Moreau Caroline, Karp Celia, Wood Shannon N, Galadanci Hadiza, Kibira Simon Peter Sebina, Makumbi Fredrick, Omoluabi Elizabeth, Shiferaw Solomon, Seme Assefa, Tsui Amy
Associate professor, Johns Hopkins University, Baltimore, MD, USA,
Assistant scientist, Johns Hopkins University, Baltimore, MD, USA.
Int Perspect Sex Reprod Health. 2020 Oct 5;46:187-198. doi: 10.1363/46e9920.
Improving women's empowerment is pivotal to public health and development programs; however, inconsistent definitions and lack of cross-cultural measures compromise monitoring efforts.
Data collected in 2017-2018 in Ethiopia, Uganda and two sites in Nigeria were used to develop a cross-cultural index of women's and girls' empowerment in sexual and reproductive health (WGE-SRH). Item development was grounded in qualitative interviews, and informed by a conceptual framework that included domains of existence of choice and exercise of choice related to sex, contraceptive use and pregnancy. Items were pilot tested among 1,229 women aged 15-49 across sites. Psychometric properties were explored to identify crosssite constructs, and logistic regression was used to assess the construct validity of each dimension.
Analyses identified subscales for sexual existence of choice (Cronbach's alphas, 0.71-0.79) and contraceptive existence of choice (0.56-0.78). A pregnancy existence of choice subscale emerged for only two sites (0.61-0.80). Internal reliability of the exercise of choice subscales varied. Construct validity analyses found that for some sites, high scores on the sexual and contraceptive existence of choice subscales were associated with elevated odds of volitional sex and contraceptive use, respectively. Combining the existence of choice and exercise of choice summary scores for sex strengthened associations with volitional sex.
The cross-cultural WGE-SRH index can be used to assess existence of choice related to contraception and volitional sex. Further work is needed to improve measures of SRH exercise of choice, and investigate the index's multidimensionality and associations with SRH outcomes.
增强妇女权能对公共卫生和发展项目至关重要；然而，定义不一致以及缺乏跨文化测量方法影响了监测工作。
利用2017年至2018年在埃塞俄比亚、乌干达以及尼日利亚两个地点收集的数据，制定了一项关于性与生殖健康方面妇女和女童赋权的跨文化指数（WGE-SRH）。项目开发基于定性访谈，并参考了一个概念框架，该框架包括与性、避孕使用和怀孕相关的选择存在和选择行使领域。在各地点对1229名15至49岁的女性进行了项目试点测试。探索了心理测量特性以识别跨地点结构，并使用逻辑回归评估每个维度的结构效度。
分析确定了性选择存在（克朗巴哈系数，0.71 - 0.79）和避孕选择存在（0.56 - 0.78）的子量表。仅在两个地点出现了怀孕选择存在子量表（0.61 - 0.80）。选择行使子量表的内部信度各不相同。结构效度分析发现，对于某些地点，性选择存在和避孕选择存在子量表上的高分分别与自愿性行为和避孕使用几率的升高相关。将性方面的选择存在和选择行使总结分数相结合，加强了与自愿性行为的关联。
跨文化的WGE-SRH指数可用于评估与避孕和自愿性行为相关的选择存在情况。需要进一步开展工作以改进性与生殖健康选择行使的测量方法，并研究该指数的多维性及其与性与生殖健康结果的关联。
