scholarly journals Associations of women’s empowerment with neonatal, infant and under-5 mortality in low- and /middle-income countries: meta-analysis of individual participant data from 59 countries

2020 ◽  
Vol 5 (1) ◽  
pp. e001558 ◽  
Author(s):  
David T Doku ◽  
Zulfiqar A Bhutta ◽  
Subas Neupane
Keyword(s):  
Meta Analysis ◽  
Child Survival ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
Individual Participant Data ◽  
Middle Income ◽  
Live Births ◽  
Middle Income Countries ◽  
Individual Participant ◽  
Low And Middle Income

BackgroundChild survival and women’s empowerment are global public health concerns and important sustainable development goals (SDGs). Low- and middle-income countries (LMICs) have the largest burden of both phenomena. The aim of this study is to investigate a measure of women’s empowerment at individual and population levels and its potential associations with neonatal, infant and under-5 mortality at national and regional levels in 59 LMICs.MethodsWe used pooled population-based cross-sectional surveys from 59 LMICs (n=6 12 529) conducted from 2000 to 2015 using standardised protocols. We constructed individual-level women’s empowerment index (ILWEI) and population-level women’s empowerment index (PLWEI) for LMICs and investigated the potential associations of these measures with neonatal, infant and under-5 mortality using two-stage random-effect individual participant data (IPD) meta-analysis.ResultsThe pooled neonatal mortality rate was 24 per 1000 live births. Infant and under-5 mortality rates were 43 and 55/1000 live births, respectively. In the pooled sample, 61.6% and 19.9% of women had autonomy regarding their healthcare and household decision-making, respectively, whereas 56.0% rejected domestic violence against women for any reason. IPD meta-analysis showed that children of women with low ILWEI had a higher risk of neonatal (OR: 1.18, 95% CI 1.14 to 1.22), infant (OR: 1.12, 95% CI 1.08 to 1.17) and under-5 (OR: 1.12, 95% CI 1.07 to 1.18) mortality compared with children of high ILWEI. Similar relationships were found across most of the regions as well as between PLWEI and all the three outcomes.ConclusionsWomen’s empowerment at individual and population levels is associated with neonatal, infant and under-5 mortality in LMICs. Our study underscores the importance of women’s empowerment in accelerating progress towards the attainment of the SDG targets for child survival in LMICs. Multi-sectoral and concerted efforts are necessary to eliminate preventable child mortality in these countries.

scholarly journals 22A Survey-Based Women's Empowerment Index for Low- and Middle-Income Countries: The SWPER Goes Global

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Fernanda Ewerling ◽  
Anita Raj ◽  
Cesar G Victora ◽  
Franciele Hellwig ◽  
Carolina VN Coll ◽  
...  
Keyword(s):  
Decision Making ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
African Countries ◽  
Middle Income ◽  
Household Decision ◽  
Middle Income Countries ◽  
World Regions ◽  
Country Rankings ◽  
Low And Middle Income

Abstract Background In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. We explored the applicability of the SWPER in national health surveys from countries in other world regions. Methods We used data from the latest Demographic and Health Survey for 62 low- and middle-income countries (LMICs) since 2000, and adapted the indicator so that it could be used for any LMIC. Adaptations included the exclusion of women's working status and recategorization of the household decision-making related items. We compared the loading patterns obtained from principal components analysis for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII). Results Most countries presented similar patterns regarding item loadings for the three SWPER empowerment domains. Correlations between the country-specific and global individual-level scores were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.71 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.82, 0.67, and 0.44, respectively, with GDI. Conclusions The SWPER global is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women's empowerment and allowing wider comparisons across countries and world regions.

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