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:

Key dimensions of women’s health and wellbeing

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.

Distribution of indicators by life course stage and dimension

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

Maternal mortality ratio by country income classification, 2000-2020

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

Percentage of births attended by skilled health personnel

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

Percentage of population with moderate or severe food insecurity, by sex (2021)

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

Regional prevalence estimates of lifetime and past year intimate partner violence among ever-partnered women aged 15-49 (2018)

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.

Ratio of female to male labor force participation rate (%)

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.

Proportion of the population that feel safe walking alone at night in the area in which they live, by sex (average for 2019-2021)

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

Forecasted global extreme poverty headcounts by sex (2017-2030)

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

Percentage of women aged 15+ with account ownership at financial institution or with a mobile-money service provider

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.

Percentage of population with access to emergency funds, by sex (2017)

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.