Women's Health and Wellbeing in Five Birth Cohorts from Low- and Middle-Income Countries: Domains and Their Associations with Early-Life Conditions

Abstract

Background: Women’s health and wellbeing (WHW) have been receiving growing attention, but limited progress has been made on how to measure its different domains in the context of low- and middle-income countries (LMICs). 

Methods: We used data from five long-term birth cohorts in Brazil, Guatemala, the Philippines and South Africa to explore different domains of adult WHW, and how these domains relate to early life exposures.  We calculated Pearson’s correlation coefficients on eight postulated WHW outcomes to identify possible domains and used principal component analyses (PCA) to derive a single continuous component variable for each domain. 

Findings: The PCA based on available adult outcome data led to the identification of three domains: human capital (intelligence, schooling, height, and absence of teen childbearing), metabolic health (body mass index, metabolic syndrome signs) and psychological health (psychological symptoms score and self-reported happiness). The domains were uncorrelated. Only 5·8% of the women were in the upper tercile of all three domains whereas 33·2% were not in the top tercile of any domain. Early determinants (wealth, maternal education, maternal height, water and sanitation, birthweight, length at 2 years and development quotient in mid-childhood) were positively associated with human capital, while birth order was negatively associated. Few associations were found for the metabolic or psychological components. Birthweight and weight at age 2 years was associated with worse metabolic health. Maternal education was associated with improved psychological health.

Interpretation: Our findings indicate that WHW is multidimensional, with most women in the cohorts being compromised in one or more domains while few women scored highly in all three domains. Early life exposures are strongly related to human capital, but not to metabolic or psychological health. Our analyses are limited by lack of data on adolescent exposures and on other relevant WHW dimensions such as safety, agency, empowerment, and violence. Further research is needed in LMICs for identifying and measuring the multiple domains of WHW. 

Funding: Wellcome Trust and Bill & Melinda Gates Foundation - Funding for the research contributing to this paper was provided by the Wellcome Trust (grant # 101815/Z/13/Z). The COHORTS consortium was established through a grant from the Wellcome Trust (# 082554/Z/07/Z) and recent data collection was supported by a grant to Emory University from Bill & Melinda Gates Foundation (OPP1164115). In addition to the named authors, the COHORTS study team included Fernando Barros, Isabelita Bas, Judith Borja, Delia Carba, Natalia Peixoto Lima, Sara Naicker, Lukhanyo Nyati, Tita Lorna Perez, Jithin Varghese and Fernando Wehrmeister. The sponsors had no role in the analysis and interpretation of the evidence, writing of the paper, or decision to submit for publication.

Declaration of Interest: ADS reports grants from Bill and Melinda Gates Foundation. ZAB reports grants from the International Development Research Centre (reproductive, maternal, newborn, child, and adolescent health in conflict settings: case studies to inform implementation of interventions) and Countdown to 2030–UNICEF. All other authors declare no competing interests.

Ethics Approval: Ethical approval for data collection and analyses was obtained at each site prior to each wave of data collection. Ethical clearance for the current pooled analyses was granted by the Research Ethics Committee of the School of Medicine, Federal University of Pelotas.

Keywords: Women's health, Wellbeing, Equity, Cohort, Life course