Women Empowerment and Access to Maternity and Reproductive Healthcare in Pakistan: Cross-validation of a Survey-based Index in Afghanistan (SWEI-A)

Background: Despite the obvious violation of women’s rights in Pakistan and the vital necessity for women empowerment, a unified country-specific scale measuring women empowerment is not yet available. This study cross-validated a survey-based women empowerment index from Afghanistan to be used in Pakistan and examined the impact that each emerged domain could have on four reproductive and maternity outcomes to ensure convergence validity. Methods The data for married Pakistani women aged 15–49 in the 2017-18 Pakistan demographic health survey was used to construct the final model using the explanatory and confirmatory factor analyses. The Cronbach’s alpha test examined the internal consistency of the developed index. The association between emerged domains and indicators of access to reproductive and maternity care was assessed by Poisson regression analysis adjusting for wealth index. Results The final index had six domains; namely, labor force participation, attitude toward violence, decision-making, access to healthcare, literacy, age at critical life events predicting women empowerment of married Pakistani women with decent reliability (Cronbach’s α = 0.70), and validity (SRSEA&SRMR  0.92). The emerged domains were significantly associated with at least one of four indicators of access to reproductive and maternity care; indicative of a favorable convergence validity. Conclusion Pakistan and Afghanistan are associated as brother countries with shared religious and ethnocultural identities in which women are inferior to men and in critical need of empowering efforts. The results of this study reflect upon this resemblance in sociocultural structure by yielding similar domains for women's empowerment in Pakistan building upon an index previously developed for Afghan women. The developed index could inform the design of future policies, interventions, and research recognizing the important indicators of women empowerment in Pakistan and could enhance the comparability of the results across future studies.