Hubert Department of Global Health and Department of Sociology, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
Department of Sociology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
BMC Pregnancy Childbirth. 2020 Sep 1;20(1):503. doi: 10.1186/s12884-020-03205-2.
Sustainable Development Goal (SDG) 5 prioritizes women's empowerment and gender equality, alone and as drivers of other SDGs. Efforts to validate universal measures of women's empowerment have eclipsed efforts to develop refined measures in local contexts and lifecycle stages. Measures of women's empowerment across the reproductive lifecycle remain limited, including in the Arab Middle East.
In this sequential, mixed-methods study, we developed and validated the Reproductive Agency Scale 17 (RAS-17) in 684 women having a normal pregnancy and receiving prenatal care at Hamad Medical Corporation in Doha, Qatar. Participants varied in age (19-46 years), trimester, gravidity (M3.3[SD2.1], range 1-14), and parity (M2.1[SD1.5], range 0-7). Using qualitative research and questionnaire reviews, we developed 44 pregnancy-specific and non-pregnancy-specific agency items. We performed exploratory then confirmatory factor analyses (EFA/CFA) in random split-half samples and multiple-group CFA to assess measurement invariance of the scale across Qatari (n = 260) and non-Qatari Arab (n = 342) women.
Non-Qatari women agreed more strongly than Qatari women that every woman should have university education, and working outside home benefitted women. Qatari women agreed more strongly than non-Qatari women that a woman should be free to sell her property. Qatari women reported more influence than non-Qatari women in decisions about spending their money (M4.6 versus M4.4), food they can eat (M4.4 versus M4.2), and rest during pregnancy (M4.5 versus M4.2). Qatari and non-Qatari women typically reported going most places with permission if accompanied. A 17-item, three-factor model measuring women's intrinsic agency or awareness of economic rights (5 items) and instrumental agency in decision-making (5 items) and freedom of movement (7 items) had good fit and was partially invariant across groups.
The RAS-17 is a contextual, multidimensional measure of women's reproductive agency validated in pregnant Qatari and non-Qatari Arab women. This scale integrates pregnancy-specific and non-pregnancy-specific items in dimensions of intrinsic agency and instrumental agency relevant to Arab women of reproductive age. The RAS-17 may be useful to screen for low reproductive agency as a predictor of maternal and perinatal outcomes. The RAS-17 should be validated in other samples to assess its full applicability across the reproductive life cycle.
可持续发展目标 5 优先考虑赋予妇女权力和性别平等，将其作为其他可持续发展目标的驱动力。验证赋予妇女权力的普遍衡量标准的努力超过了在地方背景和生命周期阶段制定更精细衡量标准的努力。在整个生殖生命周期中，衡量妇女权力的方法仍然有限，包括在阿拉伯中东地区。
在这项顺序、混合方法研究中，我们在卡塔尔多哈的哈马德医疗公司接受产前护理的 684 名正常妊娠的女性中开发并验证了生殖代理量表 17（RAS-17）。参与者的年龄（19-46 岁）、孕期（M3.3[SD2.1]，范围 1-14）和孕次（M2.1[SD1.5]，范围 0-7）各不相同。我们使用定性研究和问卷回顾，开发了 44 项妊娠特异性和非妊娠特异性代理项目。我们在随机分割样本中进行了探索性和验证性因素分析（EFA/CFA），并在多组 CFA 中评估了该量表在卡塔尔（n=260）和非卡塔尔阿拉伯（n=342）女性中的测量不变性。
非卡塔尔女性比卡塔尔女性更强烈地认为每个女性都应该接受大学教育，外出工作对女性有益。卡塔尔女性比非卡塔尔女性更强烈地认为女性应该有权出售自己的财产。卡塔尔女性在决定花钱（M4.6 对 M4.4）、吃什么食物（M4.4 对 M4.2）和怀孕期间休息（M4.5 对 M4.2）方面比非卡塔尔女性拥有更多的影响力。卡塔尔和非卡塔尔女性通常在有人陪同的情况下才能去大多数地方。一个包含 17 个项目的三因素模型，用于衡量女性的内在代理或经济权利意识（5 个项目）、决策中的工具代理（5 个项目）和行动自由（7 个项目），具有良好的拟合度，并且在群体间部分不变。
RAS-17 是一种针对怀孕卡塔尔和非卡塔尔阿拉伯妇女的生殖代理的情境、多维衡量标准。该量表将妊娠特异性和非妊娠特异性项目纳入与生殖年龄的阿拉伯妇女相关的内在代理和工具代理维度。RAS-17 可能有助于筛查低生殖代理，作为产妇和围产期结局的预测指标。RAS-17 应在其他样本中进行验证，以评估其在整个生殖生命周期中的全面适用性。
