AbstractIntroductionIn 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. External validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception. To determine its value for global monitoring, we explored the applicability of the SWPER in national health surveys from low- and middle-income countries (LMICs) in other world regions.MethodsWe used data from the latest Demographic and Health Survey for 62 LMICs since 2000. 14 pre-selected questions (items) were considered during the validation process. Content adaptations included the exclusion of women’s working status and recategorization of the decision-making related items. We compared the loading patterns obtained from principal components analysis performed 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) for external validation.ResultsConsistency regarding item loadings for the three SWPER empowerment domains was observed for most countries. Correlations between the scores generated for each country and global score obtained from the combined data were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.72 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.81, 0.67, and 0.44, respectively, with GII.ConclusionThe indicator we propose, named 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 that allows for tracking of progress over time and across countries at the individual and country levels.SummaryWhat is already known?Although survey-based women’s empowerment indicators have been used in the literature, until 2017 there was no indicator proposed for use in a large set of countries that would be comparable between and within countries.In 2017, we proposed the Survey-based Women’s emPowERment indicator (SWPER, pronounced as “super”), to be used in African countries, that encompasses three wellrecognized domains of women’s empowerment (attitude to violence, social independenceand decision making).The external validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception.Validation of the index was restricted to African countries, and a common measure to allow comparisons across low and middle-income countries (LMICs) from all world regions was still lacking.What are the new findings?We show that the SWPER Global may serve as a valid common measure of women’s empowerment among LMICs, as consistent patterns were obtained for most countries and world regions.The SWPER Global index addresses the need for a single cross-cultural standardized survey-based indicator of women’s empowerment in the context of LMICs that enables comparability between countries and over time and subgroup analyses, extending previously proposed indicators such as the Gender Development Index which is limited to the country-levelWhat do the new findings imply?The SWPER Global index enables the study of how women’s empowerment is linked to developmental and health outcomes, allowing for broad comparisons across countries and world regions.As a comprehensive cross-cultural standard tool, it also contributes to the monitoring and accountability of country progress over time in advancing gender equality and women’s empowerment.The new tool may help target and prioritize policy and advocacy efforts toward SDG 5 (achieve gender equality and empower all women and girls) at the regional and country levels.
Feminine Appeals on Cigarette Packs Sold in 14 Countries
