Women empowerment and access to maternity and reproductive healthcare in Pakistan: cross-validation of a Survey-based Index in Afghanistan (SWEI-A)

Abstract

Background Despite the obvious violation of women’s rights in Pakistan and the vital necessity for women empowerment, a unified country-specific index measuring women empowerment is not yet available. This study cross-validated a survey-based women empowerment index from Afghanistan to be used in Pakistan. Methods The data for married Pakistani women aged 15–49 in the 2017–18 Pakistan demographic health survey was used to construct the final model using the explanatory and confirmatory factor analyses. The Cronbach’s alpha test examined the internal consistency of the developed index. To assess the convergence validity of the index, the association of each emerged domain with indicators of access to reproductive and maternity care was assessed by Poisson regression analysis adjusting for wealth index. Results The final index had six domains; namely, labor force participation, attitude toward violence, decision-making, access to healthcare, literacy, age at critical life events predicting women empowerment of married Pakistani women with decent reliability (Cronbach’s α = 0.70), and validity (SRSEA&SRMR < 0.05, CFI&TLI > 0.92). The emerged domains were significantly associated with at least one of four indicators for access to reproductive and maternity care; indicative of a favorable convergence validity. Conclusion Pakistan and Afghanistan are associated as brother countries with shared religious and ethnocultural identities in which women are perceived inferior to men and in critical need of empowering efforts. The results of this study reflect upon this resemblance in sociocultural structure by yielding similar domains for women's empowerment in Pakistan building upon an index previously developed for Afghan women. The developed index could inform the design of future policies, interventions, and research recognizing the important indicators of women empowerment in Pakistan and could enhance the comparability of the results across future studies.

Intimate Partner Violence and Children Under 5 Morbidities and Mortality in Afghanistan: Findings From a National Survey

“…In this study, women of older age groups were more likely to suffer from spousal violence compared to the youngest age group (15 to 24 years), regardless of their husband’s age. This could be either due to the higher women empowerment of young women as a result of higher education and enhanced awareness of their rights that prevent IPV (Dadras, 2022), or the fear of bitter consequences sustained by an abusive partner and not willing to participate in the survey, either need to be addressed in future studies. It has been shown that most young Afghan brides are accompanied by their husbands or family members to the facilities in which the survey had been conducted and disclosure of a violent exposure experience could be fearful and threatening for them and thus, they do rather avoid participating in the survey (Dadras et al, 2020, 2021).…”

Women’s status, empowerment, and utilization of skilled delivery services in Papua New Guinea: an empirical analysis based on structural equation modeling

“…Women's empowerment is typically defined as "the process by which those who have been denied the ability to make strategic life choices acquire such an ability (33). " Extensive empirical research shows that women's status and empowerment in developing countries positively impact SBA utilization (29,31,(34)(35)(36)(37)(38). However, empirical research on the Pacific is more limited than in regions such as Asia and Africa.…”

“…Meanwhile, the definition, conceptualization, and measurement of women's empowerment are often different and controversial in other studies due to each country's various socioeconomic and cultural contexts and the fact that women's empowerment is a complex underlying structure whose internal causal processes are not yet transparent (39). For example, on the dimension of women's empowerment, the most relevant studies applying Demographic and Health Survey (DHS) data included attitudes toward partner violence and household decision-making to measure the impact of women's empowerment on SBA utilization (29,(34)(35)(36)(37)(38). Some additionally incorporated elements like access to health services, gender-based negotiation, and social independence, which may often be independently valid in different contexts (29,(34)(35)(36)(37)(38), were also considered.…”

“…For example, on the dimension of women's empowerment, the most relevant studies applying Demographic and Health Survey (DHS) data included attitudes toward partner violence and household decision-making to measure the impact of women's empowerment on SBA utilization (29,(34)(35)(36)(37)(38). Some additionally incorporated elements like access to health services, gender-based negotiation, and social independence, which may often be independently valid in different contexts (29,(34)(35)(36)(37)(38), were also considered. Moreover, although the multidimensional structure of women's empowerment has received increasing attention in terms of measurement methods (40), the majority of studies used summary measures or composite indices, which make it difficult to comprehend the contribution of each item to the dimensions and to explain the direction and patterns of change in women's empowerment.…”

Impact of Socio-Economic and Demographic Factors on Women Decision Making while making the household Purchasing - Evidence from Pakistan

“…Gender inequalities can impede communication between couples regarding reproductive decisions and women's access to reproductive health services, leading to adverse health outcomes (Reproductive Health Gebeyehu, 2022). Studies conducted using Pakistani data have revealed that women's age and family structure significantly influence their decision-making capabilities, with older women and those from nuclear households being more active participants in family decision-making (Dadras, 2022).…”