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Abstract
Despite the rising popularity of indicators of women’s empowerment in global development programmes, little work has been done on the validity of existing measures of such a complex concept. We present a mixed methods validation of the use of the Relative Autonomy Index for measuring Amartya Sen’s notion of agency freedom in rural Nepal. Analysis of think-aloud interviews (n = 7) indicated adequate respondent understanding of questionnaire items, but multiple problems of interpretation including difficulties with the four-point Likert scale, questionnaire item ambiguity and difficulties with translation. Exploratory Factor Analysis of a calibration sample (n = 511) suggested two positively correlated factors (r = 0.64) loading on internally and externally motivated behaviour. Both factors increased with decreasing education and decision-making power on large expenditures and food preparation. Confirmatory Factor Analysis on a validation sample (n = 509) revealed good fit (Root Mean Square Error of Approximation 0.05–0.08, Comparative Fit Index 0.91–0.99). In conclusion, we caution against uncritical use of agency-based quantification of women’s empowerment. While qualitative and quantitative analysis revealed overall satisfactory construct and content validity, the positive correlation between external and internal motivations suggests the existence of adaptive preferences. High scores on internally motivated behaviour may reflect internalized oppression rather than agency freedom.
Disclosure Statement
No potential conflict of interest was reported by the authors.
About the Authors
Lu Gram is a Research Fellow at London School of Hygiene and Tropical Medicine and a Ph.D. student in Global Health at UCL. He has worked for years with the World Health Organization, DFID and Saving Newborn Lives across South Asia and Sub-Saharan Africa. His main research interest lies in the intersection between women’s empowerment, development economics and public health and the promotion gender equality through collective action in development programmes.
Dr Joanna Morrison is a social scientist at the University College London Institute for Global Health. She conducts research on health systems, and also in maternal and child health and nutrition, exploring how complex public health interventions change behaviour, and how culture affects systems, behaviours and uptake of care. She is interested in community mobilization for health improvement through participatory and action-oriented approaches. Most of her research is with partners in Nepal, but she is also working on projects in India, Bangladesh, Malawi and Niger.
Neha Sharma is head of qualitative research at MIRA (Mother Infant Research Activities) in Janakpur having worked as a researcher in large-scale randomized evaluations of participatory women’s groups for more than 5 years. Her research interests focus on women’s empowerment, participatory community-based approaches to public health, prevention and control of parasite infections and intersections between public health and veterinary science.
Bhim Shrestha is a senior research coordinator at MIRA and has had more than 10 years of experience in implementing and monitoring large-scale evaluations of participatory women’s groups across a range of districts in Nepal. He is particularly interested in issues of implementation science, management and evaluation of complex interventions and participatory action-based approaches to maternal and child health.
Dharma Manandhar, President and Executive Director of MIRA (Mother and Infant Research Activities), an NGO, has been involved in hospital- and community-based studies on maternal and infant health for over two decades and has received many national awards. Besides being the Founder President of Perinatal Society of Nepal, a Past President of Nepal Pediatric Society and a Fellow of several professional bodies in Nepal, India and UK, he has been involved in many committees on maternal and child health, has designed simple low-cost equipment, authored books on newborn care, published many articles and presented in many conferences.
Anthony Costello is the Director at UCL Institute for Global Health and Centre for International Health and Development. He has been at the cutting edge of developing low-cost interventions to improve maternal and child health in Southern Asia and Africa, particularly work using peer education amongst women’s groups to demonstrate through randomized controlled trials the ability of such interventions to reduce newborn mortality. Through the Institute for Global Health, he has brought a multi-disciplinary approach to complex health problems. A major recent achievement is his Chairmanship of the UCL/Lancet Commission on Managing the Health Effects of Climate Change, published in the Lancet in May, 2009. This has been influential to national and international policy makers.
Naomi Saville is a Senior Research Associate at UCL Institute for Global Health. She is based in Nepal where she conducts cluster-randomized trials and other research associated with maternal and child nutrition and health. Since 2005 Naomi has been testing the impact of participatory learning and action women’s groups on health outcomes, in particular neonatal mortality, birth weight and maternal/child nutrition. Other research interests include prevention of stunting and health inequalities. Previously Naomi trained in zoology at the University of Cambridge and worked on livelihood diversification and community development in Nepal, India, Somalia, Sierra Leone, and Trinidad and Tobago.
Dr Jolene Skordis-Worrall is an Economist specializing in Applied Health and Development Economics. With strong networks in sub-Saharan Africa and South East Asia, she has experience of working with a wide range of international organizations. She works primarily within randomized trials of complex public health interventions, establishing research programmes that span gender empowerment and capability, multidimensional poverty and antipoverty transfer programmes, social networks, health equity and understanding fiscal space for sustainable and scalable programme delivery. She has published widely in high impact journals and has a strong international reputation. Her work has directly influenced government policy.
Notes
1. The distinction between “opportunity” and “exercise” freedom (Taylor Citation1985) mirrors the distinction between “dispositional” and “episodic” power (Haugaard Citation2010), while Amartya Sen’s concepts of “effective power” and “procedural control” (Sen Citation1985) also go under the names of “direct freedom” and “indirect freedom” (Pettit Citation2001).
2. The traditional approach in development economics to analyse such a situation would be to recast it as a bargaining problem between mother and child. The resultant portion allocations would be determined by each person’s relative bargaining power (Doss Citation2013). However, such an approach equates agency with bargaining power and assumes utility maximization as an axiom, two assumptions that are unhelpful in designing measures of freedom as they a priori make assumptions about constraints to the freedom of individuals to shape the relationship they live in and the freedom of individuals to follow or ignore their own happiness.
3. See also calls for “affiliative” dimensions of empowerment (Khader Citation2015).
4. The alignment is not perfect. With respect to its view on status-relationships, the Relative Autonomy Index could fall into either the Legitimacy or the Mastery categories depending on the interviewer and the interviewee's assumptions regarding the role of second-order choices, or choices about choices (Dworkin Citation1988). Suppose that a husband does not want his wife to take up employment and his wife adheres to him, because she has decided after a period of critical reflection that she wants to make him happy. If only her first-order choices are considered then her lack of employment is determined by her husband’s desires, i.e. it is externally motivated. However, if her second-order choices take priority, then her lack of employment is self-determined, since in this example, she has chosen not to choose, but to delegate her choice to her husband. From a Mastery perspective, she is potentially unfree, because she may be in position where it is difficult for her to make her own choices. From a Legitimacy perspective, she is potentially free, because she may feel that she is under a legitimate influence by her husband. The Relative Autonomy Index is ambiguous between these two perspectives.
5. Note, our tool differed from Vaz, Pratley, and Alkire (Citation2016) in substituting the domain of major household purchases for health seeking behaviour.
6. Analyses were carried out in Mplus 7.11.
7. Data were scored using Stata/MP 13.
8. For women living in their husband’s home, “family” or parivar in Nepali and Maithili would be practically coterminous with “household” and refer to the group which “holds property jointly and observes most life-cycle and calendrical rituals together” (Bennett Citation1983). It would exclude neighbours, friends and blood or marital relatives living outside the household, except where these hold joint property rights such as husbands working as migrant labour. For women living in their natal home, parivar would refer to the natal household members living with them.
9. This change to our measure of agency might cause problems for contexts where women live alone as the only adult in their family as such women. In our context, only married women who were not widowed, divorced or separated were eligible to take part in the trial and so this issue would not arise.
10. A question arises as to whether the many modifications to the original tool produces a “new” tool—we believe that the changes in wording made to this tool captures the same theoretical construct as the “original” tool, namely agency freedom, but with better fit to the local context.