literature review on women empowerment

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• Published: 07 April 2023

Barriers and interventions on the way to empower women through financial inclusion: a 2 decades systematic review (2000–2020)

• Omika Bhalla Saluja   ORCID: orcid.org/0000-0001-9831-1947 1 ,
• Priyanka Singh 1 &
• Harit Kumar 1  

Humanities and Social Sciences Communications volume  10 , Article number:  148 ( 2023 ) Cite this article

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• Development studies

This study aims to reduce ambiguity in theoretical and empirical underpinning by synthesizing various knowledge concepts through a systematic review of barriers and interventions to promote the financial inclusion of women. The surrounding literature is vast, complex, and difficult to comprehend, necessitating frequent reviews. However, due to the sheer size of the literature, such reviews are generally fragmented focusing only on the factors causing the financial exclusion of women while ignoring the interventions that have been discussed all along. Filling up this gap, this study attempts to provide a bird’s-view to systematically connect all the factors as well as mediations found in past studies with the present and future. PRISMA approach has been used to explain various inclusions and exclusions extracted from Scopus & WOS databases with the backward and forward searches of important studies. Collaborative peer review selection with a qualitative synthesis of results is used to explain various barriers and interventions in financial inclusion that affected women’s empowerment in the period 2000–2020. Out of 1740 records identified, 67 studies are found eligible based on systematic screening for detailed investigation. This study has identified patriarchy structures, psychological factors, low income/wages, low financial literacy, low financial accessibility and ethnicity as six prominent barriers and government & corporate programs/policies, microfinance, formal saving accounts & services, cash & asset transfer, self-help groups, and digital inclusion as six leading interventions to summarize the literature and highlight its gaps.

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Introduction

All over the world, women bear an inadequate load of poverty because of social and structural hurdles. A long-dated body of literature (Klasen, 1999 ; Dollar and Gatti, 1999 ; Klasen and Lamanna, 2009 ; Seguino, 2010 ) emphasizes the effect of numerous facets of gender inequality and economic growth. Females are found to be less educated, less paid, less on ownership and able to exercise much less economic control than their male counterparts. This discrimination, especially in education, hampers their financial development, leading to income inequality (Gonzales et al., 2015 ). Consequently, women suffer from lack of health, education, work opportunities and control over their own lives and selections (Kabeer, 1999 )

Nevertheless, we are observing a critical drive to achieve gender equality, with 193 United Nations member countries committing to achieving the sustainable development goal (SDG 5) of ending gender inequality issues by 2030. Realizing that women’s empowerment benefits not only women but also the sustainable development of the community (Vithanagama, 2016 ), numerous banks all over the world, such as Westpac in Australia, ICICI and SBI in India, Natwest in the UK, and UNITAR in Kenya, have developed products and services designed especially for women, keeping in mind their security, accessibility and affordability. To make the most of this, we need more extensive literature exploration to enable conceptually strong evidence-based solutions catalyzing women’s mobility from poverty and exploitation. Considering the vastness of literature, this can only be addressed by a scientific approach to review, which has been followed in the present study. However, due to the sheer size of the related literature, previous reviews (Holloway et al., 2017 , Kalaitzi et al., 2017 , Roy and Patro, 2022 ) are found to be fragmented as their results focused only on the factors causing the financial exclusion of women while ignoring the interventions that have been discussed all along.

Therefore, filling up this gap our review paper aims to scientifically identifying and amalgamating the related studies between 2000 and 2020 with the objective of (a) identifying the nature of major barriers, (b) exploring the most useful mediations/interventions and trends in research on the financial inclusion (FI) of women to enable the community to design thoughtful interventions for them.

The economic empowerment of women was explored in various dimensions at a much greater pace after 2000 (Priya et al., 2021 ). This inspired us to focus on the research work and other initiatives taken in the following 2 decades, defining our study period 2000–2020. Many influential articles have been published in journals dedicated to women and general development, such as World Development Footnote 1 , Feminist Economics Footnote 2 , Journal of Development Economics Footnote 3 and Gender & Development Footnote 4 . However, despite tremendous progress in the global state of FI, the gap in gender has not changed much since 2011, as a 6% difference still exists in access to Bank accounts among men and women in developing countries (Demirguc-Kunt et al., 2022 ), raising the need for considerate customized mediation.

Early studies on financial empowerment of women

Professor Irene Tinker’s work in women studies in the 1960s and 70s is the foundation for research on women development studies. Her work was instrumental in bringing about the first United Nations International conference on Women in 1975, which is also marked as International women’s year. She also founded the International Centre for Research on Women in 1976, which promotes empirical research to advocate evidence-based ways to empower women and promote gender equality.

Research in the 1970s was characterized by pioneer studies that highlighted the role of women in economic development (Boserup, 1970 ; Tinker, 1976 ), while the 1980s captured the role of females in family structures (Acharya and Bennett, 1981 ), the hardships faced by women in agriculture, which was identified as the single most important employment-generating sector for women (Staudt and Jaquette, 1982 ), and the advancement of land rights for women (Agarwal, 1988 ).

In the 1990s, research gathered pace with numerous studies about the persisting gender inequalities (Tinker, 1990 , 1999 ; Sen, 1990 ; Buvinić and Gupta, 1994 ; Mehra, 1997 , Mayoux, 1998 ; Pande, 1999 ) in cooperatives (Sen, 1990 ), financial services and microlevel entrepreneurship (Mehra and Gammage, 1999 ), and discriminations in agriculture and land rights of women to bring about sustainable development and suggest inclusive policies and practices (Mehra, 1995 ). Providing a much need direction and empirical advancement, Kabeer, 1999 proposed the measurement of women’s empowerment with the identification of the ‘resources’ they own, the ‘agency’ or commanding role they have and their ‘achievement’, which can be understood as the outcome in terms of well-being as the basic constructs to be observed. This is one of the most cited articles in the context of studies about the economic empowerment of women. By the end of the decade, the World Bank’s research report presented a cross-country comparison of the impact of gender inequalities on growth and development (Klasen, 1999 ), thus introducing crucial insights into the geographical diversity of the issue.

Thus, the literature around the financial empowerment of women began with recognizing the crucial role of women in the commercial progress at macro level then; it started to realize their critical role at family level and nature of their contribution at social level, which highlighted gender inequalities. Various dimensions in which such discrimination existed were identified giving scope to future researchers to explore various barriers in the way of women development and to develop suitable policy interventions.

Research methodology

Systematic reviews must follow the preset protocol, which is an advance plan of action specifying the methods to be used in the study and is generally accepted as a research design in social science studies. These rules are crucial to avoid researcher bias in data selection and analysis and increase the reliability of reviews (Xiao and Watson, 2019 ).

In this section, we have described systematic steps undertaken to extract data using specific channels, keywords, inclusion & exclusion criteria and expert selection explained through the PRISMA framework (Fig. 1 ).

Our initial result of 1734 documents (results as on 30 January 2022) was filtered by including only peer reviewed open access, full text English articles on Financial inclusion and women empowerment, resulting in 67 eligible documents. (author created).

Further, the studies thus extracted have been classified and synthesized qualitatively for deeper insights.

Channel used for literature search

Literature for this review has been found using the two sources suggested by Xio and Watson in 2019. These sources are:

Electronic database —Web of Science (WOS) and Scopus. WOS has the longest indexing coverage from 1900 to the present (Li et al., ( 2010 ) while Scopus has an extensive coverage of good quality academic work (Gavel and Iselid, 2008 ). A literature search using both databases despite the overlapping articles is still recommended to avoid missing out high-impact documents (Vieira and Gomes, 2009 ). Extractions from Scopus and WOS for this study were made on January 30, 22.

Backwards and forward search —Articles cited in important studies (highly cited) were traced to identify the inspiration and key background variables, likewise the articles that cited important studies were explored to determine the direction of the flow of research. (Webster and Watson, 2002 ; Haddaway et al., 2022 ). Also, publications by key authors (highly cited) who contributed to the pool of knowledge were identified to ensure that all their important studies were included.

Concepts from the search statement were extended by synonyms, abbreviations, verb forms and related terms to select keywords (Rowley and Slack, 2004 ), as shown in the Table 1 below:

To capture the essence of the study’s research objectives, a dive was made into the Web of Science and Scopus data extracting 751 and 983 records, respectively, based on identified keywords.

PRISMA approach

Data pulled out were filtered using Preferred Reporting Items for Systematic Reviews and Meta-Analyses—PRISMA (Fig. 1 ), that explains initial screening, determining parameters for inclusion and exclusion and outlining work limitations (Stovold et al., 2014 ; Selçuk, 2019 ).

Inclusion parameters

Publications from 2000–2020.

Open access articles.

Research areas: “Business management, social science, economics, econometrics, accounting and finance”

Exclusion parameters

Incomplete and non-English language publications.

Conference reviews, books, chapters, book reviews, conference papers, and surveys were excluded.

Articles in press.

Collaborative peer review-based exclusion

Expert selection and evaluation

After the electronic screening of records, a double screening was performed by all three authors, where all 89 studies were reviewed by each author individually. Later, 48 studies were screened out as they were not found to be measuring the population (vulnerable women) or outcomes (barriers and interventions) of interest, and 41 studies were finally selected. Additionally, 26 important and relevant studies, including 8 working papers, were identified through backwards and forward searches while reviewing the studies. The included working papers are listed in the Table 2 for reference. After the screening of the literature, a total of 67 articles were documented individually and classified and amalgamated in tables followed by a qualitative synthesis of these studies.

To achieve our research objectives, the selected articles were classified as barrier-related studies, experimental studies and studies evaluating interventions, with a few studies covering more than one dimension (Fig. 2 ).

Venn grouping of the selected studies on the basis of their evaluation of barriers or interventions and the nature of study being experimental or otherwise (author created).

Tabular synthesis

In Table 3 below, we have classified and connected 67 eligible articles based on their contribution to developing different perspectives about barriers and interventions in FI-based women empowerment.

Additionally, twenty-four experimental studies during 2000–2020 are presented in a tabular form (Table 4 ) for review. For the purpose of our study, only the gender-based findings are listed for each study. Owing to the high level of heterogeneity of quantitative data, we could not conduct a meta-analysis; instead, we summarized studies based on their characteristics, factors, mediations and results (Bohren et al., 2015 ).

Qualitative synthesis

The ideas forwarded through the tabular classifications in the studies of FI and WE have been knit to arrive at a thematic discussion about barriers, intervention-based studies and intervention types, which are the three main dimensions of our study.

Barriers to financial empowerment of women

Women have been suppressed and exploited physically, socially, mentally and economically for a long time. Developing countries particularly have a patriarchal set up where women are seen second to men (Nagindrappa and Radhika, 2013 ). While there is a section of society that encourages women empowerment, numerous barriers continue to restrict their advances.

Through our set of identified studies, we have presented below a discussion about various barriers that have been found through the discussion to be interlinked and often cyclical in nature. Figure 3 highlights the scope of our further discussion about the barriers to FI in women.

Six cyclic and interconnected barriers to the FI of women identified through an expert evaluation of selected studies (author created).

Patriarchy structures

Patriarchy is a socio-ideological concept in which men in the family (father, brother, husband, son, etc.) are considered to be superior to women. It is also described as a social arrangement in which men (patriarchs) dominate, oppress and exploit women (Walby, 1989 ).

Delving into the subject of patriarchy, noted author, Naila Kabeer, 2015 pointed to two types of inequities against women. First, gender mediated social class-based violence, rape and other sexual exploitation that women get subject to, and second, domestic violence due to scarcity or poverty and related helplessness of males within the household.

The abuse of women does not stem from scarcity or poverty; even affluent families exploit their daughters by denying them their land and property rights. The Indian government introduced a gender-progressive inheritance law to combat this injustice; despite the reforms, parents continued to deprive their daughters of their rights based on emotions and compensation in the form of higher education and higher dowries (Roy et al., 2015 ). This ill treatment of woman, which starts from her parental abode, continues in her husband’s house, where the ordered unequal power relations developed out of patriarchy further diminish her position. Her production, reproduction and sexuality are controlled by men. This biased treatment of women in the household adversely affects all levels of her social interactions, depriving her of access to resources and opportunities (Manta, 2019 ; Ghosh and Günther, 2018 ) and financial independence (Schaner, 2017 ).

Psychological factors

For obvious reasons, as discussed under the previous heading, many women lose self-confidence and self-esteem and perceive opportunities with fear of failure (Koellinger et al., 2008 ). An experimental study found that females in the lower income group tend to be more risk averse than their male counterparts and think about the negative consequences of not being able to pay back loans. (Manta, 2019 ) Thus, psychological factors must be carefully studied as crucial drivers of the FI of women (Kavita and Suman, 2019 ).

It was found that investment pattern, group experience and age impacted women’s perception about barriers to FI (Lombe et al., 2012 ), and attitude could be explained by personality traits, ability to cope-up, resource utilization, entrepreneurial abilities, organizational control, financial inclusion and economic betterment (Patil and Kokate, 2017 ).

Low income/wages

Although the concepts of income inequality and gender have been discussed separately in the literature, they cannot be compartmentalized, as they keep interacting by the way of inequality in outcomes and opportunities, which are a bye-product of inequalities mainly in education, financial access, social structures and individual perspectives.

With the biasness of patriarchy and her own fallen self-esteem, a woman’s low negotiation and bargaining power leads her to enter into the social contracts where she is able to earn a low level of income and wages compared to men for the same work. This discrimination is popularly referred to as the “glass ceiling” and is experienced by women at all levels of hierarchy. This reminds us of the much-discussed US presidential elections in 2016, where former U.S. Senator and Secretary of State Hillary Clinton was subject to misogynistic attacks indicating to her being too weak to serve the nation’s highest office. (Marie et al., 2017 ). Hence, women being exploited at work in terms of work treatment and low wages are no exception. At lower levels of education and power, gendered wage gaps are even more pronounced (Gonzales Martínez et al., 2020 ) and are found to further contribute to financial exclusion (Ghosh and Vinod, 2017 ) and further impede the economic growth of women.

Low financial literacy

With cyclical interconnections with all other barriers to the financial empowerment of women, financial literacy has been much discussed by researchers. Hung, A. et al, 2009 combined all previous definitions of financial literacy to express it as “knowledge of basic economic and financial concepts, as well as the ability to use that knowledge and other financial skills to manage financial resources effectively for a lifetime of financial well-being.” Successive studies have recognized financial awareness, financial knowledge, financial skills, financial attitude and financial behavior as key factors in determining financial literacy (Kumari and Azam, 2019 )

Financial literacy has been supported as one of the critical factors to bring about FI and has greater importance for increasing economic empowerment among women, especially the rural poor (Gonzales et al., 2015 ; Montanari and Bergh, 2019 ; Kumari and Azam, 2019 ; Kaur and Kapuria, 2020 ), who in the lack of it make wrong choices and become vulnerable to high financial risks (Manta, 2019 ). With a lack of financial knowledge and skills, women cannot access financial services and the benefits of the formal financial system, making them economically dependent on men and confined to the vicious circle of low investments, low income and low profits (Manta, 2019 ). Montanari and Bergh, 2019 found that the participation of women in the earnings and decision-making activities of rural cooperatives was almost nonexistent. It insisted that women’s roles in such institutions were restricted to low-cost or free physical labor, while those who benefited were literate and generally educated people.

Spatial diversity and related factors play an important role in the effective communication of financial literacy. Gendered gaps in education were found to be greatly related to the general variation in educational achievement across countries, signifying a shortage of access to education. (Gonzales et al., 2015 ).

A cross-regional comparison showed high-level gendered discrimination based on education level and economic participation in South Asia. Observations in Asian countries indicate lessening of the gendered employment gap with the rise in gendered education levels, while in the Middle East and North Africa (MENA), gender gaps in education have decreased, yet women have not obtained opportunities in employment (Klassen and Lamanna, 2009 ). This result hints at the presence of interwoven barriers that are passed on locally.

Overall, a high level of financial literacy is expected to result in greater economic participation of women, where she has an opportunity to express her thoughts and receive suggestions about investment avenues and updates about new profitable products and services, encouraging her towards group effort and informed financial behavior (Ingale and Paluri, 2020 ), which in turn improves her relative wealth (Doss et al., 2020 ) and empowers her.

Low financial accessibility

Access to bank accounts, savings instruments, and other financial amenities may result in women’s better control of their earnings, personal consumption and commercial expenditure (Bernasek, 2003 ), and lack of it pushes her back to obscurity. This was exemplified in an experimental study in Kenya that found that credit constraint prevented women from starting a business and savings constraint further barred them from sustaining it (Brudevold et al., 2017 ).

While trying to develop within the male dominant society, a woman is subject to biases that pull down her self-confidence hurling her into the loop of less education, low employment and low wages, denying her the benefits of access to formal finance such as credit, deposits, insurance, payments and other risk management services (Demirguc-Kunt et al., 2022 ). Findings in an Africa-based study indicate that access to formal finance is mainly driven by individual characteristics such as education, age, income, residence area, employment status, marital status, household size and degree of trust in financial institutions (Soumare et al., 2016 ). Most of the above factors have been identified as obstacles for the FI of women, thus emphasizing women’s overall lack of opportunity to access finance.

Women’s lack of access to financial products and services may also happen because of the absence of a bank branch in rural areas that are not commercially viable for banking. Marginalized women living in underdeveloped far-flung areas with poor infrastructure and roads find it hard to regularly visit bank branches in other areas (Manta, 2019 ), so they avoid banking altogether. This problem was addressed by Mueller et al. in 2020, who worked to develop a travel time model to indicate market accessibility, which is the summary travel time to the nearest state capital city in hours. Such indicators may help in planning inclusion strategies.

Another major reason for women’s lack of access to finance is the lack of commercial interest of banks in disbursing small credit to poor women with no credit history or collateral. Such lending may lead to the building up of non-performing assets and eventually high losses for banks. Therefore, they avoid giving loans to underprivileged women depriving them of economic opportunities. Moreover, the absence of collateral with women is further enhanced by biased traditional property rights (Manta, 2019 ), which denies her resources to build upon a better future.

Looking at the brighter side, ambitious efforts are being made through pathways such as microfinance (Kemp and Berkovitch, 2020 ) and digital inclusion to pull women out of these never-ending and self-building barriers.

In recent studies, ethnicity has emerged as an important factor to be considered while promoting FI in women. Gonzales Martínez et al. ( 2020 ) conducted a controlled laboratory experiment in Bolivia to evaluate whether credit officers in microfinance institutions rejected loan applications on the basis of the interaction of gender and ethnicity of potential buyers. Although the study supported that women were benefitting from microcredit, it indicated discrimination based on ethnicity, as nonindigenous women had twice the probability of getting loan approved, whereas indigenous women had only 1.5 times the probability of getting loan approved compared to men. This idea was supported by another contemporary study (Kaur and Kapuria, 2020 ), suggesting that households headed by females belonging to socially underprivileged backgrounds had a poorer likelihood of obtaining finance from institutions. This suggests that important insights for FI for women can be derived from ethnic studies.

Experimental studies on women’s financial empowerment

As the researchers identified various variables related to the financial empowerment of women through exploratory and descriptive studies, a number of empirical and experimental studies were undertaken to understand the relationship between them. The three main types of interventions identified during our analysis were as follows:

Economic interventions —Involving cash/asset transfer, free bank accounts, free services, subsidies

Social interventions —Comprising family counseling, life skill training, vocational training, awareness programs

Bundled Economic and Social Interventions

Mostly, field experiments measuring the long-term impact of interventions on women’s financial empowerment were conducted. Overall, economic interventions were found to be highly effective in reducing the economic vulnerability of women (Stark et al., 2018 ; Brudevold et al., 2017 ). However, Ismayilova et al., 2018 and Buehren et al., 2015 ) suggested that bundling up economic, social and psychological interventions could make them more constructive.

Interventions implemented for financial empowerment of women

Intervention studies have guided various programs and policies of governments that are essential to support, promote and scale up the literacy, access and growth of financial products and services for women’s empowerment. Realizing the fact that women’s empowerment benefits not only women but also the sustainable development of the community (Vithanagama, 2016 ), numerous banks all over the world, such as Westpac in Australia, ICICI and SBI in India, Natwest in the UK, and UNITAR in Kenya, have developed products and services designed especially for women, keeping in mind their security, accessibility and affordability. Figure 4 defines the scope of our further discussion about six successful interventions in the way of FI of women.

Six most important interventions in empowering women through FI identified through an expert evaluation of selected studies (author created).

Government/corporates programs and policies

The insights developed from the conclusive studies provided governments and public and private enterprises around the world to design suitable inclusive programs, schemes and policies to address the gender gap in finance. Interventions such as government-to-people transfers and the inclusion of post office financial services were evaluated by researchers to comprehend their success or failure in bringing about fairness for women. Swamy ( 2014 ) evaluated the Indian government’s inclusive plans, policies and programs by observing changes in income level, food security, living standards, production levels and asset creation to find that the FI initiatives had a much higher impact on women than on men. These results were cited in many successive studies and laid the groundwork for more intensive inclusive efforts in India.

While acknowledging the imperative need for women’s empowerment for nation building, governments and related organizations all over the world launched ambitious programs to support women. Strategies of the Green Morocco Plan (GMP) were explored by Montanari and Bergh ( 2019 ) to conclude towards the persisting miserable circumstances of women despite planned efforts.

Similar to the actions taken by the states, many private sector companies design schemes, products and programs to promote gender equality for the benefit of their women staff. A Turkish study (Gülsoy and Ustaba, 2019 ) investigated diversity management strategies of companies and found that company leadership played an important role in bringing about equality programs in the workplace. However, they also pointed to the profiteering motive of corporations, which could be served by associating with image building activities, higher productivity and innovation capability, which could result from greater employee satisfaction.

However, some studies claim that many such initiatives had failed because they did not fully anticipate the importance and influence of social institutions such as age, gender, ethnicity, literacy, race, background and religion towards building an enabling environment for inclusion (Gonzales Martínez et al., 2020 ; Kaur and Kapuria, 2020 ).

Microcredit/microfinance

Microfinance helps to bring about the financial independence of poor or exploited women by enabling them to participate in economic activities, improving their status in households and society and reinforcing their power to make decisions (Zhang and Posso, 2017 ; Lall et al., 2017 ). A strong correlation was found between the level of outreach of microfinance institutions and women’s empowerment (Laha and Kuri, 2014 ).

Zhang and Posso ( 2017 ) used case studies to support the constructive role of microfinance to reduce gender inequality. This idea was strengthened by the empirical diary data-based study (Elu et al., 2019 ) in Mozambique, Sub-Saharan Africa, which revealed that being a woman had a positive treatment effect on procuring microcredit. A longitudinal panel study (Khandker and Samad, 2014 ) comparing the effects of microcredit programs in Bangladesh showed that a 10% increase in borrowing by women lowered extreme poverty by 5% and increased the willingness to work of women by 0.46%.

The usefulness of microfinance, microcredit, and microenterprises to promote the empowerment of women has been widely studied (Karlan et al., 2007 ; Swamy, 2014 ; Laha and Kuri, 2014 ; Zhang and Posso, 2017 ), along with the impact of bundling them up with vocational trainings, education or counseling (Kim et al., 2007 ; Buehren et al., 2015 ; Karlan et al., 2007 ). It has been found that both economic and social empowerment programs together were effective in reducing IPV (Kim et al., 2007 ). One such intervention affirms that lifeskills and livelihood training along with microfinance resulted in the likelihood of higher earnings and consumption along with a reduction in teen pregnancy and early marriage (Buehren et al., 2015 ). Likewise, it was found that health knowledge along with microcredit could help in reducing health risks (Karlan et al., 2007 ).

On the other hand, the success of microfinance policy based on outreach was challenged with an argument that institutions and their policies had engaged in a residual rather than the relational understanding of poverty (Johnson, 2013 ). Similarly, it was also questioned by Gonzales et al. in 2020 by highlighting the regressive attitude and biasness of credit officers against indigenous women.

Formal accounts/services

Formal account ownership and its use have been established as an important indicator of FI, and with the support of several research experiments, it has been adopted as an important policy intervention in many countries. Worldwide, 55% of males have a formal account at a financial institution, whereas only 47% of women own or co-own such an account with a gloomier picture in developing countries where women are 28% less likely to have an account at a formal financial institution. (Demirguc-Kunt et al., 2022 ).

Bank accounts result in savings that lead to wealth creation, which is an identified determinant of FI. A study in Kenya found that women made use of savings account far more than men. It observed that there was a 45% increase in savings on business investments among women when commitment-saving bank accounts were opened along with a high fee on withdrawal (Dupas and Robinsion, 2013 ). However, in their successive study (Dupas et al., 2014 ), where instead of a compulsive intervention, the mediation was only to facilitate account opening, it was found that men saved more than women and were more frequent in making transactions.

Hence, the mere opening of bank accounts in the names of women will not ensure their inclusion in the financial mainstream, and their usage of the same over the long run is crucial development. An experimental study found that 22% of such mediated accounts were active in the short run, and only 7% were used in the third year. Many women claim that they use the formal account of someone else in their family so they do not need an account in their own name. In many cases, husbands hold access to the ATM card of their wife, hinting towards the family structures that deprive women of a sense of ownership, making her dependent on other family members in financial matters. (Schaner, 2017 ; Demirguc-Kunt et al., 2022 ).

On the brighter side, it was found that with the sense of ownership of wealth, women tend to appreciate themselves by spending on their personal needs, elevating their sense of self-worth. There was a 40% increase in women’s personal expenditure (Dupas and Robinsion, 2013 ) and an increase in education and health after the account opening (Prina, 2015 ). Additionally, the ATM cards issued along with bank accounts were found to be quite popular among married couples, as transactions increased up to 62% in the short run and 68% in the long run. It was found to enable wives to participate in joint financial decisions along with their husbands (Schaner, 2017 ). These results reflect the positive impact of free account opening and subsidized or free financial services on inclusion but also emphasize the need to ensure that the benefits reach out to the targeted vulnerable women and have long-term effects.

Cash/asset transfer program

CTs benefit women through financial well-being, economic security and emotional well-being, leading to a reduction in intimate partner violence and significant improvement in women’s status and relationships in the family. (Ismayilova et al., 2018 ; Buller et al., 2018 )

Studies have supported adding cognitive and emotive features such as training, counseling and coaching with economic strategies in policy interventions to empower women (Ismayilova et al., 2018 ; Brudevold et al., 2017 ). When CT intervention was compared with the one coupled with life skill training, it was found that sole cash transfers were more useful in increasing the income of women in the short run only, whereas the likelihood of employment could be increased with life skill training and CT bundled together (Brudevold et al., 2017 ). An interesting study to find the real beneficiaries of CT in the long run found that benefits were largely retained by women, as they had less pressure to share their income with their relatives on the pretext that their earning options were limited (Squires, 2018 ).

The impact of productive asset transfer (livestock) in the name of women was explored in an experimental setting in Bangladesh. It revealed that although women’s asset ownership increased significantly, the real beneficiaries were men instead of women (“fly paper effect”), male sole ownership in agriculture and land increased significantly after the intervention (Roy et al., 2015 ). This reaffirms the earlier made point about the way dowry benefits are reaped by the male members.

The usefulness of CT or asset transfer cannot be denied in the short run, where lack of cash or assets averts women from starting a business, but their limitation to save prevents them from sustaining the benefits in the long run (Brudevold et al., 2017 ).

Self-help groups (SHG), philanthropy, NGOs

SHGs are informal groups of rural women formed to socially and economically support each other with a sense of belongingness and responsibility among themselves. These groups foster FI along with the social empowerment of women. Members join the SHG mainly to obtain financial support to meet basic needs, especially in the case of emergency (Nagaraj and Sundaram, 2017 ).

Most SHG members are young in age, are less educated, have less income and lack any kind of previous experience in handling money. After their SHG experience, women have been found to be managing cash (Kabeer, 2011 ; Maclean, 2012 ; Ramachandar and Pelto, 2009 ), although some studies have found that even after SHG training, there was no impact on asset formation or income of participants (Deininger and Liu, 2013 ), women remained unsure and pressurized about their financial decisions, especially in the presence of a community member (Maclean, 2012 ; Ramachandar and Pelto, 2009 ).

It was found that when the members become old in the group, they start realizing their social responsibilities, which transforms their social participation and builds up their confidence in making decisions (Mehta et al., 2011 ), enabling them to fight against exploitation at the family or societal level.

Many philanthropists and NGOs have dedicated themselves to the cause of women’s empowerment. The BOMA project in Kenya, which works to achieve the UN sustainable development goals of poverty reduction, reducing gender inequality and mitigating the effects of climate change, has been instrumental in increasing income and savings (Tiwari et al., 2019 ). In 2019, Hendriks studied the logic and strategy of the functioning of one such philanthropic Bill & Melinda Gates foundation that aims to reduce the gender gap through FI, while in 2020, Kemp and Berkovitch worked to study feminist NGOs in Israel.

Digital inclusion

Gender was identified as a key variable in consumer readiness in adopting mobile payment services and strategizing market segmentation (Humbani and Wiese, 2018 ). Digital financial services have been discussed in papers as one of the most effective FI models (Arnold and Gammage, 2019 , Natile, 2019 ), promising greater privacy, confidentiality and control of women over their finances (Duflo, 2012 ). An influential African study by Efobi et al. in 2018 found a strong positive relationship between progressions in information technology through mobile & internet penetration and the participation of women in the economy.

With the advent of mobile banking, many women who cannot reach out to financial institutions have been linked to financial services and are more likely to save than men, even with limited amounts (Ouma et al., 2017 ), gaining greater flexibility to spend on household expenditures and child welfare measures (Duflo, 2012 ). In 2016, Suri and Jack found that Kenyan mobile money system M-PESA was able to lift 194,000 households, which was 2% of the total households, out of poverty, with a significant positive impact in female households driven by higher savings and better employment of women. Acknowledging its phenomenal reach, the drawbacks and efficiencies of mobile banking were discussed further to promote FI (Humbani and Wiese, 2018 ; Arnold and Gammage, 2019 ). Prospects of digitizing G2P payments were evaluated (Klapper and Singer, 2017 ) to find that with the backing of government, there could be a dramatic reduction in costs, higher efficiencies, transparency and greater acceptance of technology.

Deliberating imperfections, on the one hand, complex financial products and services are being launched every other day; on the other hand, almost 80% of women in low-income economies still earn their wages in cash (Klapper and Dutt, 2015 ). Inherent inequalities in financial access (Klapper and Dutt, 2015 ), innumeracy, illiteracy and unfamiliarity with technology (Tiwari et al., 2019 ) are barriers to women’s digital FI. Reiterating the above idea, the exploration of inclusionary arrangements found the exploitation of the M-PESA program to identify market opportunities causing its failure to adopt the redistributive measures necessary for the benefit of society (Natile, 2019 ). This suggests that there is a need for a very well-planned, systematic digital intervention with higher transparency, sensitivity and awareness.

Our systematic study seeks to explore its research objectives through three dimensions viz. barriers, intervention types and intervention/experimental studies (Fig. 2 ). The results obtained with regards to each dimension have been further discussed to present the contribution of our work.

Out of 67 related studies 24 studies provided us insights about the barriers in the way to financial Inclusion of women. A tabular synthesis of these studies resulted in the identification of six barriers, which were further qualitatively synthesized to find that they were interlinked and often cyclical in nature. We found that the study conducted for understanding one barrier led the way to explore other barrier. The long-term ill treatment of women due to patriarchy structures induce low self-esteem and other psychological barriers, which in turn reduce their negotiation power and more often than not they have to settle for low income and wages coupled with low literacy levels than their male counterparts. Low finances, economic power and low literacy directly affect their decision-making, leadership and opportunities. With fewer opportunities to grow, females get lesser access to finance and the women who have been underprivileged on account of their ethnicity face greater challenges in accessing finance their development. Lack of financial strength and literacy keeps pushing women into the patriarchy structures and hence the viscous cycle of disempowering women continues.

The results obtained from the tabular synthesis of 34 intervention studies, identified Government/Corporates programs and policies, Microcredit/Microfinance, Formal accounts/services, Cash/asset transfer program, Self-Help Groups (SHG), Philanthropy, NGOs and Digital Inclusion as the main interventions. These interventions have been individually documented to get insights about the related studies. The qualitative results suggest that there is a significant role of public and social institutions, related experiences, economic nature of intervention and technical advancement in financial services in fostering financial empowerment of women.

Also, we have presented a tabular synthesis of 24 intervention or experimental studies, which give an insight about the kind of intervention, the key findings and the research methodology that has been adopted in previous studies (Table 4 ). The findings from intervention studies suggest that economic interventions alone or bundled with social interventions were useful in financially empowering women.

Previous studies such as Holloway et al. ( 2017 ) and Kalaitzi et al. ( 2017 ) have used thematic mapping and traditional review methods to approach similar problem. Holloway et al. ( 2017 ) studied the impact of various saving, credit, payments and insurance products on women empowerment and found that there are numerous demand and supply-side barriers, some of which could be overcome by product design features. The study suggested that a greater degree of control and privacy surrounding women’s income and expenditure decision could boost their inclusion in the financial system. Our study results supports this finding especially while planning financial inclusion of women through digital ways where transparency, sensitivity and awareness must be considered as important variables.

Kalaitzi et al. ( 2017 ) identified 26 barriers to women leadership in Healthcare, Academia and Business, some of which were common while some were found to be starkly different across sectors. A systematic review by Roy and Patro ( 2022) synthesized evidence from 73 studies to find out that demand side factors were the main cause of gender-based exclusion. Unlike these studies, we have not only identified the different types of barriers, but also have attempted to understand the nature of these barriers, which has led to physical, social, mental, economic exploitation and overall suppression of women since a very long time. The focus of previous studies was only on the factors and the importance of the FI of women, giving us the opportunity to discuss the subject at a comprehensive level by including related interventions. Also, our findings about the experimental studies have not been presented in former studies making our contribution significant in women studies.

Thus, filling up the gaps, we have discussed the nature of six main barriers, summarized 24 key experimental studies and have clearly identified six major interventions that have been applied in the first 2 decades of the twenty-first century to provide a bird’s-view to systematically connect the factors as well as mediations found in past studies with the present and future.

However, as mentioned earlier in the result section of this paper, the presence of heterogeneity of the quantitative studies prevented us from conducting a meta-analysis, which we have tried to compensate with a rigorous synthesis of results from various studies. Sincere efforts have been made to include all the major contributors to the research topic, but due to the vastness of the subject and the limitation of our research design, some insightful studies may have been omitted from the discussion. Nevertheless, we believe that the current work covers inputs from many imminent studies, such as Kabeer ( 2011 ), Kabeer and Sweetman ( 2015 ), Beck et al. ( 2007 ), Brudevold et al. ( 2017 ), Swamy ( 2014 ), Efobi et al. ( 2018 ), Klapper and Dutt, ( 2015 ), and Dupas and Robinsion ( 2013 ) is able to provide the readers with a comprehensive, yet quick overview of the literature and its gaps while contributing to the development of useful interventions to achieve the sustainability goal of gender equality by 2030.

Practical implications

Considering the vastness of the subject and the need for urgent attention as the fifth sustainability goal, a quick understanding to formulate useful policies, programs and other interventions is much needed. Therefore, the findings of our study can provide useful insights to policy makers.

The barriers to financial Inclusion of women have been found to be inter-related and cyclical. This implies that a constant endeavor to eradicate even one such hurdle will have a multifold effect and will be useful in removing others. On the flip side, if attention is not paid to remove even one of these hurdles, they will keep occurring and obstructing the way of women’s development. Therefore, long-term policy interventions with continuous monitoring of efforts are required to bring about inclusive financial growth of women.

We have found through our exploration of intervention studies (Table 3 ) that though Government-to-people transfers (G2P), such as pensions, conditional cash transfers, financial literacy programs, microfinance, other socioeconomic transfers and products & services of public facility institutions such as post-offices, have resulted in the growth of savings and thereby higher entrepreneurship among women, but the related experiences of poor women determine their likelihood of connecting with the system in the long run. Hence, merely designing the intervention is not enough, and careful monitoring of such interventions must be done to achieve the objectives.

We have also found that SHGs, NGOs and other local communities enable women to become a part of the value chain and the familiarity and trust of vulnerable women in such organizations gives them a comparative advantage over other formal institutions. Therefore, as these formal or informal setups help women to get past the psychological hurdles, they must be included in all programs devised for including women in the financial system.

Moreover, we have found digital inclusion to be the most promising intervention with the widest range and prospects to connect with left-behind poor women. This calls for a sensitive customized approach keeping in mind the convenience of vulnerable and less educated women in adapting to the digital ways.

Furthermore, through our exploration of experimental studies (Table 4 ) we have found that economic interventions are more useful than social interventions in promoting entrepreneurship, savings, consumption and general betterment of the lifestyle of women. However, the most effective programs are those in which both economic and social components are incorporated. This insight can be utilized towards designing valuable mediations to support entrepreneurship among women, keeping in view that such intervention should not just be on papers, but must actually reach to the beneficiary and be utilized towards the identified cause only.

Future scope for research

The 67 studies discussed in this work have exposed many gaps in the related literature. As we have found that all the barriers are inter-related and cyclical, there is a need to break the cycle. Our findings can help future researchers to develop deeper insights about each of the highlighted barrier. A few future areas for research have been identified as:

Meaningful and important insights can be derived from ethnic studies to measure the impact of cultural institutions such as women’s dress codes and their expected public behavior on the level of their economic participation.

Exploration of behavioral irrationality of rural women towards financial products and services.

Biasness at the workplace in terms of income, authority and leadership should be explored further to devise suitable interventions.

The perception, attitude, and behavior of women towards finance have been evaluated in many studies, but not much has been discussed to understand the supply-side psychological hurdles at the individual level in disbursal of finance.

Likewise, our results suggest and discuss the evaluation of most effective interventions, which can help researchers to understand the way these mediations have developed so far and the way in which they can be improvised. Some future areas, which may be explored in theory may be:

The usefulness of online education to promote financial literacy and awareness in the remote corners of countries and across countries.

The lack of discussion about insurance products to mitigate risk and encourage investments among women can be addressed.

There is a need to discuss security, transparency and awareness in digital financial services along with thoughtfully designing simpler digital interfaces, tools and devices customized for women.

Moreover, as the problem of the FI of women has evidently been discussed primarily in developing nations, there is a need for exploration studies about poor or indigenous women in developed countries.

Thus, offering a deeper insight to the subject of Women empowerment through Financial Inclusion, we have identified six prominent barriers to FI of women: patriarchy structures, psychological factors, low income/wages, low financial literacy, low financial accessibility and ethnicity and have uniquely found that these barriers are interconnected with cyclical impact, resulting in redistribution effects that further widen the gaps between the privileged and the underprivileged, which must be considered while designing interventions in future.

Similarly, we have recognized six main interventions that have been introduced thus far: government and corporate programs/policies, microfinance, formal saving accounts/services, cash or asset transfer, self-help groups and digital inclusion and have presented various methods and findings of related experimental researches to provide direction for future inquiry. The consequences, appreciation and criticism of various interventions have been documented in the results and discussion to provide useful vision for future policy or theoretic implementation. Overall, this study has exclusively presented a summary of the barriers and interventions, which have been inquired into during 2000–2020 thereby contributing to achieving sustainable development goal (SDG 5) of ending gender inequality issues by 2030.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information file.

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Saluja, O.B., Singh, P. & Kumar, H. Barriers and interventions on the way to empower women through financial inclusion: a 2 decades systematic review (2000–2020). Humanit Soc Sci Commun 10 , 148 (2023). https://doi.org/10.1057/s41599-023-01640-y

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Women empowerment in reproductive health: a systematic review of measurement properties

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Introduction

There is a considerable dearth of official metrics for women empowerment, which is pivotal to observe universal progress towards Sustainable Development Goals 5, targeting "achieve gender equality and empower all women and girls.” This study aimed to introduce, critically appraise, and summarize the measurement properties of women empowerment scales in sexual and reproductive health.

A comprehensive systematic literature search through several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct was performed on September 2020, without a time limit. All studies aimed to develop and validate a measurement of women empowerment in sexual and reproductive health were included. The quality assessment was performed through a rating scale addressing the six criteria, including: a priori explicit theoretical framework, evaluating content validity, internal consistency, and factor analysis to assess structural validity.

Of 5234 identified studies, fifteen were included. The majority of the studies were conducted in the United States. All studies but one used a standardized measure. Total items of each scale ranged from 8 to 23. The most common domains investigated were decision-making, freedom of coercion, and communication with the partner. Four studies did not use any conceptual framework. The individual agency followed by immediate relational agency were the main focus of included studies. Of the included studies, seven applied either literature review, expert panels, or empirical methods to develop the item pool. Cronbach's alpha coefficient reported in nine studies ranged from α = 0.56 to 0.87. Most of the studies but three lack reporting test–retest reliability ranging r = 0.69–0.87. Nine studies proved content validity. Six criteria were applied to scoring the scales, by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality.

Most scales assessed various types of validity and Internal consistency for the reliability. Applying a theoretical framework, more rigorous validation of scales, and assessing the various dimensions of women empowerment in diverse contexts and different levels, namely structural agency, are needed to develop effective and representing scales.

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Recognition and measurement of women empowerment are critical for global development and human rights [ 1 ]. This was accentuated as the Sustainable Development Goal (SDG 5), which targets to "achieve gender equality and empower all women and girls” [ 1 ].

Although the growing body of literature addresses the impact of women empowerment on reproductive outcomes, it is only recently that reproductive empowerment was explicitly distinguished as a distinct dimension of empowerment itself [ 2 , 3 ]. Edmeades et al. (2018) proposed the following definition of reproductive empowerment according to a recently developed framework: “Both a transformative process and an outcome, whereby individuals expand their capacity to make informed decisions about their reproductive lives, amplify their ability to participate meaningfully in public and private discussions related to sexuality, reproductive health, and fertility, and act on their preferences to achieve desired reproductive outcomes, free from violence, retribution or fear” [ 2 ].

Reproductive and sexual empowerment is critical because, in many contexts, intimate relationships frequently occur between individuals with vastly unequal power. In many cultures, normative expectations toward gendered heterosexual sex roles and gender inequalities negatively influence women’s sexual power and restrict their ability to negotiate sexual matters with male partners [ 4 ].

The literature review showed that scales of women empowerment in reproductive health, especially in the past years, concentrated more on “power”, where power structures limit women’s sexual and reproductive health capabilities. These measures such as Sexual Assertiveness Scale [ 5 ], The Sexual Relationship Power Scale [ 6 ], and the Sexual Pressure Scale [ 7 , 8 ], mainly addressed the experience of pressure and coercion regarding sexual activity, sexual desires, HIV/AIDS (Human immunodeficiency virus/Acquired immunodeficiency syndrome) risk and prevention, and STD (sexually transmitted diseases) prevention to better capture the gender norms and dynamics shaping women’s sexual decisions and outcomes. The recent measures, on the other hand, recognize “choice” as a critical component of empowerment. Kabeer's foundational work on women's empowerment in the early 2000s, and then developing a framework by World Bank [ 9 , 10 ], introduced decision-making and exercise of choice as the components of the agency. These concepts were used commonly to design scales of women empowerment measurements such as Sexual and reproductive empowerment [ 11 ], Reproductive Decision-making Agency [ 12 ], Women’s and Girls’ Empowerment in Sexual and Reproductive health (WGE-SRH) [ 13 ], aimed to assess women’s agency in decision making over vital sexual and reproductive health matters.

The lack of standardized terminology and measurements of women reproductive empowerment in addition to the conceptual ambiguity have directly influenced implications for its measure. Consequently, there is considerable variability in the association between reproductive empowerment and health outcomes. This restrains policymakers and authorities from planning effective interventions to improve reproductive empowerment or reproductive outcomes [ 3 ].

Although it is suggested that gender-based control in hetro-sexual relationships is correlated with sexual and reproductive consequences [ 14 ], there is a considerable dearth of official metrics for women empowerment, which is pivotal to observe progress towards SDG 5 [ 1 ]. Demand for developing standard measurements of women empowerment would be more highlighted given that adequate data for 80% of indicators to monitor SDG5 is lacking, often due to the absence of valid measures [ 15 ]. This study aimed to introduce, critically appraise, and summarize the quality of the women empowerment’s measurement properties in sexual and reproductive health.

Conceptual framework

In this review, we applied the Kabeer framework where conceives empowerment as the ability of exercise choice consisting of three inter-related dimensions including (1) resources, defined as not only access to but the future claims to material, human and social resources; (2) agency, including decision making, negotiation, deception, manipulation, subversion and resistance; and (3) achievements encompasses well-being outcomes which are sexual and reproductive health [ 9 ]. We also used the conceptual framework of women reproductive empowerment proposed by Edmeades, Mejia, and Sebany (2018). Within this approach, reproductive empowerment results from the interaction of three interrelated, multi-level processes: voice, choice, and power. Voice indicates women’s capacity to exercise their reproductive goals, interests, and desires and have meaningful participation in reproductive decision making. Choice implies the ability of women to make a meaningful contribution to reproductive decisions.Power indicates the ability to shape the process of reproductive decision-making by exerting power over others [ 3 ]. Power operates at multiple levels, including couple level, families level, and expanding to the community and societal levels [ 13 ].

Combining both frameworks, we sought psychometric assessment studies that had chosen any of the abovementioned concepts and considered sexual and reproductive health as the main outcome.

Study design and search strategy

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 16 ] were used to conduct the current review. A comprehensive literature search was carried out to identify women empowerment scales used in sexual and reproductive health and their properties. The first author (M.V) performed the systematic review on September 2020, in several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct, without a time limit. Various search strategies involving keywords, index/subject terms, and Medical Subject Headings (MeSH) terms were used. A brief sample of keywords included: (women, female, girls) AND (reproduction, sexual, family planning, family planning services, fertility, contraception, birth spacing, birth intervals) AND (empowerment, power, agency, decision-making, autonomy, coercion, choice, negotiation, mobility) AND (measurement, scale, instrument, tool, questionnaire, indicator) AND (psychometric, validity, validation study, reliability, reproducibility of results). Moreover, Google Scholar and the references of the included articles were reviewed manually.

Inclusion and exclusion criteria

All studies aimed to develop a new scale or adapt an existing scale and reported the results of the reliability and validity testing were included in this research. Studies that developed and validated a women empowerment scale but the primary outcome were not the sexual and reproductive health were excluded. Moreover, studies that used a new scale without performing a psychometric analysis were excluded, too. Studies published in a language other than English and non-peer-reviewed reports, books, and dissertations, were excluded.

Outcome of interest

In the aim of this review, the construct of interest is “women reproductive empowerment” the population of interest is “women and girls”, the type of scale of interest is “all” either self-report questionnaire or interviewer-administered, and “all” measurement properties were evaluated in the review.

Data extraction

The first author (M.V) screened all titles and abstracts from the search results. After identifying all relevant articles, full texts were reviewed by all authors. Two authors (M.V and A.Z) contributed to extracting the data from the included studies. Characteristics of the study samples and scales and the measurement properties were extracted. The qualitative data analysis was chosen to synthesize data in this study for two reasons. First, we found a large degree of heterogeneity between studies by examining the study characteristics, including population features, methods of determining construct validity, different domains addressed in scales, etc. Second, considering the purpose of this study to introduce, critically appraise, and summarize the measurement properties of relevant scales, the authors decided not to use quantitative data analysis, which has little implication.

Assessment of methodological quality

Assessing the methodological quality of included studies was performed by two authors (M.V and A.Z) separately. Both authors discussed the ranking system to ensure its accuracy. The differences between them, either in data extraction or quality rating, were solved by another author, Z.BM.

Methodological quality was evaluated through three dimensions, including the developments of items, validity, and reliability. To evaluate item development, we assessed whether a literature review, empirical study, or expert panel were conducted to develop the measurement. Assessing reliability focused on whether internal consistency and test–retest reliability were determined. Validity was assessed by examining the methods used to determine content validity (the degree to which the content scale reflects the construct); structural validity (the degree to which the scores on the scale represent the dimensionality of the construct); internal construct validity (the consistency between scales and hypothesis); and external construct validity (whether measures of constructs strongly correlate or minimally correlate with one another in the hypothesized way” (Table 2 ) [ 17 , 18 ].

A rating scale applied in some systematic reviews was used to evaluate the quality of the scales’ measurement properties [ 17 , 19 ]. Six criteria were the basis of the scoring, including whether studies used a priori explicit theoretical framework; assessed the content validity; assessed the internal reliability scores (α > 0.7), determined the structural validity using exploratory factor analysis; determined the internal construct validity through confirmatory factor analyses; and assessed the external construct validity or not. The scores on each item range from 0 (none of all six criteria were fulfilled) to 6 (all of six criteria were fulfilled). The total score of study ≤ 2 interprets as poor quality; 3–4 means medium quality, and the total score ≥ 5 is considered high quality (Table 3 ).

Study characteristics

The search strategy yielded 5234 relevant records. Finally, 62 full texts were reviewed, of which 15 separate scales were identified (Fig.  1 ).

PRISMA flow diagram of study process

Ambiguous scales that measured the components, dimensions, or subscales of women empowerment but did not fit in our framework and original search strategy were excluded to consistently adhere to our conceptual framework (n = 46). Another full text aimed at the psychometric analysis of Reproductive Agency Scale 17 (RAS-17), composing pregnancy-specific and non-pregnancy-specific agency items among Qatari and non-Qatari women with a normal pregnancy [ 20 ], was excluded to achieve the maximum homogeneity of the results. Some scales such as the Survey-Based Women’s Empowerment (SWPER) Index and Composite Women’s Empowerment Index (CWEI) have been developed to measure women empowerment [ 21 , 22 ]; however, they did not include in this review because they were not applicable in sexual or reproductive health.

A detailed description of the included scales is shown in Table 1 . The results revealed that included articles did not represent diverse geographical areas. The majority of studies (8/15) were conducted in the United States [ 5 , 6 , 7 , 8 , 23 , 24 , 25 , 26 ]. Two were done in Nepal [ 12 , 27 ], one in Spain [ 28 ], and the rest of the studies (4/15) were carried out in African countries [ 13 , 29 , 30 , 31 ]. The sample size varied from 235 to 4674 in primary studies and 111,368 in one study using the Demographic and Health Surveys (DHS). The age of participants ranged between 16 and 71. The items of each scale ranged from 8 to 23. The target population in studies were as following: three studies (3/15) included adolescents and young adults (15–24 years) [ 11 , 29 , 30 ], three (3/15) were carried out on young women aged 16–29 [ 7 , 8 , 25 ]; one conducted in young women 20–35 years [ 12 ]; six studies (6/15) aimed to assess women in reproductive age defined as those aged 15 to 49 years [ 5 , 6 , 13 , 26 , 27 , 31 ]. Two studies extended the age group of participants beyond 45 years; in one study, women at the ages of 15 to 60 [ 24 ]; and in another, women ages 18 to 71 were included [ 32 ].

The most common domains of women empowerment in reproductive health that had been measured were: freedom from coercion, decision-making, communication with the partner, choice, control, autonomy, and ability to negotiate. “Kabeer’s framework of empowerment” was applied as the empowerment framework in two studies (2/15) [ 11 , 31 ]; “The theory of gender and power” developed by Connell in four studies (4/15) [ 6 , 24 , 29 , 30 ]; and “Sex scripts” (gender-stereotypical expectations to engage in sexual behavior) was used in two studies (2/15) [ 7 , 8 ]. Moreover, the “Reproductive empowerment framework” developed by Edmeades et al. (2018) and “General conceptualization of assertiveness based on human rights to autonomy”, each one was used in one study [ 12 ]. The “World Bank’s Empowerment Framework” and “The sexual and health empowerment framework” developed by the authors were used in a study conducted by Moreau et al. [ 13 ]; whereas the rest of the studies did not apply any specific empowerment framework.

Reliability and validity testing

Of the included studies, seven applied either literature review, or expert panels, or empirical method to develop the item pool (Table 2 ). Adequate internal consistency defined as the alpha > 0.7 was reported in nine studies (9/15). However, in four studies, poor internal consistency (α < 0.70) was seen. Two studies also did not report internal consistency. Most of the studies but three lack reporting test–retest reliability. Nine studies proved content validity. Six criteria were applied to score scales by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality (Table 3 ).

Summary of included measures

Sexual and reproductive empowerment scale.

Sexual and Reproductive Empowerment Scale is a 23-item questionnaire developed and validated by Upadhyay et al. (2020) and aimed to assess the latent construct of sexual and reproductive empowerment among a national sample of American males and females adolescents and young adults (AYAs) aged 15–24 years. This scale contains the following domains: comfort talking with a partner (three questions); choice of partners, marriage, and children (three questions); parental support (4 questions); sexual safety (4 questions); self-love (4 questions); the sense of future (2 questions); and sexual pleasure (3 questions). The total score could range from 0 to 92. The items can be self-administered, and on average, AYAs could answer all items in less than 2 min. The baseline results demonstrated that sexual and reproductive empowerment was associated with access to sexual and reproductive health services and information, and also at 3-month follow-up was moderately associated with the use of desired contraceptive methods. In contrast to most reproductive empowerment measures, this scale can also be used among men and boys [ 11 ].

Reproductive Autonomy Scale

As a multi-dimensional scale, Reproductive Autonomy Scale (RAS) was developed and validated in the USA to measure “reproductive autonomy” among women. This scale is comprised of 14 items and three subscales. Reproductive autonomy was defined as women’s power to decide about and exercise control on issues related to using contraception, pregnancy, and childbearing. The participants were selected from the family planning and abortion facilities in the United States. Three subscales of the scales were freedom from coercion (five questions), communication (five questions), and decision-making (four questions). The study found a reverse association between freedom from coercion and communication subscales with unprotected sex [ 24 ].

Reproductive decision-making agency

Hinson et al. (2019) developed and validated the reproductive decision-making agency scale among Nepalese women aged 15–49. The 17-item scale attempts to measure women’s decision-making over reproductive behaviors in three domains, including women’s agency in using family planning methods, agency in choosing the method of family planning, and agency in choosing the time of getting pregnant. In this study, women whose husbands or other relatives rather than themselves mainly made decisions on reproductive behaviors were considered the lowest agency. In contrast, women reporting sole or joint decision makingwere categorized as the medium and high agency, respectively. The scale’s scores varied between three and nine, the higher scores representing the higher agency. This scale can be applied to assess a range of reproductive outcomes, particularly those related to reproductive control.

Women’s and Girls’ Empowerment in Sexual and Reproductive health (WGE-SRH)

WGE-SRH was developed by Moreau, Karp, et al. (2020) in three African countries, Ethiopia, Uganda, and Nigeria, to provide a cross-cultural scale. This 21-items scale attempts to assess the existence of choice and exercise of choice across the three domains related to sex, using contraception, and pregnancy. Participant’s agreement or disagreement with each item scored from 1 to 10. The results showed that women who indicated higher scores on the contraceptive choice subscale are more likely to use contraception. Moreover, higher scores on the sexual exercise scale were associated with a higher possibility of volitional sex [ 13 ].

A short-form Reproductive Coercion Scale (RCS)

This 5-item measure was derived from the Reproductive Coercion Scale (RCS) by McCauley et al. (2017). The scale was validated in two longitudinal randomized controlled trials conducted on young English- or Spanish-speaking women aged 16–29 in the USA. These five questions constructed two subscales: pregnancy coercion (three items) and condom manipulation (two items). Items include dichotomous (yes/no) answers. The short form of scale was useful in recognizing women who endorse low levels of reproduction coercion. This scale is particularly sensitive to identifying women who experience less common forms and multiple forms of reproduction coercion. Furthermore, this scale would provide a rapid assessment of reproductive coercion in clinics.

Sexual Assertiveness Scale (SAS)

SAS was developed to measure women’s understanding over the three subscales of assertiveness regarding initiation of sex, refusal of sex, and prevention of sexually transmitted disease/pregnancy (STD-P) with a regular partner. It comprises 18 items rated on a 5-point response format with anchors of 0 (Never) and 4 (Always). The higher scores on the scale, the higher sexual assertiveness is predicted. The SAS was developed and validated in a sample of young American women ages 16–29. After 6 and 12 months intervals, test–retest reliabilities were assessed [ 5 ].

Spanish version of Hurlbert Index of Sexual Assertiveness

Antos-Iglesias and Carlos Sierra (2010) adapted the Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991) among the Spanish community. The psychometric analysis was conducted among 400 Spanish men and 453 women who had a partner for at least six months. The original scale was composed of 25 items, ranging from 1 (Never) to 5 (Always). The total scores were between 0 to 100. The higher scores represent the higher sexual assertiveness. The exploratory and confirmatory factor analyses identified a 19-item structure with two correlated factors (Initiation and No shyness/Refusal). Six items from the original version were eliminated. Finally, the Spanish version showed satisfactory psychometric characteristics [ 32 ].

Sexual Assertiveness Questionnaire (SAQ)

SAQ was derived from the Sexual Assertiveness Scale (Morokoff and colleagues, 1997) by Loshek and Terrell (2014) to provide a scale that does not include the condom insistence. The underlying hypothesis was although the sexual assertiveness scale encompasses condom insistence, it might not be administered to women at all life stages or in various kinds of relationships. The final scale comprises 18 items and three subscales, including the ability to initiate and communicate across desired sex, the ability to refuse unwanted sex, and the ability to talk about sexual history and risk. Response choices included a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree). The results demonstrate satisfactory psychometric properties [ 26 ].

Sexual Pressure Scale (SPS)

This 19-items scale aimed to measure gender-stereotypical expectations engaging in sexual behaviors. This study hypothesized that sexual pressure is associated with HIV sexual risk behavior. Scale composed of five factors: Condom Fear, Sexual Coercion, Women’s Sex Role, Men Expect Sex, and Show Trust. Higher sexual pressure was identified through a higher score. The SPS can be used to assess to what extent adherence to gender-stereotypical expectations may limit women’s sexual choices and lead to adverse consequences, such as being less assertive in communicating their desire to reduce risk and being more likely to be engaged in sex with men who are at the higher risk of HIV [ 7 ].

Sexual Pressure Scale for Women-Revised (SPSW-R)

Jones and Gulick (2009) revised the sexual pressure scale (Jones, 2006) to improve its reliability. The study was carried out on a sample of young adult urban women. The reliability and confirmatory factor analysis using structural equation modeling resulted in 18 items with higher reliability than the original scale. After eliminating the Condom Fear factor, a 4-factor model encompassing Show trust, Women’s sex role, Men expect sex, and Sexual coercion was remained [ 8 ].

Sexual Relationship Power Scale (SRPS)

This measure was designed by Pulerwitz et al. (2000) to address interpersonal power in sexual decision-making. SRPS consists of 23 items and two subscales, Relationship Control (RC) and Decision-Making Dominance (DM). RC subscale encompasses fifteen,and DM is composed of eight questions. The totalscore was ranged from 8 to 24. Lower scores on SRPS were associated with higher physical violence and lower consistent use of a condom [ 6 ].

Sexual Relationship Power Scale (SRPS) among adolescent girls and young women (AGYW)

This scale was derived from the Relationship Control subscale of the SRPS and then validated among AGYW who were at the risk of HIV in Kenya. The original subscale consisted of 15 items. A modified scale was extracted after removing three items related to condom use, resulting in 12 items in total. Participants were asked to express to what extent they agree or disagree with each item on a 4-point Likert scale. The results showed that AGYW with higher relationship power were less likely to experience sexual violence and more likely to use a condom and have knowledge of partner’s HIV status [ 29 ].

Sexual Relationship Power equity (SRP equity)

SRP equity is a South African adaptation of the Sexual Relationship Power, originally developed by Pulerwitz et al. in 2000 [ 6 ]. Over the community-based cohorts, 235 young men and women aged 16–24 years completed this questionnaire. Follow-up study performed six months later. The original SRPS consists of 13 questions. Participants answered on a 4-point Likert scale for each item, ranging from (‘strongly agree’ to ‘strongly disagree’). Higher scores representing greater equity in sexual relationship power. Finally, a 8-item scale for women and a 9-item scale for men were constructed. SRP equity was associated with higher education and no recent partner violence [ 30 ].

Women Autonomy Measurement Scale

This scale was developed by Bhandari et al. (2014) to provide a validated scale for measuring Nepalese women’s autonomy as one of the predictors of using maternal health care services. The 23 items were answered on a 3-point scale anchored with zero (not necessary), one (useful not essential), and two (essential). Three subscales, including decision-making autonomy, financial autonomy, and freedom of movement, constitute the scale. The Autonomy Measurement Scale showed appropriate psychometric characteristics and introduced a valid and standard scale for assessing women’s autonomy in developing countries [ 27 ].

Women’s Empowerment on Demographic and Health Surveys: indicators for health dimension

Using Demographic and Health Surveys (DHS) from nineteen countries in four African regions, a scale composed of 26 indicators was developed to assess different dimensions of women empowerment, including economic, socio-cultural, education, and health. Access to healthcare composes distance, money, and permission. For instance, items such as: whether women have the “access” or “financial constraints” to make beneficial health choices were included. If women reported difficulties accessing healthcare services, they were assigned a 0 score; otherwise, women were scored 1. This scale provided region-specific indicators of women empowerment in Sub-Saharan Africa [ 31 ].

To the best of our knowledge, this is the first review that systematically appraised and summarized the measurement properties of validated women empowerment scales in sexual and reproductive health and also assessed the methodological quality of the included studies. The study results contributed to present a comprehensive picture of the main developments in women reproductive empowermentmeasuresments. Although women empowerment is a broad concept with various domains at different levels, few validated scales exist to measure them. Some domains such as decision-making, freedom of coercion, and communication with a partner were measured more often, whereas others got less attention. It is possibly because most studies concentrated on the individual agency and agency within intimate partnerships (i.e., immediate relational agency). Various domains assessed in the included studies may represent the complex and multi-faceted nature of women empowerment [ 23 ]. On the other hand, distant agency focusing on structural empowerment received less attention. Only one study evaluated women's empowerment at the structural level [ 31 ]. In this study, Asaolu et al. (2018) investigated healthcare access as a significant contributor to women’s empowerment. The healthcare domain included three variables of distance, money, and permission [ 31 ]. They hypothesized that social norms hindering women from going out without somebody’s companionship, financial constraints, farther distance, poor road conditions, or unreliable/no transportation could influence women’s access to healthcare [ 31 ]. Women empowerment is a multi-level concept, and social and structural obstacles hinder many women from exercising agency beyond the barriers they face in their marriages or families. Researchers highlighted the importance of embedding the macro-level factors in the definition and measurement of women empowerment [ 33 ]. Many factors at the various intrapersonal, interpersonal, and ecological levels determine the degree that a woman is empowered [ 33 ]. Social, economic, and cultural systems that operate at the uppermost level play an essential role in shaping the parameters of empowerment in specific contexts. For instance, availability and accessibility of health services, women’s position in the society, the level of power that women can impose in their relationships with their male partners, and cultural expectations of women, effectively influence women empowerment regardless of their individual or household characteristics. Thus, designing scales to measure these structural factors is crucial to understanding reproductive empowerment [ 3 ].

All included studies except one used standardized measures that can be applied in other contexts. Comparing women empowerment across the countries would be possible through standardized scales such as autonomy, decision-making, and communication with a partner [ 34 ]. Although standards measures are more likely to compare various populations in different cultures, context-specific scales can provide opportunities to reflect women’s lived experiences in contexts in which they live and also allow us to compare the status of their empowerment with peers [ 35 ]. In studies that adapted a scale in the new context, some items were removed or substituted by others, indicating the contextual spirit of women empowerment and this fact that dominant beliefs, practices, and values can influence women empowerment. So, probably factors constituting the women empowerment are not similar in different contexts [ 36 , 37 ]. However, exploring how women in other countries experience empowerment is possible through adapting the existing scales in other contexts to compare women’s situations across the countries.

Sexual Relationship Power Scale and sexual assertiveness scale were most examined as three studies used each of these scales. All included studies focused on women and girls who were in a sexual relationship. Although this enables using scales that measure household, family-in-law, and financial issues of family and capturing the power balance between girls and women and their sexual partners, none of the studies address the never-married women highlighting a gap in developing suitable scales for assessing girls, singles, widows and never-married women. Some studies included men, providing a comparison between women and men's attitudes over women empowerment.

It should be mentioned that all included studies were based on cross-sectional data, limiting the assessment of temporal ordering. A significant concept of women empowerment is the process, emphasizing the changes from one state to another over time [ 10 ]. Women’s levels of power can transform over time [ 28 ]. Thus, considering changes in the state of women empowerment over time is vital.

Assessing the scales' quality showed that content validity, construct validity, and internal consistency were the most common properties evaluated. Just three studies assessed test–retest reliability. Consequently, their stability to apply to other contexts is doubtful. Rigorous psychometric assessment of the scales is vital. Because poor validity and reliability can endanger the risk of correct evaluation and diagnosis of scales, consequently leading to misinterpretation and inaccurate research findings [ 38 ]. In this review, most of the studies achieved moderate or high quality, indicating the appropriate methodology. It appears that the geographic distribution of validated scales is limited to the USA and some African countries. The lack of administration of these scales across various contexts could lead to inadequate external validity [ 39 ].

These findings give insights to develop new scales covering more domains of women reproductive empowerment or validate the currently available measurements in various settings on diverse samples.

Limitations

This systematic review's main focus was finding quantitative measures of women empowerment in sexual and reproductive health, so studies that characterize scales and domains without reporting the development and psychometric analysis were not included. Another limitation of this study is publication bias as the inclusion criteria just considered peer-reviewed articles and excluded gray literature, non-peer-reviewed reports, books, and dissertations. Additionally, including only articles in English may lead to language bias.

Some dimensions, namely the structural dimension of women empowerment, are being ignored in the existing scales. Including the diverse populations and samples to develop and refine women empowerment’s measurements would facilitate measuring variations in the contexts in which reproductive empowerment is evolved. This study highlighted the necessity of designing and developing comprehensive measures to address the various dimensions of women reproductive empowerment at different levels and in diverse contexts.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available as all data are included in the manuscript body, but are available from the corresponding author on reasonable request.

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Acknowledgements

This article is a part of the PhD thesis of the first author supported and granted by Tehran University of Medical Sciences, Tehran, Iran.

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Vizheh, M., Muhidin, S., Behboodi Moghadam, Z. et al. Women empowerment in reproductive health: a systematic review of measurement properties. BMC Women's Health 21 , 424 (2021). https://doi.org/10.1186/s12905-021-01566-0

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What really empowers women? Taking another look at economic empowerment

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• Indrani Gupta   ORCID: orcid.org/0000-0002-2053-9375 1 &
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The gender inequality gap has widened in recent years, despite significant global awareness and efforts to address the issue. This indicates the possibility that there is still uncertainty about the selection of the most important levers for reducing gender inequality. While economic empowerment has been analysed and discussed as an important input into women’s empowerment, evidence remains inconclusive and interventions sparse, especially in the context of large populous lower middle-income countries like India. The paper examines the impact of economic empowerment on a woman’s overall ability to take decision using data from the National Family Health Survey in India. Data on decision-making, economic empowerment and other socioeconomic variables of currently married women, aged 15–49 years, are used to analyse to whether and to what extent economic empowerment has an impact on women’s agency. Nine decision-making areas were used cumulatively in an ordered logit model, and the results indicated that economic empowerment was important in improving women’s decision-making abilities, including other key variables on the socioeconomic status of the women. The results imply that while education would remain a key policy tool, policies on women’s empowerment need to incorporate programmes and interventions on women’s economic empowerment, and programmes guaranteeing women employment and focusing on their employment conditions need to get much higher budget allocations within the government’s overall budget.

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Gupta, I., Roy, A. What really empowers women? Taking another look at economic empowerment. J. Soc. Econ. Dev. 25 , 17–31 (2023). https://doi.org/10.1007/s40847-022-00215-y

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Women’s empowerment and fertility: A review of the literature

Ushma d. upadhyay.

a Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States

g Women’s Health & Empowerment Center of Expertise, University of California Global Health Institute, United States

Jessica D. Gipson

b Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, CHS 46-071B, Los Angeles, CA 90095-1772, United States

Mellissa Withers

c UCLA Center for the Study of Women, Box 957222, Public Affairs 1500, Los Angeles, CA 90095-7222, United States

Shayna Lewis

e UCSF/UC Hastings Consortium on Law, Science and Health Policy, University of California Hastings College of the Law, 200 McAllister St., San Francisco, CA 94102, United States

Erica J. Ciaraldi

Ashley fraser.

d Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, 17 University Hall, Berkeley, CA 94720, United States

Megan J. Huchko

f San Francisco General Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, United States

Ndola Prata

Women’s empowerment has become a focal point for development efforts worldwide and there is a need for an updated, critical assessment of the existing evidence on women’s empowerment and fertility. We conducted a literature review on studies examining the relationships between women’s empowerment and several fertility-related topics. Among the 60 studies identified for this review, the majority were conducted in South Asia ( n = 35) and used household decision-making as a measure of empowerment ( n = 37). Overall, the vast majority of studies found some positive associations between women’s empowerment and lower fertility, longer birth intervals, and lower rates of unintended pregnancy, but there was some variation in results. In many studies, results differed based on the measure of empowerment used, sociopolitical or gender environment, or sub-population studied. This article is one of the first evaluations of the literature assessing the relationships between women’s empowerment and fertility. We identify several key issues that merit further investigation.

1. Introduction

Over the last two decades, women’s empowerment has become a focus for development efforts worldwide. In 2000, 189 countries signed on to the eight Millennium Development Goals, which included a commitment to promoting gender equality and empowering women (MDG3) ( United Nations, 2000 ).

Since then, several scholars have attempted to synthesize existing knowledge on women’s empowerment and international development. In the only review that focused on reproductive-related outcomes, published over a decade ago, Blanc (2001) synthesized the research examining the role of gender-based power in sexual relationships and its impact on reproductive health. Malhotra et al. (2002) summarized the most promising methods to measure and analyze women’s empowerment and provided a review of empirical studies from the fields of economics, sociology, anthropology, and demography. In 2008, Kishor and Subaiya (2008) provided data on the distribution and correlates of women’s empowerment in 23 countries documenting the wide variation in levels of decision-making power and gender-equitable attitudes.

Recently, the World Bank devoted the World Development Report (2012) to the theme of Gender Equality and Development. The report argues that the success of global development efforts hinges on gender equality and recommends public policies that promote gender equity as a means of ensuring economic growth.

At the same time that these efforts aimed to improve the status of women globally, support for family planning—an integral component in transforming women’s lives—waned ( Cleland et al., 2006 ; Crossette, 2005 ). The recent London Summit on Family Planning brought renewed attention to the importance of family planning as a means of reducing fertility and expanding the options available to women beyond reproduction ( Carr et al., 2012 ).

This literature review builds on previous reviews of women’s empowerment, by focusing specifically on research that examines its associations with fertility. To guide our work we use a definition and conceptualization of women’s empowerment based on Kabeer’s (1999 ; 2001) : “the expansion of people’s ability to make strategic life choices in a context where this ability was previously denied to them.” Within this definition, two central components of empowerment are the agency and the resources needed to exercise life choices. This definition allows a broader conceptualization than interpersonal sexual relationship power.

We conducted literature searches using PubMed, POPLINE, and Web of Science search engines in May 2013. Searches were conducted by using the following individual and combined keywords (and MeSH terms in PubMed): fertility, family size, ideal family size, birth intervals, birth/birth spacing, induced abortion, reproductive health, unplanned pregnancy, unintended pregnancy, parturition, birth, pregnancy, pregnancy spacing/intervals, and childbearing, published from January 1990 to December 2012. This initial search resulted in 6259 articles in PubMed, 3578 in POPLINE, and 4508 in Web of Science, for a total of 14,345 articles, including duplicates among the three databases ( Fig. 1 ).

Flow chart of literature search.

We evaluated each article against our inclusion criteria based on the title and abstract. To be included, studies must have: 1) been in English, 2) used quantitative analysis, 3) used observational or experimental study design, 4) analyzed data from low- or middle-income countries as defined by the World Bank, 5) examined one or more of the searched fertility topics, 6) examined “women’s empowerment” either as an independent or dependent variable and described how it is measured. To meet the last criterion, an article had to include, either in its theoretical framework or stated research objective, the intention to examine women’s empowerment, women’s autonomy, women’s status, or a closely related construct that fit within our definition of women’s empowerment ( Kabeer, 2001 ). Based on the research that demonstrates the distinction empirically (e.g., Hindin, 2000 ) and general theoretical consensus ( Caldwell, 1986 ; Jejeebhoy, 1995 ; Mason, 1986 ), education may contribute to women’s empowerment but is a distinct construct; therefore, studies that examined women’s education or literacy in their own right were not included in this review. However, studies that conceptualized education as one form of empowerment, and/or used education as a proxy for empowerment were included. In order to limit the scope of this review, abstracts were further screened to exclude studies focused on the following topics: family planning and contraception (without also focusing on fertility), sexually transmitted infections, HIV/AIDS, and maternal, infant and child health. References from key articles were hand-searched to ensure that our review included all pertinent studies. This step allowed for the inclusion of book chapters, reports, and gray literature. This process resulted in 263 articles.

We then compiled a list of articles and abstracted data on the study design, study sample, measures of empowerment, independent variables, dependent variable(s), and results. This process eliminated 203 articles that did not meet the specified criteria, resulting in 60 reviewed articles. We first describe the measures of empowerment used in the studies. We then summarize the characteristics of the articles and synthesize the findings by topic. Dependent variables were considered positively associated with independent variables based on statistical tests conducted by the original authors at the significance level they determined. We conclude with a discussion of the ongoing challenges for the design, measurement and analysis of studies in this inherently complex area of investigation and make recommendations for future studies on empowerment and fertility.

3.1. Measures of women’s empowerment

We identified 19 domains of women’s empowerment in the reviewed studies and for each, provided specific examples of how the studies operationalized empowerment ( Table 1 ). While the majority of the 60 studies assessed empowerment across multiple domains, 4 studies examined only one domain. In over two-thirds ( n = 47) of the studies, multidimensionality was determined through the use of composite or sum scores, indices, factor analysis and multi-item scales, while the remaining 17 studies used individual items to represent empowerment.

Domains of women’s empowerment used in the reviewed studies.

Women’s participation in household decision-making was the most common measure of women’s empowerment, used in 37 articles. Typically researchers created an index representing the number of household decisions in which a woman participates (e.g., decisions about personal healthcare, buying children’s clothes, visiting relatives, and purchasing land). There was substantial variation in how these indices were developed. Some papers included decisions in which the woman has some say (joint or sole decision-making), while others counted only those decisions in which the woman has final say. Some included both major and minor decisions, while others included only major decisions, excluding day-to-day household decisions and those within women’s traditional purview.

The next most commonly assessed empowerment domain was women’s mobility, with 27 articles including this domain. This was determined by creating an index for the number of locations women can visit within their community, such as the market, movie theater, or health clinic, and outside of her community, such as her natal home. Some papers counted only locations where she was able to visit alone or without permission ( Al Riyami and Afifi, 2003a , 2003b ; Jejeebhoy, 1991 ).

Certain domains were more relevant and therefore, more commonly used in some regions. For example, the mobility index was more common in studies conducted in South Asia than in other regions.

The studies used a mix of both context-specific and standardized measures. Context-specific measures were used in some studies (e.g., Lee-Rife, 2010 ; Upadhyay and Hindin, 2005 ) to reflect locally-defined dimensions of women’s status, whereas other studies employed measures that are applicable in all contexts, such as items that assess a woman’s gender attitudes and beliefs. Among the articles, 25 conducted primary data collection and developed contextually-specific empowerment measures. For example, Upadhyay and Hindin (2005) used a locally defined measure of empowerment—whether the woman, her house and children were “well-kept” as a measure of empowerment based on findings from qualitative interviews. Singh et al. (2002) used whether the woman believes in the Parda system (wearing a veil). Context-specific measures are more likely to reflect women’s lived experiences, and the characteristics or opportunities in women’s lives that may make them more ‘empowered’ in comparison to their peers ( Mumtaz and Salway, 2009 ). However, standardized measures allow for comparisons across study settings. Nineteen studies in our review used Demographic and Health Survey (DHS) standardized measures, most commonly, the household decision-making index.

Some authors used sociodemographic variables as controls, while others used them as proxies for women’s status. For example, Woldemicael (2009) used women’s educational attainment, employment, household economic status and rural/urban residence as proxies for women’s status. Variables were not always clearly defined as either sociodemographic controls or measures of women’s empowerment. In such cases, it was difficult to make conclusions about effects that were found.

The study population influenced the type of empowerment domain or measure used. Three-quarters of the studies focused on currently married women ( n = 44, 73%), enabling the use of measures involving the household, finances, and in-laws. Over a quarter ( n = 16) of the articles included ever married women, including widows and divorcees. None of the articles included never-married women. Among all of the articles, 21 included data from men and women and of these, only one included matched couples—that is, both the male and female married partners.

Twelve studies incorporated community-level or aggregated contextual measures ( Aghajanian, 1992 ; Balk, 1994 ; Bhattacharya, 1998 , 2006 ; Hirschman and Guest, 1990 ; Kravdal, 2001 ; Malhotra et al., 1995 ; Pallitto and O’Campo, 2005 ; Sanderson, 2001 ; Sanderson and Dubrow, 2000 ; Vlassoff, 1991 ; Wasim, 2002 ). Contextual factors at the community-level ( Table 1 , #20) included gender-specific and community-level socio-demographic factors measured through study-specific instruments and aggregate DHS data. For example, while the authors did not include individual-level empowerment data, Malhotra et al. (1995) used measures of women’s status relative to men to capture the external, community-level factors influencing empowerment.

As indicated in Table 1 , some studies incorporated other measures of women’s empowerment (e.g., control by partner or family, gender attitudes or beliefs of woman or partner, exposure to public life, aspirations). Although less represented among the reviewed studies, several of these domains are noted by scholars such as Kabeer (2001) as important elements of women’s empowerment.

3.2. Findings by fertility-related topic

Of the 60 reviewed studies, the majority ( n = 25, 42%) collected primary data, including surveys designed to examine women’s empowerment. Many used large nationally-representative databases ( n = 19, 32%), and the same number used existing data from DHS or World Fertility Surveys ( n = 19, 32%). Most ( n = 54, 90%) used cross-sectional study designs while the remaining used repeated cross-sectional, panel data, or longitudinal designs.

Studies with primary data collection tended to be smaller and aimed to assess women’s empowerment and its impact on reproductive outcomes. Examples include the Survey of Women’s Status and Fertility in Nigeria ( Kritz et al., 2000 ), Women’s Reproductive Choices and Behaviors conducted in Madhya Pradesh, India ( Lee-Rife, 2010 ), and the Status of Women and Fertility survey in five Asian countries ( Mason and Smith, 2000 ). Several of these employed mixed methods—using both qualitative and quantitative methods to focus on issues within specific communities or villages (e.g., Bates et al., 2007 ; Vlassoff, 1991 ). These studies tended to be of high quality and usually made special effort to interpret and synthesize the findings.

Other studies with primary data collection relied on samples from subpopulations such as a village ( Vlassoff, 1991 ) or slum ( Pande et al., 2011 ). Four primary data collection studies were designed to evaluate the impact of microcredit, employment generation, or other non-governmental organization projects on the empowerment of women ( Amin et al., 1995 ; Feldman et al., 2009 ; Mahmud, 1991 ; Steele et al., 1998 ).

Other national datasets used included the Oman National Health Survey 2000 ( Al Riyami and Afifi, 2003a , 2003b ), fertility and family planning surveys (e.g., Hogan et al., 1999 ; Speizer et al., 2005 ), and census data (e.g., Aghajanian, 1992 ; Bhattacharya, 2006 ; Hirschman and Guest, 1990 ; Malhotra et al., 1995 ; Wasim, 2002 ).

The majority of studies were from South Asia ( n = 35, 58%), possibly because some of the earliest conceptualizations were developed in this region ( Bhatt, 1989 ; Dyson and Moore, 1983 ; Vlassoff, 1982 ). Almost one-fifth were from sub-Saharan Africa ( n = 10, 17%), and one-tenth from the Near East and Eurasia ( n = 5, 8%). The fewest studies were in Latin America ( n = 4, 7%) and East Asia ( n = 1, 2%); articles from these regions may be more often published in major regional languages, rather than in English. One study compiled data from multiple countries across South and East Asia and four others compiled data from multiple developing countries worldwide ( Fig. 2 ).

Distribution of articles by region ( n = 60).

Many of the articles reviewed examined multiple fertility-related topics. The majority examined number of children ( n = 38, 63%) or fertility preferences ( n = 18, 30%) as topics ( Fig. 3 ).

Distribution of articles by fertility topic. Note: studies may include multiple topics.

3.2.1. Number of children

We reviewed 38 articles that examined women’s empowerment and the number of children they have had. Most studies ( n = 29) analyzed the number of children either ever born or born within a specific period for individual women ( Adak and Bharati, 2011 ; Al Riyami and Afifi, 2003a , 2003b ; Ali et al., 1995 ; Ali and Sultan, 1999 ; Amin et al., 1995 ; Audinarayana, 1997 ; Balk, 1994 ; Bates et al., 2007 ; Goni and Saito, 2010 ; Gwako, 1997 ; Hari, 1991 ; Hindin, 2000 ; Hirschman and Guest, 1990 ; Jejeebhoy, 1991 ; Jin, 1995 ; Kabir et al., 2005a , 2005b ; Khan and Raeside, 1997 ; Kravdal, 2001 ; Larsen and Hollos, 2003 ; Manzoor and Mahmood, 1993 ; Muhammad and Fernando, 2010 ; Sathar and Kazi, 1997a ; Singh et al., 2002 ; Steele et al., 1998 ; Upadhyay and Karasek, 2012 ; Vlassoff, 1991 ; Yabiku et al., 2010 ). Five studies looked at district-level ( Aghajanian, 1992 ; Bhattacharya, 1998 , 2006 ; Malhotra et al., 1995 ; Wasim, 2002 ), and four at country-level ( Abadian, 1996 ; Sanderson, 2001 ; Sanderson and Dubrow, 2000 ; Wickrama and Lorenz, 2002 ) fertility rates.

Most studies tested multiple measures of empowerment and found an inverse relationship between number of children and at least one empowerment measure. Only three studies failed to find any significant association between number of children and women’s empowerment measures ( Adak and Bharati, 2011 ; Jejeebhoy, 1991 ; Yabiku et al., 2010 ).

Ten studies found significant inverse associations between women’s empowerment and number of children ( Audinarayana, 1997 ; Bhattacharya, 1998 , 2006 ; Hari, 1991 ; Hindin, 2000 ; Jin, 1995 ; Kabir et al., 2005a , 2005b ; Khan and Raeside, 1997 ; Manzoor and Mahmood, 1993 ) while 22 yielded a combination of significant inverse findings and non-significant associations suggesting that the relationship across all empowerment domains is not always consistent or clear ( Abadian, 1996 ; Aghajanian, 1992 ; Al Riyami and Afifi, 2003a , 2003b ; Ali et al., 1995 ; Ali and Sultan, 1999 ; Amin et al., 1995 ; Balk, 1994 ; Bates et al., 2007 ; Booth and Duvall, 1981 ; Goni and Saito, 2010 ; Gwako, 1997 ; Hirschman and Guest, 1990 ; Kravdal, 2001 ; Larsen and Hollos, 2003 ; Malhotra et al., 1995 ; Muhammad and Fernando, 2010 ; Sanderson, 2001 ; Sanderson and Dubrow, 2000 ; Singh et al., 2002 ; Steele et al., 1998 ; Vlassoff, 1991 ; Wasim, 2002 ; Wickrama and Lorenz, 2002 ). For example, Abadian (1996) used the 1992 World Demographic Report on 54 countries to analyze whether three empowerment measures: female age at marriage, age difference between spouses, and female secondary education were associated with total fertility rates. Women’s mean age at marriage ( β = −0.157, p < .05) and secondary education ( β = 0.039, p < .05) were negatively associated with total fertility rates when controlling for family planning effort scores and infant mortality rates. However, no significant associations were found between spousal age difference and total fertility rates. Abadian explains this lack of effect may be because mean spousal age difference is strongly associated with female age at marriage. In another example, Balk’s study (1994) of about 5000 women in 218 rural villages in Bangladesh found, as expected, that mobility was inversely associated with total number of children ever borndboth when looking at village-level ( β = −0.435, p < .01) and individual-level variables ( β = −0.213, p < .001). However, other measures of women’s decision-making power were not significantly associated with fertility. Balk argues that proxy measures of women’s status, such as education and occupation, are less likely than direct measures to adequately measure the association between women’s status and fertility.

Three studies found both positive and inverse associations between empowerment measures and fertility ( Amin et al., 1995 ; Sathar and Kazi, 1997b ; Upadhyay and Karasek, 2012 ). Sathar and Kazi (1997b) who analyzed data from 1036 Pakistani women found that freedom to make household purchases was negatively correlated ( β = −0.101, p < .001; β = −0.136, p < .001), while economic autonomy ( β = 0.068, p < 001; β = 0.167, p < .001) was positively correlated, with both recent and cumulative fertility and mobility was positively correlated with births within the last five years ( β = 0.052, p < .001) but negatively correlated with cumulative fertility ( β = −0.093, p < .001). In another example of unexpected findings, Upadhyay and Karasek (2012) examined the effect of women’s empowerment on ideal family size and achievement of desired fertility among over 8500 matched couples in four sub-Saharan African countries using DHS data. In Namibia greater household decision-making and in Zambia a belief in women’s right to refuse sex were associated with having more children than desired (Odds Ratio (OR) 2.3, 95 percent confidence interval [95% CI] = 1.01–5.34, p < =.05 and OR = 1.4, 95% CI = 1.01–2.02, p < .05 respectively). The authors explain this paradox by concluding that in these countries it may be that more empowered women fulfilled social expectations of high fertility, although they personally desired smaller families.

3.2.2. Fertility preferences

We reviewed 18 articles that examined fertility preferences, such as ideal family size and spousal communication around desired fertility ( Amin et al., 1995 ; El-Zeini, 2008 ; Goni and Saito, 2010 ; Hindin, 2000 ; Hogan et al., 1999 ; Isiugo-Abanihe, 1994 ; Jin, 1995 ; Kritz et al., 2000 ; Mason and Smith, 2000 ; McAllister et al., 2012 ; Moursund and Kravdal, 2003 ; Pande et al., 2011 ; Speizer et al., 2005 ; Steele et al., 1998 ; Upadhyay and Karasek, 2012 ; Vlassoff, 1991 ; Woldemicael, 2009 ; Zafar, 1996 ). All of these studies found that at least some women’s empowerment variables were positively associated with the ability to make fertility decisions and increased spousal communication, but many found significant positive and negative findings, depending upon the context and measures of empowerment used.

All seven studies examining women’s empowerment and desire for more children found a significant inverse association for at least some measures of women’s empowerment, but most also had some non-significant findings ( Hogan et al., 1999 ; Kritz et al., 2000 ; Moursund and Kravdal, 2003 ; Steele et al., 1998 ; Upadhyay and Karasek, 2012 ; Vlassoff, 1991 ; Woldemicael, 2009 ). For example, Steele et al. (1998) found that women’s household decision-making was negatively associated with a desire for more children ( β = −0.24, p < .001), but no association was found with their degree of mobility.

The two contextual-level studies that examined the relationship between women’s empowerment and the desire for more children had inconsistent findings between individual and community-level measures. Moursund and Kravdal (2003) used data from the 1998–99 India National Family Health Survey for 60,382 married women who had at least one child to examine the relationship between women’s autonomy and wanting no more children. At the individual-level, a higher score on the mobility index was associated with wanting no more children ( β = 0.04, p < .05). However, at the community-level, the results suggested that women who lived in areas with higher mobility ( β = −0.57, p < 001) were less likely to report wanting to stop childbearing. The authors could not explain the desire for higher fertility among women in areas where they have considerable freedom of movement. Kritz et al. (2000) examined the desire for more children using data from married women from five regional/tribal groups in Nigeria. Higher decision-making and household financial contributions of individual women were not associated with desire for more children after controlling for regional gender equity and ethnic group. However, when the communities were grouped into low, medium, and high gender equity areas, some interesting differences were noted. In areas of low and medium gender equity, measures of women’s autonomy, such as higher decision-making, some primary education, secondary education, women’s higher financial contribution to the household (in relation to her husband), and labor force participation were positively associated with the desire for no more children. However, in areas of high gender equity, no significant associations were found between women’s autonomy measures and the desire for no more children. Taken together, these contextual-level studies suggest that the context in which women live may be more influential than their own specific level of empowerment.

Seven studies examined women’s empowerment effects on ideal family size preferences ( El-Zeini, 2008 ; Isiugo-Abanihe, 1994 ; McAllister et al., 2012 ; Upadhyay and Karasek, 2012 ; Vlassoff, 1991 ; Woldemicael, 2009 ; Zafar, 1996 ). All found that at least some measures of women’s empowerment were positively associated with smaller ideal family size preferences but all also had non-significant associations and significant negative associations. For example, Woldemicael (2009) demonstrated that women who reported their husbands had all the decision-making power regarding small or large household purchases were more likely to desire large families (five or more children) compared to women who had at least some say in household decisions (OR = 1.39, p < .05; OR = 1.27, p < .05). As expected, women who reported that wife-beating is not justified were less likely to want large families than those who reported that wife-beating was justified (OR = 0.74, p < .01). However, women who reported their husbands had the final decision-making autonomy on whether they could visit family or friends were unexpectedly less likely to desire large families compared to women who reported decision-making autonomy with regard to visiting family or friends (OR = 0.70, p < .05).

Three studies assessed women’s empowerment and ability to make fertility decisions ( Gwako, 1997 ; Jin, 1995 ; Mason and Smith, 2000 ) and all found significant positive associations. Two studies examined the impact of empowerment on husband-wife communication about fertility intentions or preferences ( Hindin, 2000 ; Hogan et al., 1999 ) and found significant positive associations between women’s status variables and couple communication. In Hindin’s study (2000) using Zimbabwe DHS data from 3701 women, those who had no say over household purchases (OR = 0.61, p < .001) were less likely to have discussed their desired number of children with their partners, even after controlling for women’s status variables (e.g., work status, education, literacy). Hogan et al. (1999) examined the effect of women’s empowerment on the likelihood of spousal communication around preferred family size in Ethiopia. Among both urban and rural women, higher age at first marriage (rural OR = 1.65, p < .05; urban OR = 1.59, p < .05), literacy (rural OR = 2.52, p < .05; urban OR = 3.05, p < .05), and involvement in domestic decisions (rural OR = 1.31, p < .05; urban OR = 1.26, p < .05) were associated with increased odds of discussing family size preferences with their husbands.

3.2.3. Birth intervals

Seven studies examined associations between women’s empowerment and birth intervals ( Al Riyami and Afifi, 2003a , 2003b ; Feldman et al., 2009 ; Fricke and Teachman, 1993 ; Isvan, 1991 ; Nath et al., 1999 ; Upadhyay and Hindin, 2005 ) but two report the same findings using the same dataset and analyses ( Al Riyami and Afifi, 2003a , 2003b ). Among the six unique studies, five found significant associations, despite measuring birth spacing differently. Two studies examined the length of the first birth interval (period between marriage and first birth) ( Fricke and Teachman, 1993 ; Nath et al., 1999 ), another examined the length of the most recent closed birth interval (period between two most recent births) ( Al Riyami and Afifi, 2003a , 2003b ), another examined the length of the most recent open birth interval (period between last birth and interview date) ( Isvan, 1991 ), and the remaining two studies examined the length of the birth interval during a specified observation period ( Feldman et al., 2009 ; Upadhyay and Hindin, 2005 ).

Three studies found that greater household decision-making power was associated with longer birth intervals ( Al Riyami and Afifi, 2003a , 2003b ; Nath et al., 1999 ; Upadhyay and Hindin, 2005 ). However, Upadhyay and Hindin (2005) also found that, in the Philippines, women’s status variables, specifically older age at first birth (Hazard ratio (HR) = 1.10, p < .01) and whether the woman works for pay (HR = 1.29, p < .05), shortened birth intervals.

Fricke and Teachman (1993) examined first birth intervals in Nepal, finding that women who had more autonomy in choosing a spouse (OR = 2.41, p < .05) and who were married at age 19 or older had shorter first birth intervals (OR = 4.14, p < .001). The authors concluded that having a choice in one’s spouse and being older foster couple closeness and intimacy, thereby contributing to a shorter interval to first birth.

Feldman et al. (2009) was the one birth interval study that did not find significant associations. This intervention study in Mexico examined the effect of participation in a conditional cash-transfer program on women’s autonomy and its subsequent effect on birth intervals. While the program increased women’s autonomy among participants compared to controls, there was no differential effect on the length of birth intervals, the authors hypothesize, perhaps because the cash-transfer program allowed men to reduce migration for work and remain home, thus driving fertility up to the same levels as the controls.

3.2.4. Unintended pregnancy

Five articles addressed women’s empowerment and unintended pregnancy, finding inconsistent effects. In an analysis of 1200 women from urban and rural areas of the Philippines, Williams, et al. (2000) explored the effects of several domains of women’s agency (i.e., women’s income, education, degree of comfort in discussing sex with husband, and fatalism regarding fertility) on the likelihood of an unintended pregnancy. For rural women, women’s income was associated with a lower likelihood of unwanted pregnancy (ORs = 0.52–0.59 across models), whereas those indicating a higher degree of fertility fatalism were associated with higher odds of an unwanted pregnancy (OR = 2.77). The effects of other domains for rural women and for urban women were not significant or only marginally significant.

Pallitto and O’Campo (2005) examined the relationships between gender inequality, intimate partner violence (IPV), and unintended pregnancy using DHS data from Colombia. They found that women living in municipalities where men exhibit high levels of patriarchal control and high rates of IPV were more likely to experience an unintended pregnancy; however, none of the aggregated autonomy or status variables were significantly associated with unintended pregnancy.

Using life history data from Madhya Pradesh, India, Lee-Rife (2010) conducted an analysis examining the cumulative influence of reproductive events including unwanted or mistimed pregnancy, on several dimensions of empowerment: mobility, financial discretion, violence, and threats of abandonment/homelessness. Reproductive events were associated with the violence dimension only. Women with more mistimed pregnancies were less likely to experience recent violence after controlling for initial empowerment, sociodemographic characteristics, and other covariates.

Two additional analyses used DHS data to examine the relationships between women’s autonomy and unintended pregnancy among married, pregnant women in the Philippines ( Abada and Tenkorang, 2012 ) and in Bangladesh ( Rahman, 2012 ). Abada and Tenkorang (2012) used measures from the 2003 Philippines National Demographic and Health Survey to examine household autonomy and sexual decision-making autonomy, finding that higher household and sexual decision-making autonomy were associated with lower odds of unwanted pregnancy (RR: .458 and .588, respectively). There were no significant effects found, however, for mistimed pregnancies. Moreover, there was an interaction with age, such that older, more autonomous women were more likely to report unwanted pregnancies.

In Rahman’s (2012) analysis, women’s autonomy was assessed according to whether women reported having any say in five household decisions (health care, large household purchases, household purchases for daily needs, visits to family or relatives, and child health care). In multivariate models controlling for sociodemographic characteristics, women with higher autonomy scores were less likely to report an unintended (mistimed or unwanted) pregnancy (OR = 0.84).

3.2.5. Abortion

Only two articles examined the relationship between women’s empowerment and abortion, both focusing on India. The aforementioned analysis by Lee-Rife (2010) of women’s life history data in India (where abortion is legal) indicated that, after controlling for initial empowerment conditions and other covariates, women with more abortions were nearly four times as likely to experience recent violence. The author suggested that women may seek abortion as a means of preventing a child from being born into a violent household, or may suffer a violent response from a husband who disagrees with the use of abortion to regulate fertility.

In Agrawal’s (2012) analysis, women’s autonomy was measured with questions on household decision-making and ability to make decisions regarding money and mobility. Although the effect sizes are somewhat attenuated by the inclusion of sociodemographic and fertility-related variables (e.g., sex composition of living children), the effect of women’s autonomy on the reporting of an abortion persisted—women who reported ‘high’ and ‘medium’ levels of autonomy were significantly more likely to report ever having an abortion (AOR: 1.20 and 1.15, respectively), as compared to women with ‘low’ levels of autonomy. The authors discuss how sociocultural differences across Indian states inform these findings, yet there is limited attention to how women’s autonomy may interact with other factors in predicting abortion, such as son preference or sex composition of children.

4. Discussion

4.1. summary of findings.

Overall, empowerment was inversely associated with number of children in the majority of studies, although many studies also found no association between some indicators of women’s empowerment and number of children. Studies that used multiple and multidimensional measures of empowerment were more likely to find consistent associations, highlighting the importance of choosing appropriate measures that better approximate women’s empowerment.

Empowerment was also demonstrated to be positively associated with fertility preferences, such as the ideal number of children and desire for no more children. When empowerment was measured as higher spousal communication around fertility and women’s reported fertility decision-making ability, they were more likely to be associated with the desire for fewer children. While all of these studies found that at least some women’s empowerment variables were positively associated with fertility preferences, the associations were less consistent than with number of children. Many found significant positive and negative findings, depending upon the measure used and the level of the measure (e.g., individual and/or community-level). These inconsistent findings call attention to the need to better understand the indicators that best approximate empowerment in each study setting ( Moursund and Kravdal, 2003 ; Upadhyay and Karasek, 2012 ).

Together, the birth interval studies suggest that household decision-making power lengthens birth intervals, but certain aspects of women’s empowerment contribute to shorter birth intervals. As women attempt to reconcile opportunities such as education and work with childbearing, birth intervals may become shorter. For example, two studies found that older age at first birth was associated with shorter birth intervals, suggesting that these women may be trying to “catch up” with other women and one also found that working for pay shortened birth intervals ( Fricke and Teachman, 1993 ; Upadhyay and Hindin, 2005 ).

The few studies assessing the relationship between empowerment and unintended pregnancy found inverse associations and non-significant effects (e.g., Pallitto and O’Campo, 2005 ). Similar to the complexities inherent in measuring women’s empowerment, pregnancy intention is also a nuanced, multidimensional, and culturally-defined construct ( Santelli et al., 2003 ). The literature has yet to comprehensively address the extent to which the perceived ability to control fertility (the ‘calculus of conscious choice’) ( Coale, 1973 ) and the labeling of pregnancies as ‘unwanted’ or ‘unintended’ is itself an indicator of women’s agency or empowerment. The scarcity of studies on the relationships between empowerment and both unintended pregnancy and abortion is remarkable and an area for future research.

There are three limitations to acknowledge. First, it is possible that relevant studies were omitted if they used different terms to describe empowerment than those included in our search criteria. Second, we omitted articles in non-English languages that undoubtedly add to the theory and current knowledge in this area. This may explain why few studies in Latin America were identified. Third, since this review emphasizes breadth over depth; interesting study-specific issues, such as the interactive effects of particular sociodemographic characteristics or context-specific measures, were not highlighted.

4.2. Selecting appropriate measures of empowerment

Certain measures of women’s empowerment, such as household decision-making, are used much more frequently than other measures. The household decision-making domain was one of the earliest ways of operationalizing women’s empowerment ( Dyson and Moore, 1983 ) and formed the basis of empowerment items incorporated into the standard questionnaire of the DHS ( Kishor and Subaiya, 2008 ). Other domains, such as mobility, appeared frequently due to the predominance of studies from South Asia where mobility is considered a key indicator of women’s empowerment. Although the repeated use of specific measures across study settings facilitates global comparisons, continued work is needed to determine the relevance and validity of these measures, especially in lesser studied settings ( Agarwala and Lynch, 2006 ; Mumtaz and Salway, 2009 ). Further research should also test innovative and infrequently used measures of women’s empowerment (e.g., exposure to public life, aspirations) as listed in Table 1 .

Another measurement issue concerns the use of proxy measures to represent women’s empowerment. Women’s education, for example, is a marker of numerous influences and processes – family socioeconomic status, family investment in a daughter’s social development, sufficient mobility to attend school, and exposure to new ‘worldviews’ ( Jejeebhoy, 1995 ). While some studies simply controlled for women’s education, others used it as a proxy for women’s empowerment or women’s status ( Al Riyami and Afifi, 2003a , 2003b ; Hindin, 2000 ; Upadhyay and Hindin, 2005 ; Woldemicael, 2009 ). When proxy measures (e.g., education, employment, economic status) were included alongside other measures of women’s empowerment, researchers often found independent effects suggesting that they exert their influence in different ways ( Woldemicael, 2009 ). Future research could, either through the study design or the analysis phase, tease apart the individual contributions of education—and other sociodemographic characteristics—and women’s empowerment, as well as assess their synergistic influences. Such research would help disentangle complex causal pathways and better direct subsequent research and intervention efforts ( Upadhyay and Karasek, 2012 ).

More fundamentally, defining and appropriately operationalizing women’s empowerment remains a challenge. Studies examining the effect of empowerment across settings and populations found differential effects of measures across subgroups or settings, even within the same country or region (e.g., Hogan et al., 1999 ). The “well-kept” measure in the Philippines ( Upadhyay and Hindin, 2005 ) exemplifies the unique capabilities of qualitative research methods in constructing locally-relevant measures and testing the validity of existing measures. Qualitative research is also critical in identifying the multiple dimensions of women’s empowerment and illustrating the ways in which women may be more empowered within certain domains of their lives, as compared to others ( Gipson and Hindin, 2007 ). The multidimensionality of women’s empowerment likely contributed to some of the null and counterintuitive effects of empowerment measures in this review, emphasizing the importance of further refinement and conceptualization of women’s empowerment measures, as well as the incorporation of statistical techniques (e.g., multilevel and structural equation modeling) to better capture this complex, latent construct in quantitative analyses. Multidimensional measures of women’s empowerment that represent a single domain sometimes improve explanatory power ( Agarwala and Lynch, 2006 ). For example, empowerment measured by several items representing involvement in fertility and/or family planning decisions was consistently associated with fertility (e.g., Gwako, 1997 ; Jin, 1995 ; Pande et al., 2011 ). Lastly, considerable variation in the operationalization of empowerment measures likely affects what can be learned from the comparison of measures across studies. For example, the household decision-making measures can be constructed to examine ‘sole’ versus ‘joint’ decision-making, or to determine whether women had ‘any’ say in these household decisions, each of which may produce different estimates when examining relationships with reproductive outcomes ( DeRose and Ezeh, 2010 ). Moreover, the chosen constructions of these measures may also reflect biases on the part of the researchers in what defines women’s empowerment in a particular setting and if these constructions are even an appropriate or worthwhile goal ( Mumtaz and Salway, 2009 ). Further investigations of the linkages between women’s empowerment and health outcomes will continue to benefit from these debates and discussions, particularly those that draw on developments and insights gained from diverse multi-disciplinary perspectives.

4.3. Study design considerations for future research

This review revealed key issues that affect our ability to understand the linkages between and the conclusions drawn from existing studies on women’s empowerment and fertility. We suggest ways in which subsequent studies could advance this area of investigation.

First, there is a predominance of studies from South Asia. While the persistence of norms and practices that subjugate South Asian girls and women (e.g., sex-selective abortion and child marriage) warrant continued attention, other regions, like East Asia and Latin America, are minimally represented in this review. The gravitation towards certain research settings narrows our understanding of the linkages between women’s empowerment and fertility when comparing studies globally, as well as when attempting to understand the unique relationships and mechanisms within each region.

Additionally, most studies in this review included only currently married women and no studies included never married women as a focus of study. Although this review focuses on fertility-related topics that, in many settings, are most likely to occur within the context of marriage, including unmarried women in subsequent studies could illuminate interactions between women’s empowerment and relationship status on fertility-related outcomes. Similarly, few studies include matched couples or male perspectives on women’s empowerment. Collecting information from both partners provides the opportunity to account and control for men’s characteristics and fertility desires within the same models, as well as to assess couple concordance regarding reproductive intentions.

Beyond the inclusion of male partners, more studies are needed that account for the influence of communities and broader, sociopolitical forces on women’s empowerment and fertility outcomes. Several reviewed studies found synergistic or countervailing influences of individual and community-level measures of women’s empowerment on reproductive outcomes (e.g., Balk, 1994 ; Kritz et al., 2000 ; Pallitto and O’Campo, 2005 ). Although limited, these studies demonstrate the need to incorporate multiple levels of analysis to examine how social environment shapes the construction of empowerment and its relationship to fertility. Related to this, multilevel modeling could also be harnessed to shed light on the complex interactions between women’s empowerment, operating at the individual level and gender equity, operating at levels higher than the individual ( Malhotra, 2012 ).

We identified only a few studies that evaluated interventions aimed to mediate the relationship between women’s empowerment and reproductive health, which were almost entirely focused on credit programs (e.g., Amin et al., 1995 ; Feldman et al., 2009 ; Steele et al., 1998 ). Other types of interventions aimed at fostering women’s empowerment merit further investigation, especially given the ongoing empowerment programs being implemented by organizations such as the Population Council and the International Center for Research on Women.

Finally, the majority of the studies in this review relied on cross-sectional data, which limits our understanding of the linkages between women’s empowerment and fertility. Cross-sectional data does not allow us to map causal pathways nor determine the direction of causality – i.e., how does women’s empowerment cause changes in fertility outcomes? These relationships may also work in the opposite direction, such that fertility outcomes may cause changes in women’s empowerment, or be mutually influencing. Even when the measurement of empowerment precedes an outcome (e.g., subsequent fertility), we are still unable to establish causality in the absence of controls for external, concurrent secular changes that are also likely to influence these relationships. Longitudinal designs are needed to better reflect the process of women’s empowerment and to determine the causal mechanisms and mediating factors that may facilitate or hinder women’s empowerment ( Malhotra et al., 2002 ). As noted by Lee-Rife (2010) , the significant and independent effects found for women’s initial empowerment conditions (i.e., between marriage and first birth) highlight the importance of examining the “trajectory” and the dynamic nature of women’s empowerment across the life course and in response to reproductive events.

5. Conclusion

Improvements in the status and empowerment of women is central to progress in global development efforts and, perhaps more importantly, to the achievement of equitable treatment and representation of the 3.5 billion women in the world. Understanding individual women’s experience of empowerment and its effects is a crucial early step in making major advances in gender equity at the society level, and in achieving the Millennium Development Goal of promoting gender equality and empowering women. This review is one of the few efforts to provide an overview of quantitative studies assessing the relationships between women’s empowerment and fertility. It is our hope that this review serves as a resource to researchers, practitioners, and policymakers to help shape directions for future research and programmatic efforts.

Acknowledgments

This research was supported by the University of California Global Health Institute (UCGHI) Women’s Health and Empowerment Center of Expertise. U. Upadhyay’s participation was supported by the Advancing New Standards in Reproductive Health (ANSIRH) program at University of California, San Francisco (UCSF). J. Gipson’s participation was supported by NIH Grant #1K01HD067677. A. Fraser and N. Prata’s participation was supported by the Bixby Center for Population, Health and Sustainability, University of California, Berkeley. S. Lewis’ work on this paper was initiated while she was at the ANSIRH Program at UCSF. E. Ciaraldi’s participation was supported by the the Bixby Center on Population and Reproductive Health in the Fielding School of Public Health. M. Huchko’s participation was supported by UCSF-CTSI Grant Number KL2 RR024130. The authors thank Stephanie Blount for assistance with initial literature searches and Sheila Desai for reviewing the draft.

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Literature Review on Women Empowerment

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Women Empowerment is the vital instrument to expand women's ability to have resources and to make strategic life choices. Empowerment of women is essentially the process of up liftment of economic, social and political status of women, the traditionally underprivileged ones, in the society. Of prior days' women were not treated equal to men in many ways. They did not have share in the property of their parents, they had no voting rights, and they had no freedom to choose their work or job and so on. Now that we have come out of those dark days of oppression of women, there is a need for strong movement to fight for the rights of women and to ensure that they get all the rights which men have or in other words a movement for the Empowerment of Women. It is the process of guarding them against all forms of violence. Because, to help women is to help society. The purpose of the paper is to discuss some issues of Women Empowerment, to know about the hurdles to achieving women empowerment, needs for Women Empowerment in modern context, to know the role of education in Women Empowerment, measures for ensuring Women Empowerment and some suggestion for achieving equal human rights of women.

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Focused on the theory that women are different from men in social roles and that these disparities result in asymmetrical, discriminatory gender power relationships, &#39;women&#39;s empowerment&#39; relates to increasing women&#39;s right to influence of their strategic decisions in life and their opportunity to completely grow their potential.As an economic, political and social culture phase, women&#39;s empowerment questions the framework of sexual stratification that has contributed to the subordination and marginalization of women to increase the quality of life of women.This review article provides an overview of women empowerment status in India.

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