Development and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults

Upadhyay, Ushma D.; Danza, Phoebe; Neilands, Torsten B.; Gipson, Jessica D.; Brindis, Claire D.; Hindin, Michelle J.; Foster, Diana Greene; Dworkin, Shari L.

doi:10.1016/j.jadohealth.2020.05.031

Cited by 28 publications

(32 citation statements)

References 47 publications

(29 reference statements)

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“…Sexual safety and security 5,23 Experience of reduced threat coupled with experience of actions taken to assuage vulnerability 24 Free expression of sexuality; 25,26 rituals of safety; 27 relationship trust; 28 coercion-free environments 29 Gender-based violence; 30 technologies for partner identification; 31 sexual coercion; 28,32 legal protections for sexual rights; 33,34 teaching sexual consent; addressing risks to sex workers Little worry about future sex life; absence of unwanted vulnerability during sexual activities; feeling safe with a sexual partner Sexual respect 5 Perception of positive regard by others for one's sexual personhood 35 Mitigates influence of experiences of violence; 36 tolerance of differences; 37 validation by others 38,39 Elements of interventions to reduce sexual harassment (eg, in higher education 39 ); sexual rights of people with minority identities and or marginalised experiences (eg, sexual minority groups living with HIV 40 )…”

Section: Definition Contribution To Sexual Wellbeing Relevance To Public Health (Examples) Potential Operationalised Measuresmentioning

confidence: 99%

What is sexual wellbeing and why does it matter for public health?

Mitchell

Lewis

O’Sullivan

et al. 2021

The Lancet Public Health

119

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Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.

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Section: Definition Contribution To Sexual Wellbeing Relevance To Public Health (Examples) Potential Operationalised Measuresmentioning

confidence: 99%

What is sexual wellbeing and why does it matter for public health?

Mitchell

Lewis

O’Sullivan

et al. 2021

The Lancet Public Health

119

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“…Contraceptive autonomy, defined as “the factors that need to be in place in order for a person to decide for themselves what they want in regards to contraceptive use, and then to realize that decision,” is proposed as a novel family planning indicator [ 21 ]. Measures such as contraceptive autonomy, reproductive autonomy [ 47 ], and sexual and reproductive empowerment [ 48 ] should be tailored for adolescents and used to guide programs and funding priorities. Finally, contraceptive access and the ability to prevent pregnancy with contraception when desired are clearly critical to efforts to improve adolescent SRH outcomes.…”

Section: Discussionmentioning

confidence: 99%

“Spoiled” girls: Understanding social influences on adolescent contraceptive decision-making in Kenya

et al. 2021

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Objectives Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents’ own reproductive priorities and the social influences on their decision-making align and compete. We examined the social context of contraceptive decision-making among Kenyan female adolescents. Methods Using community-based sampling, we conducted 40 in-depth interviews and 6 focus group discussions among sexually-active or partnered adolescent girls and young women aged 15–19 in the Nyanza region of Kenya. We analyzed the data in Dedoose using an inductive, grounded theory approach, and developed a conceptual model from the data illustrating social influences on adolescent contraceptive decision-making. Results Participants viewed adolescent pregnancy as unacceptable, and described severe social, financial, and health consequences of unintended pregnancy, including abortion under unsafe conditions. Yet, their contraceptive behaviors often did not reflect their desire to delay pregnancy. Contraceptive decision-making was influenced by multiple social factors, centering on the intersecting stigmas of adolescent female sexuality, pregnancy, and contraceptive use, as well as unequal power in sexual relationships. To prioritize pregnancy prevention, adolescents must navigate conflicting social norms and power dynamics, and put their perceived future fertility at risk. Conclusions Contraceptive decision-making among Kenyan female adolescents is strongly influenced by opposing social norms within families, communities, and sexual relationships, which compel them to risk stigma whether they use a contraceptive method or become pregnant as adolescents. These findings put into perspective adolescents’ seemingly incongruent pregnancy preferences and contraceptive behaviors. Interventions to address adolescent unintended pregnancy should focus on supporting adolescent decision-making agency, addressing fertility-related contraceptive concerns, and promoting innovative contraceptive access points rather than increasing contraceptive prevalence.

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“…Kabeer's foundational work on women's empowerment in the early 2000s, and then developing a framework by World Bank [ 9 , 10 ], introduced decision-making and exercise of choice as the components of the agency. These concepts were used commonly to design scales of women empowerment measurements such as Sexual and reproductive empowerment [ 11 ], Reproductive Decision-making Agency [ 12 ], Women’s and Girls’ Empowerment in Sexual and Reproductive health (WGE-SRH) [ 13 ], aimed to assess women’s agency in decision making over vital sexual and reproductive health matters.…”

Section: Introductionmentioning

confidence: 99%

Women empowerment in reproductive health: a systematic review of measurement properties

et al. 2021

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Introduction There is a considerable dearth of official metrics for women empowerment, which is pivotal to observe universal progress towards Sustainable Development Goals 5, targeting "achieve gender equality and empower all women and girls.” This study aimed to introduce, critically appraise, and summarize the measurement properties of women empowerment scales in sexual and reproductive health. Methods A comprehensive systematic literature search through several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct was performed on September 2020, without a time limit. All studies aimed to develop and validate a measurement of women empowerment in sexual and reproductive health were included. The quality assessment was performed through a rating scale addressing the six criteria, including: a priori explicit theoretical framework, evaluating content validity, internal consistency, and factor analysis to assess structural validity. Results Of 5234 identified studies, fifteen were included. The majority of the studies were conducted in the United States. All studies but one used a standardized measure. Total items of each scale ranged from 8 to 23. The most common domains investigated were decision-making, freedom of coercion, and communication with the partner. Four studies did not use any conceptual framework. The individual agency followed by immediate relational agency were the main focus of included studies. Of the included studies, seven applied either literature review, expert panels, or empirical methods to develop the item pool. Cronbach's alpha coefficient reported in nine studies ranged from α = 0.56 to 0.87. Most of the studies but three lack reporting test–retest reliability ranging r = 0.69–0.87. Nine studies proved content validity. Six criteria were applied to scoring the scales, by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality. Conclusion Most scales assessed various types of validity and Internal consistency for the reliability. Applying a theoretical framework, more rigorous validation of scales, and assessing the various dimensions of women empowerment in diverse contexts and different levels, namely structural agency, are needed to develop effective and representing scales.

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Development and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults

Cited by 28 publications

References 47 publications

What is sexual wellbeing and why does it matter for public health?

What is sexual wellbeing and why does it matter for public health?

“Spoiled” girls: Understanding social influences on adolescent contraceptive decision-making in Kenya

Women empowerment in reproductive health: a systematic review of measurement properties

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