Measuring Women’s Empowerment and its Associations with Maternal and Child Health Outcomes Open Access
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This dissertation explores the longstanding hypothesis that women’s empowerment is associated with maternal and child health outcomes. It does so by examining evidence from the developing world in three interrelated manuscripts. First, through a systematic literature review of the literature, which confirms a positive association in a majority of the reviewed literature. Second, by testing three popular measurement models for best model fit using data on indicators of women’s empowerment from the Nigeria 2013 demographic and health survey. Lastly, the association between the best fitting multidimensional model of women’s empowerment is tested for its association with antenatal care uptake. A positive and significant association is found between women’s access to information and antenatal care uptake as well as women’s ability to refuse sex and antenatal care uptake. The findings in this dissertation contribute to efforts by policy makers and practitioners to promote and monitor the empowerment process and its putative effects on health promotion, health-related knowledge, attitude and behaviors as well as healthcare seeking behaviors. For policy makers, intersectoral policies aimed at addressing health inequities through action on social determinants of health, for example using a multi-sectoral approach such as the health in all policies approach have potential to enable women to act towards better health outcomes by supplementing income through opportunities for employment, conditional and other cash and in kind transfers, facilitation of equitable access to health services and the provision of information for health promotion in peer group and other settings and spaces to practice healthy behaviors. To advance research in this area, it is recommended more quasi- and experimental studies are conducted in which direct indicators of the empowerment process and maternal and child health outcomes are measures. Researchers should use measures of empowerment that would specifically capture indicators in dimensions related to health outcomes. While currently the majority of studies rely on cross sectional data and non-experimental study designs, more studies in this field are emerging that use experimental and quasi-experimental designs. It is recommended a full systematic literature review and eventually a meta-analysis is conducted to further understand the causal relationships between empowerment and maternal and child health outcomes. More work is needed to find and validate good measures of health empowerment and the dissertation concludes with suggestions for a way forward in designing such a multidimensional measure of women’s health empowerment.