Fernando Pires Hartwig, Anushka Ataullahjan, Linda Adair, Helen Gonçalves, Bernardo Horta, Nanette Lee, Reynaldo Martorell, Ana Maria B Menezes, Janaina Vieira dos Santos Motta, Shane Norris, Manuel Ramirez-Zea, Linda Richter, Zulfiqar Bhutta, Aryeh D Stein, Cesar Victora
Background Women’s health and well-being (WHW) have been receiving growing attention, but limited progress has been made on how to measure its different domains in low- and middle-income countries (LMICs). We used data from five long-term birth cohorts in Brazil, Guatemala, the Philippines and South Africa to explore different domains of adult WHW, and how these domains relate to early life exposures. Methods Based upon an a priori conceptualisation of eight postulated WHW outcomes available in the data, we grouped them as follows: human capital (intelligence quotient, schooling, height, and teenage childbearing), metabolic health (body mass index and metabolic syndrome score), and psychological (happiness and Self-Reported Questionnaire (SRQ) scores). Correlation analyses confirmed the variables theoretically belonging to the same dimension of WHW were statistically related. We then applied principal component analysis to each group of variables separately and used the first principal component as a summary quantitative measure of the corresponding WHW dimension. Finally, we assessed the association of each domain with a range of early-life factors: wealth, maternal education, maternal height, water, and sanitation, birthweight, length at two years and development quotient in mid-childhood. Results The three domains were largely uncorrelated. Early determinants were positively associated with human capital, while birth order was negatively associated. Fewer associations were found for the metabolic or psychological components. Birthweight and weight at age two years were inversely associated with metabolic health. Maternal education was associated with better psychological health. Conclusions Our findings indicate that WHW is multidimensional, with most women in the cohorts being compromised in one or more domains while few women scored highly in all three domains. Our analyses are limited by lack of data on adolescent exposures and on other relevant WHW dimensions such as safety, agency, empowerment, and violence. Further research is needed in LMICs for identifying and measuring the multiple domains of WHW. © 2024 The Author(s)
Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States; USC Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; SAMRC Pathways for Health Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala; Department of Science and Innovation, National Research Foundation Centre of Excellence in Human Development, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan; International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
