Caroline Moreau1, Celia Karp2, Shannon N Wood2, Hadiza Galadanci3, Simon Peter Sebina Kibira4, Fredrick Makumbi5, Elizabeth Omoluabi6, Solomon Shiferaw7, Assefa Seme7, Amy Tsui8. 1. Associate professor, Johns Hopkins University, Baltimore, MD, USA, cmoreau2@jhu.edu. 2. Assistant scientist, Johns Hopkins University, Baltimore, MD, USA. 3. Consultant obstetrician and gynecologist, Bayero University, Kano, Nigeria. 4. Lecturer, Makerere University, Kampala, Uganda. 5. Senior lecturer, Makerere University, Kampala, Uganda. 6. Managing director, Centre for Research Evaluation Resources and Development, Ile-Ife, Nigeria. 7. Associate professor, Addis Ababa University, Ethiopia. 8. Professor emeritus, Johns Hopkins University, Baltimore, MD, USA.
Abstract
CONTEXT: Improving women's empowerment is pivotal to public health and development programs; however, inconsistent definitions and lack of cross-cultural measures compromise monitoring efforts. METHODS: Data collected in 2017-2018 in Ethiopia, Uganda and two sites in Nigeria were used to develop a cross-cultural index of women's and girls' empowerment in sexual and reproductive health (WGE-SRH). Item development was grounded in qualitative interviews, and informed by a conceptual framework that included domains of existence of choice and exercise of choice related to sex, contraceptive use and pregnancy. Items were pilot tested among 1,229 women aged 15-49 across sites. Psychometric properties were explored to identify crosssite constructs, and logistic regression was used to assess the construct validity of each dimension. RESULTS: Analyses identified subscales for sexual existence of choice (Cronbach's alphas, 0.71-0.79) and contraceptive existence of choice (0.56-0.78). A pregnancy existence of choice subscale emerged for only two sites (0.61-0.80). Internal reliability of the exercise of choice subscales varied. Construct validity analyses found that for some sites, high scores on the sexual and contraceptive existence of choice subscales were associated with elevated odds of volitional sex and contraceptive use, respectively. Combining the existence of choice and exercise of choice summary scores for sex strengthened associations with volitional sex. CONCLUSIONS: The cross-cultural WGE-SRH index can be used to assess existence of choice related to contraception and volitional sex. Further work is needed to improve measures of SRH exercise of choice, and investigate the index's multidimensionality and associations with SRH outcomes.
CONTEXT: Improving women's empowerment is pivotal to public health and development programs; however, inconsistent definitions and lack of cross-cultural measures compromise monitoring efforts. METHODS: Data collected in 2017-2018 in Ethiopia, Uganda and two sites in Nigeria were used to develop a cross-cultural index of women's and girls' empowerment in sexual and reproductive health (WGE-SRH). Item development was grounded in qualitative interviews, and informed by a conceptual framework that included domains of existence of choice and exercise of choice related to sex, contraceptive use and pregnancy. Items were pilot tested among 1,229 women aged 15-49 across sites. Psychometric properties were explored to identify crosssite constructs, and logistic regression was used to assess the construct validity of each dimension. RESULTS: Analyses identified subscales for sexual existence of choice (Cronbach's alphas, 0.71-0.79) and contraceptive existence of choice (0.56-0.78). A pregnancy existence of choice subscale emerged for only two sites (0.61-0.80). Internal reliability of the exercise of choice subscales varied. Construct validity analyses found that for some sites, high scores on the sexual and contraceptive existence of choice subscales were associated with elevated odds of volitional sex and contraceptive use, respectively. Combining the existence of choice and exercise of choice summary scores for sex strengthened associations with volitional sex. CONCLUSIONS: The cross-cultural WGE-SRH index can be used to assess existence of choice related to contraception and volitional sex. Further work is needed to improve measures of SRH exercise of choice, and investigate the index's multidimensionality and associations with SRH outcomes.
Authors: Linnea A Zimmerman; Dana O Sarnak; Celia Karp; Shannon N Wood; Caroline Moreau; Simon P S Kibira; Fredrick Makumbi Journal: Stud Fam Plann Date: 2021-05-20