Women’s and girls’ sexual empowerment differs by geographical context: a population-based validation study

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OBJECTIVE: To validate a sexual empowerment sub-scale of the Women’s and Girls’ Sexual and Reproductive Empowerment Index (WGE-SRH) across eight countries in sub-Saharan Africa and Asia, and compare sexual empowerment across these contexts. METHODS: This study leverages cross-sectional, population-based survey data collected among women of reproductive age in Burkina Faso (n = 4,012), Côte d’Ivoire (n = 2,278); Kongo Central, Democratic Republic of the Congo (DRC (n = 1,097)); Kinshasa, DRC (n = 1,143); Rajasthan, India (n = 4,004); Kenya (n = 5,454); Kano, Nigeria (n = 780); Lagos, Nigeria (n = 804); Niger (n = 2,286); and Uganda (n = 2,228) to validate eight sexual empowerment measures via confirmatory factor analysis. Overall scores of the validated measures were descriptively examined across settings. FINDINGS: Final models confirm the theoretical structure of the sexual empowerment measure, including two- dimensions: “existence of choice” and “exercise of choice”, each comprised of three items, with moderate internal consistency ranging from 0.59 to 0.69. Factor loadings, goodness-of-fit, and percent agreement varied in Rajasthan, India compared to sub-Saharan African settings. Marked variations were seen across sites in women’s perceptions of their partners’ responses to refusing sex, as well as their own confidence in voicing when and when not to have sex. CONCLUSION: This measure was developed in sub-Saharan Africa and works well for the population that it was designed to serve, however, cannot be extrapolated to other settings. To comprehensively capture the dynamic nature of sexual empowerment, future research is needed to examine measures across cultures and time. Validation across diverse settings opens avenues for holistic examination of positive sexual health, including factors that enhance women’s sexual empowerment and rights.

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