Women’s Health and Wellbeing
UNDP Gender Inequality Index by country
Investing in women’s health and wellbeing (WHW) across the life course can improve health outcomes and financial opportunities for families, communities, entire economies, and future generations. These investments are also crucial to achieving all of the UN Sustainable Development Goals. Yet we lack the framework or tools for measuring outcomes and developing strategies to address the substantial sex and gender-based barriers that continue to affect women’s wellbeing today.
Quick facts on women’s health and wellbeing
Women’s health and wellbeing across the life course is influenced by a variety of factors, including formal and informal employment, education, and legal rights. Sex-based disparities impede economic progress and compromise overall health and development in communities and countries.
20%
If gender employment gaps were closed, GDP per capita could, on average, increase by almost 20%.1
US$15–$30 T
The World Bank estimates that limited educational opportunities combined with barriers to school completion for girls cost countries between US$15 trillion and US$30 trillion in lost lifetime productivity and earnings.2
75%
Women, on average, have just three-quarters of the legal rights afforded to men.3 The most persistent gaps remain in the areas of pay and parenthood.
Women’s health and wellbeing (WHW) refers to the physical, mental, and social-emotional wellness of women and their overall quality of life, from birth through old age.
WHW is shaped by a girl’s or woman’s freedom to have autonomy over her body, exercise personal choices, and have access to quality health care, food, education, and employment opportunities without fear of gender-based harm or discrimination. The effects of these interconnected elements are magnified during critical periods of intense growth and development, such as childhood and adolescence.
WHW is important for improving outcomes at both the individual and societal levels.
- Individual: Women are disproportionately vulnerable to stressors that compromise their basic freedoms and make it less likely they will realize their full potential. These include gender-based violence, workforce discrimination, and health factors such as maternal mortality, among many others.
- Societal: Improving WHW has a substantial effect on a country’s long-term health and wealth. It also has a large influence on future generations because a woman’s health and wellbeing are closely tied to the health and wellbeing of her children. For instance, poor maternal health and nutrition are associated with poor newborn and infant outcomes, which can increase the risk of child stunting, impede cognitive development, and affect productivity in adulthood.4 Maternal education is also strongly associated with children’s cognitive development and positive health outcomes.5
For more information on maternal education as a driver of progress in global health, refer to the Exemplar topics on Stunting and Neonatal and Maternal Mortality.
While there has been progress toward improving WHW, serious gender inequities persist across areas both between and within countries. For example, many WHW metrics, such as women living in extreme poverty, are much higher in low- and middle-income countries than in higher-income countries. 6 Within countries, access to resources that ensure a girl or woman can lead a safe and healthy life are often unequal, influenced by factors such as race, ethnicity, caste, socioeconomic status, gender identity, and religion, among others.
A new study by Exemplars in Global Health aims to strengthen and improve our understanding of WHW as we set out to conceptualize, measure, and identify the critical drivers of women’s health and wellbeing across low- and middle-income countries. We do this by identifying positive outliers in terms of their progress in improving WHW across the life course and conducting rigorous mixed methods research to distill key lessons that can be used to inform funding streams, policies, and programs.
This work builds on findings from other research topics underway at Exemplars in Global Health that identify elements of women’s health as outcomes or highlight them as drivers of success in other areas. These include Family Planning, Stunting, Anemia in Women of Reproductive Age, Neonatal and Maternal Mortality, and Under-5 Mortality.
While many dimensions of physical and mental health have well-established metrics for tracking and measurement, “wellbeing” is not consistently or universally defined.
Moreover, gendered experiences have historically been studied through the lens of a specific illness or phase of life—not through their cumulative effects holistically across the life course.7 Though the need to take a holistic perspective is becoming increasingly acknowledged, there is still a dearth of research and tools for measurement and tracking.
We sought to identify a comprehensive set of driving factors of WHW across the life course that can be measured and tracked for progress to inform global and national priorities. It’s also essential to learn the reasons why countries that perform well in some or most of the areas we’ve identified may struggle in others, as is often the case. This understanding will help inform recommendations on how to achieve progress across the board.
The Exemplars in Global Health research consortium began by creating a conceptual framework for WHW. Drawing on the capabilities framework,8 we define wellbeing as a set of capabilities—a mix of “freedoms to” and “freedoms from”—that enable women to achieve positive outcomes throughout their lives.
For example, women can attain an education when they have the capability—or freedom—to participate in learning. They are safe and secure when they have freedom from fear and discrimination. They are empowered when they have the freedom to exercise personal choices.
Based on this approach, our conceptual framework for understanding WHW spans 10 dimensions, each defined through a “freedom” or capability perspective, which together play an important role in shaping a woman’s quality of life. The 10 dimensions are defined in the graphic below:
Next, we identified available indicators within each dimension of our framework that could be used to assess country performance, compare countries with other peer countries, and identify positive outliers for further study.
Our final list of 32 indicators for country selection spans 9 of the 10 dimensions of WHW and includes data from over 130 countries.
Each of a woman’s key life stages is represented by indicators in at least three dimensions, ensuring a holistic approach over the course of her life.
There have been global advancements across all 10 dimensions of WHW, but substantial disparities remain, especially in low- and middle-income countries.
Globally, there has been progress in reducing maternal mortality and adolescent fertility rates while increasing access to health care services, such as having a skilled health professional attend a live birth. More girls are also attending school and have higher completion rates than boys.
However, entrenched challenges have led to an increase in gender gaps in food insecurity, more women living in poverty compared to men, and the ongoing prevalence of gender-based violence. At the same time, women continue to trail men in participating in the workforce and receiving equal pay.
These and other adverse conditions compromise a woman’s independence and freedom to make informed choices.
While all dimensions of WHW are interconnected and influence each other across the life course, we review the status for each dimension separately below:
The 10 dimensions of women’s health and wellbeing
Health
Globally, maternal mortality decreased from 339 to 223 deaths per 100,000 live births between 2000 and 2020.9 Adolescent fertility (ages 15 to 19), another important indicator of women’s health, has also declined over time.10 Yet deep disparities still exist, especially at the regional level. This can be seen in sub-Saharan Africa, which accounted for about 70% of all maternal deaths in 2020.9 It also has the highest adolescent fertility rate, with 25% of women giving birth before the age of 18.3
Access to services
Access to health services that prevent negative outcomes for women’s health has increased. In recent years, more than 80% of global births were attended by a skilled health professional, up about 20 percentage points from 2000. South Asia and sub-Saharan Africa are lagging in these areas, but they have also made the greatest progress of all regions in the past two decades.11
Access to good nutrition
Gender gaps in food insecurity have worsened in recent years. In 2021, nearly 32% of women experienced food insecurity, compared to 27.6% of men. This gender gap has widened by 1 percentage point since 2020.12 Women also have an increased risk for certain nutrition-related conditions, such as anemia.13
Harmful practices and gender-based violence
Female genital mutilation and intimate partner violence are still prevalent. About one in three women worldwide are estimated to have experienced gender-based violence.14 Younger women are particularly vulnerable. In 2018, about 16% of women ages 15 to 24 were subject to intimate partner violence, the highest rate among women who have been in a relationship.14 In addition, at least 200 million women alive today have undergone female genital mutilation.10 It is mainly practiced in 31 countries, and in some places, it remains as prevalent as it was three decades ago.10
Education
Girls, particularly those in wealthier countries, are increasingly outnumbering boys in school and universities,15 and girls exceed boys in global completion rates across all levels of education by about 2 percentage points.16 However, gender inequities persist in low-income countries and become more pronounced after primary school.17 The World Bank estimates that limited educational opportunities combined with barriers to school completion for girls cost countries between US$15 trillion and US$30 trillion in lost lifetime productivity and earnings.2
Work
Gaps between men and women remain in both labor force participation and pay,18 ,19 which contributes to higher global poverty rates for women relative to men and makes it harder to achieve financial independence and empowerment.6 As many as 84 countries restrict the types of work that women are legally allowed to do.1
Women also spend about one to five more hours per day on unpaid care work relative to men,20 limiting their ability to allocate time and energy toward earning income. Finally, jobs in the informal economy—such as street vendors, domestic workers, and subsistence farmers—are disproportionately occupied by women. This often limits access to labor law protections and benefits including pensions, health insurance, and paid sick leave, which collectively can have long-term impacts on women’s health and wellbeing.
Safety and security
The lack of perceived public safety can make people reluctant to trust their neighbors, participate in their community, and engage in daily activities like walking to school and going to fetch clean water. Over time, this can negatively affect their wellbeing and hamper development. On average, nearly 40% of women in the world say they feel unsafe walking alone in their neighborhoods at night, which has held steady for years and is about 10 percentage points lower than that of men.10 There are notable regional differences. Only a third of women in Latin America and the Caribbean feel safe walking alone at night, while more than two-thirds of women in Europe and Northern America say the same.
Poverty
Income level is one of the most powerful factors in determining a girl’s future. It is closely tied to whether she will have access to education, health services, and economic opportunities. Yet more women and girls continue to live in poverty compared to men. About 15 million more women worldwide live on less than US$1.90 a day compared to men, with the vast majority living in sub-Saharan Africa and Central and Southern Asia. Overall poverty rates were on the decline, but disruptions from the COVID-19 pandemic have hindered progress.21
Empowerment and agency
Many of the indicators from other dimensions, such as poverty, work, and education, are both causes and consequences of limitations in women’s empowerment and agency. Those and other barriers continue to compromise many women’s rights to make independent and informed decisions, including choices regarding sexual relations, contraceptive use, and reproductive health care.22 Just 57% of women ages 15 to 49 in a relationship made autonomous decisions about their reproductive and sexual health and contraceptive use, between 2007 and 2021.10 In sub-Saharan Africa, it was less than half.10
Access to financial services can also be seen as a form of empowerment. However, women are less likely than men to have bank accounts—a gap of 9% globally—which curtails their agency in getting jobs, managing finances, and starting their own businesses.23 This, along with limitations in women’s property rights and other factors, contributes to an estimated US$1.5 trillion annual credit deficit for women-owned small- and medium-enterprises.1
Climate change and environmental factors
Systemic gender discrimination and traditional gender roles have meant that women experience the adverse effects of climate change more heavily than men. This has worsened in recent years due to the acceleration of extreme weather events, particularly in low- and middle-income countries. Daily tasks like collecting firewood and water, which are usually performed by women, have become harder and more dangerous because they must travel farther to complete them due to climate change. Some girls drop out of school as a result. Gender-based violence and child marriage have also increased, as households attempt to secure funds or other assets in the aftermath of climate-induced disasters.24Access to funds needed in the case of emergency also differs by gender, with men more likely to have access across regions.
We share the objectives outlined in the UN Sustainable Development Goals, all of which touch on aspects of WHW. Two of these goals are particularly relevant for WHW: SDG 3 on good health and wellbeing for all and SDG 5 on gender equality.
Supporting WHW can lead to healthier, more productive, and better educated societies. Investments in WHW, such as family planning services and legalized abortion, have been associated with healthier pregnancies and babies, more women pursuing higher education and employment, and greater participation in the workforce—all of which can improve outcomes for future generations.4
That is why we share the global goals set by the SDGs, which have established expansive objectives emphasizing the importance of both women’s health and gender equality.
SDG 3: Good Health and Wellbeing. Several targets and indicators within SDG 3, to be achieved by 2030, focus specifically on WHW. They include the goal to “ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.”25 There is much work to be done to achieve this and other targets, such as 3.1,26 which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. The global maternal mortality ratio reached 223 deaths per 100,000 live births in 2020.9
SDG 5: Gender Equality. Our 10 dimensions reflect the targets set in SDG 5 that together lay out what must be accomplished for all women to lead a healthy, safe, and autonomous life. The targets include: “end all forms of discrimination against women and girls,” “eliminate all forms of violence against women and girls,” and “undertake reforms to give women equal rights to economic resources.”27
We also share the goals of the many researchers and policymakers who have called for better tools to conceptualize and measure wellbeing. We must establish a consistent and universal definition for wellbeing over the life course in the way we have for physical and mental health to measure outcomes and develop strategies that improve WHW holistically.
Over 2 billion people will not experience gender equality as outlined by SDG targets by 2030 if current trends continue.28 We must act now to ensure these important goals are met.
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Women’s Health and Wellbeing Exemplars
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1
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2
Wodon Q, Montenegro C, Nguyen H, Onagoruwa A. Missed Opportunities: The High Cost of Not Educating Girls. The Cost of Not Educating Girls Notes Series. Washington, DC: World Bank; 2018. Accessed May 15, 2023. http://hdl.handle.net/10986/29956
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World Bank. Women, Business and the Law 2022. Washington, DC: World Bank; 2022. Accessed May 15, 2023. https://openknowledge.worldbank.org/entities/publication/b187725b-29ff-5c61-91e7-5110ab3c4a71
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Onarheim KH, Iversen JH, Bloom DE. Economic benefits of investing in women’s health: a systematic review. PLoS One. 2016;11(3):e0150120. https://doi.org/10.1371/journal.pone.0150120
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Jackson M, Kiernan K, McLanahan S. Maternal education, changing family circumstances, and children’s skill development in the United States and UK. Ann Am Acad Pol Soc Sci. 2017;674(1):59-84. https://doi.org/10.1177/0002716217729471
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UN Women. Poverty deepens for women and girls, according to latest projections. Women Count Data Hub. February 1, 2022. Accessed May 15, 2023. https://data.unwomen.org/features/poverty-deepens-women-and-girls-according-latest-projections
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McMunn A, Bartley M, Kuh D. Women’s health in mid-life: life course social roles and agency as quality. Soc Sci Med. 2006;63(6):1561-1572. https://doi.org/10.1016/j.socscimed.2006.03.039
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8
Robeyns I, Morten FB. The capability approach. In: Zalta EN, Nodelman U, eds. The Stanford Encyclopedia of Philosophy (Summer 2023 Edition). https://plato.stanford.edu/entries/capability-approach/
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9
Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2023. Accessed May 15, 2023. https://www.who.int/publications/i/item/9789240068759
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United Nations (UN). The Sustainable Development Goals Report 2022. New York: UN; 2022. Accessed May 15, 2023. https://unstats.un.org/sdgs/report/2022/
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United Nations Department of Economic and Social Affairs (UNSD). Goal 3: good health and well-being. In: The Sustainable Development Goals Extended Report 2022. New York: United Nations; 2022. Accessed May 15, 2023. https://unstats.un.org/sdgs/report/2022/extended-report/Extended-Report_Goal-3.pdf
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12
United Nations Food and Agriculture Organization (FAO), International Fund for Agricultural Development, United Nations Children’s Fund, World Food Programme, and World Health Organization. The State of Food Security and Nutrition in the World 2022: Repurposing Food and Agricultural Policies to Make Healthy Diets More Affordable. Rome: FAO; 2022. Accessed May 2023. https://doi.org/10.4060/cc0639en
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13
Exemplars in Global Health. Anemia among women of reproductive age. Accessed May 15, 2023. https://www.exemplars.health/topics/anemia-among-wra
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World Health Organization (WHO). Violence Against Women Prevalence Estimates, 2018: Global, Regional and National Prevalence Estimates for Intimate Partner Violence Against Women and Global and Regional Prevalence Estimates for Non-Partner Sexual Violence Against Women. Geneva: WHO; 2021. Accessed May 15, 2023. https://www.who.int/publications/i/item/9789240022256
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United Nations Educational, Scientific and Cultural Organization (UNESCO). Equity: Scoping Progress in Education. Published January 24, 2020. Accessed May 15, 2023. https://www.education-progress.org/en/articles/equity
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United Nations Department of Economic and Social Affairs (UNSD). The Sustainable Development Goals Extended Report 2022. New York: UN; 2022. Accessed May 15, 2023. https://unstats.un.org/sdgs/report/2022/extended-report/Extended-Report_Goal-4.pdf
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United Nations Educational, Scientific and Cultural Organization (UNESCO). Scoping Progress in Education: Equity. Accessed May 15, 2023. https://www.education-progress.org/en/articles/equity
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World Bank. Ratio of female to male labor force participation rate (%) – global [data set]. Accessed May 15, 2023. https://genderdata.worldbank.org/indicators/sl-tlf-cact-fm-zs/
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World Bank. Women, business and the law: pay indicator score (scale 1-100) – global [data set]. Accessed May 15, 2023. https://genderdata.worldbank.org/indicators/sg-law-indx-py/
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20
World Bank. Proportion of time spent on unpaid domestic and care work (% of 24 hour day) – global [data set]. Accessed May 15, 2023. https://genderdata.worldbank.org/indicators/sg-tim-uwrk/?view=bar
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21
Azcona G, Bhatt A. Poverty is not gender-neutral. Women Count Data Hub. March 7, 2023. Accessed May 15, 2023. https://data.unwomen.org/features/poverty-not-gender-neutral
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22
World Bank. Women making their own informed decisions regarding sexual relations, contraceptive use and reproductive health care (% of women age 15-49) – global [data set]. Accessed May 15, 2023. https://genderdata.worldbank.org/indicators/sg-dmk-srcr-fn-zs/?flip-axis=1&groups=LIC_LMC_UMC&view=correlation
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23
World Bank. Account ownership at a financial institution or with a mobile-money-service provider (% of population ages 15+) – global [data set]. Accessed May 15, 2023. https://genderdata.worldbank.org/indicators/fx-own-totl-zs/?gender=female&gender=male&geos=WLD_LIC_LMC_UMC&view=bar
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24
United Nations Framework Convention on Climate Change. Dimensions and Examples of the Gender-Differentiated Impacts of Climate Change, the Role of Women as Agents of Change and Opportunities for Women. Synthesis Report by the Secretariat. Report presented at: Bonn Climate Change Conference – June 2022; June 6-16, 2022; Bonn, Germany. Accessed May 15, 2023. https://unfccc.int/documents/494455
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United Nations. SDG indicator 3.7.1 on contraceptive use. Accessed May 15, 2023. https://www.un.org/development/desa/pd/data/sdg-indicator-371-contraceptive-use
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28
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