproductive Health (SRH): A Cross-Cultural Index for Measurement, Monitoring, and Progress Toward Improved SRH

Caroline Moreau, Institut National de la Santé et de la Recherche Médicale (INSERM)
Celia Karp , Johns Hopkins Bloomberg School of Public Health
Shannon Wood
Selamawit Desta, Bill & Melinda Gates Institute for Population and Reproductive Health
Hadiza Galadanci, Bayero University
Simon Peter Sebina Kibira, Makerere University School of Public Health
Frederick Makumbi, Makerere University
Elizabeth F. Omoluabi, Centre for Research Evaluation Resources and Development (CRERD)
Solomon Shiferaw, Addis Ababa University
Assefa Seme, Addis Ababa University
Qian-Li Xue, Johns Hopkins Bloomberg School of Public Health
Amy Tsui, Johns Hopkins University

Lack of validated cross-cultural measures for women’s sexual and reproductive health empowerment (WGE-SRH) compromises progress. We developed a cross-cultural WGE-SRH index by implementing qualitative research to inform a quantitative instrument. Conducted in 2017-2018 throughout Ethiopia, Nigeria, and Uganda, the WGE-SRH tool was piloted among 1,229 women aged 15-49. Qualitative research validated the WGE-SRH framework, which was applied to outcomes of sex, contraception, and pregnancy. Psychometric properties were explored and sub-scales of autonomy for sex (alphas 0.72-0.79), contraception (alphas 0.59-0.80), and pregnancy (alphas 0.61-0.80) emerged; alphas for self-efficacy sub-scales varied. Associations between WGE-SRH measures and SRH behaviors indicated increased odds of volitional sex with increased sexual autonomy and increased odds of contraceptive use with increased contraceptive autonomy. Combined measures of autonomy and self-efficacy yielded stronger associations with these outcomes. This innovative WGE-SRH index can be used to assess women’s empowerment related to contraception and volitional sex across diverse geo-cultural contexts.

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 Presented in Session 1. Fertility, Family Planning, Sexual Behavior, & Reproductive Health 1