The Global Early Adolescent Study

Measuring Empowerment

Linnea Zimmerman, PhD, MPH

GEAS Research Working Group

Assistant Professor

Johns Hopkins Bloomberg School of Public Health

USA

In the Global Early Adolescent Study

2The Global Early Adolescent Study: Measuring Empowerment

Agenda

▪Existing Measures of Empowerment

• Definitions and Limitations

▪Measuring Empowerment in the GEAS

• Definition

• Conceptual Framework

• Measures

The Global Early Adolescent Study: Measuring Empowerment 3


EmpowermentDefinitions

• Multiple definitions and frameworks exist

• World Bank

• Bill and Melinda Gates Foundation

• Commonalities in frameworks

• Empowerment is a process and an outcome

• Multidimensional

• Involves both external (e.g. structural, resources) and internal (e.g. self-

efficacy, self-esteem) processes

• Differences

• Identification of specific domains and dimensions

• Global versus specific definitions (economic empowerment, sexual and

reproductive health empowerment etc)


● Specific domains may not be relevant to adolescents age 10-14

● Adolescents cannot participate broadly in legal and political spheres

● Oversight of domestic expenditures, versus personal decision making

● Sexual behavior is generally infrequent and thus empowerment

measurement specific to sexual and reproductive health,

contraception, and fertility intention cannot be effectively

measured

EmpowermentLimitations of Existing Definitions


● Use the World Bank definition:

○ The process of enhancing an individual’s or group’s capacity to make

effective choices, that is, to make choices and then to transform

these choices into desired actions and outcomes

● Agency - individual or group’s ability to make purposeful choices and act

on values

● Opportunity structure - institutional, social, and political context of

formal and informal rules and norms within which individuals can exert

agency

GEAS Definition of Empowerment

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GEAS Empowerment Framework

The Global Early Adolescent Study: Measuring Empowerment

Opportunity Structures

Agency

Achievement of

desired outcomes

Family Economic Education Social

Capital

Voice

● Ability to express opinions and be heard

● Ability to express needs and desires

Decision-Making

● Ability to make decision that govern daily life

Political Cultural Legal

Freedom of Movement

● Ability to move autonomously within the environment

8

GEAS Empowerment Measures


Can you tell me how often you are allowed to do the following

alone (without an adult present)?

● Go to after-school activities

● Go to the community center/movie/youth center

● Visited a friend of the opposite sex

● My parents ask for my opinion on things

● My friends ask my advice when they have a problem

● I can ask adults for help when I need itVoice

How often are you able to make the following decisions on

your own?

● What to eat when you are not home

● Who you can have as friends

Freedom of

Movement

Decision-

Making

■ Initial work focused on the identification and development of scales• Confirmatory factor analysis and comparison of results

across countries, age, and gender■ Continuing and future research expands on this preliminary

work to further explore:• How agency and context relate • How decision making and voice are associated with

communication around SRH• How freedom of movement and violence perpetration are

associated

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Ongoing Research


How does context relate to agency?

Eric Mafuta, MD, MPH, PhD

GEAS Field Coordinator

Assistant Professor

University of Kinshasa School of Public Health

Democratic Republic of the Congo

Findings from baseline data in three GEAS sites

10The Global Early Adolescent Study: How does context relate to agency?

11

Introduction

The Global Early Adolescent Study: How does context relate to agency?

How do ecological (contextual) factors relate to each domain of

agency?

○ Individual factors: age, pubertal maturation

○ Family factors: wealth

○ Peer factors: sex structure, time spent with peers

○ Neighborhood factors: cohesion, perceived safety

Consider how these associations differ by sex, place & social class

The Global Early Adolescent Study: Associations of Empowerment and Perceived FP Access in Shanghai 12

Results: Sample Distributions


13

Levels of Agency per site: Freedom of Movement, Voice, Decision Making


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Agency and Adolescent Development


Freedom of Movement and Voice tend to increase with age, while

Decision Making remains stable, except in Kinshasa

15

Cross-Domain Analysis Inter-domain correlations


Kinshasa

(n= 2753) Mobility Voice Decision-Making

Mobility 1 0.25 0.27

Voice 1 0.22

Shanghai



Voice 1 0.40

Cuenca



Voice 1 0.17

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Freedom of Movement: Multivariate analysis


Freedom of Movement Kinshasa Shanghai Cuenca

Gender (Boy ref) Girls 0.38*** 0.72*** 0.45***

Age (10-12 ref) Age 13-14 1.46*** 1.24*** 2.47***

Puberty onset (no ref) Puberty onset 1.49*** 1.51*** 2.74***

Education (lower than grade level ref) At Grade level 1.29** 1.35 0.41

Wealth tertile (lowest ref)Medium 1.08 1.45*** 1.22

Highest 1.09 1.60*** 1.14

Family structure (lives with no parents ref)Lives with one parent 0.98 1.42 1.43

Lives with both parents 1.08 1.30 1.45

Parent Migration 0.99 0.85** 1.41

Parent awareness 0.96 0.99 2.04***

Parent closeness 0.86** 0.97 0.71***

Time spent with friends (no time ref)Some time 1.71*** 2.91*** 2.94***

A lot of time 1.96*** 2.92*** 3.72***

Neighborhood social cohesion (low ref) 1.47*** 1.06 1.71**

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Voice: Multivariate analysis


Voice Kinshasa Shanghai Cuenca

Gender (Boy ref) Girls 0.64*** 0.91 1.09

Age (10-12 ref) Age 13-14 1.29*** 0.78*** 0.93

Puberty onset (no ref) Puberty onset 1.82*** 1.07 1.08

Education (lower than grade level ref) At Grade level 1.37*** 1.57***

Wealth tertile (lowest ref)Medium wealth tertile 1.02 1.24** 1.09

Highest wealth tertile 1.23* 1.39*** 0.80

Family structure (lives with no parents

ref)

Lives with one parent 1.02 0.65** 1.38

Lives with both parents 0.86 0.88* 1.10

Parent Migration 0.94 1.12*** 0.85

Parent awareness 1.19** 1.70*** 2.10***

Parent closeness 1.67*** 2.23*** 2.51***

Time spent with friends (no time ref)Some time 1.32 1.28*** 1.04

A lot of time 1.26 0.93 1.25

Neighborhood social cohesion (low ref) 1.93*** 2.04*** 1.63***

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Decision-Making : Multivariate analysis


Decision-Making Kinshasa Shanghai Cuenca

Gender (Boy ref) Girls 0.73*** 1.22*** 1.21

Age (10-12 ref) Age 13-14 1.32*** 1.08 1.85***

Puberty onset (no ref) Puberty onset 1.55*** 1.28 1.32

Education (lower than grade level ref) At Grade level 1.37*** 1.16 0.68

Wealth tertile (lowest ref)

Medium wealth tertile 1.08 1.21 1.47**

Highest wealth tertile 1.01 1.14* 1.36

Family structure (lives with no parents

ref)

Lives with one parent 1.14 1.44 0.62

Live with both parents 0.95 1.26* 0.66

Parent Migration 1.05 0.86 0.95

Parent awareness 0.75** 0.75* 1.39**

Parent closeness 0.80** 1.17*** 1.19

Time spent with friends (no time ref)

Some time 1.31* 1.54*** 1.53*

A lot of time 1.28 1.13 1.65***

Neighborhood social cohesion (low ref) 1.12 1.15* 1.28**

Associations of Voice and Decision-Making with Communication about SRH

Anna Kågesten, PhD, MPH

Postdoctoral Researcher

Department of Public Health Sciences, Karolinska Institutet

Sweden

Findings from baseline data in three GEAS sites

19The Global Early Adolescent Study: Associations of Voice and Agency with Communication about SRH

20

Objective

Explore interplay between two domains of agency - voice and decision-making

- and communication about SRH

The Global Early Adolescent Study: Associations of Voice and Agency with Communication about SRH

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Measures

Outcomes: Ever talked to anyone about three SRH topics

■ Pregnancy and how it occurs

■ Contraception

■ Sexual Relationships

Key Predictors: Two agency domains dichotomized at the median

■ Voice

■ Decision-making



Sample

KinshasaN=2,539

ShanghaiN=1,197

CuencaN=638

Analysis

Sample Distributions Chi2 and Student’s t-

tests

■ Differences by Site

Bivariate analyses Simple logistic

regressions

■ Crude Odds Ratios

Multivariate analyses Multivariable logistic

regressions

■ Overall

■ Stratified by Sex

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BivariateVoice - Overall

* - p<0.05 ** - p<0.01 *** -

p<0.001 The Global Early Adolescent Study: Associations of Voice and Agency with Communication about SRH

***** ***

******

***

24

BivariateDecision - Overall


***

* - p<0.05 ** - p<0.01 *** -

p<0.001

***

***

***

***

*

***

**

25

MultivariateVoice - Overall


Kinshasa Shanghai Cuenca

aOR 95% CI aOR 95% CI aOR 95% CI

Sexual Relationships 1.90*** a (1.51, 2.39) 1.13** a (1.04, 1.22) 1.77*** (1.32, 2.37)

Pregnancy 1.74*** a (1.31, 2.31) 1.18** a (1.05, 1.32) 1.52** (1.14, 2.02)

Contraception 1.55*** a (1.21, 1.98) 1.10 a (0.75, 3.14) 1.92** (1.31, 2.80)

a = model did not adjust for age and parental awareness due to collinearity.

* - p<0.05 ** - p<0.01 *** -

p<0.001

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MultivariateVoice - Boys




Sexual Relationships 1.85*** (1.32, 2.58) 1.22* a (1.01, 1.47) 2.02* (1.08, 3.76)

Pregnancy 1.75** (1.21, 2.53) 1.29 a (0.86, 1.93) 1.43 (0.87, 2.33)

Contraception 2.07** (1.36, 3.15) 1.22 a (0.93, 1.61) 1.53 (0.75, 3.14)

a = model did not adjust for age and parental awareness due to collinearity.

* - p<0.05 ** - p<0.01 *** -

p<0.001

27

MultivariateVoice - Girls




Sexual Relationships a 1.97** (1.28, 3.07) 1.11 (0.77, 1.62) 1.67* (1.09, 2.54)

Pregnancy a 1.80** (1.23, 2.63) 1.14 (0.72, 1.81) 1.64 (0.78, 3.42)

Contraception a 1.25 (0.92, 1.70) 1.02 (0.58, 1.82) 2.19** (1.28, 3.75)

a - these models did not adjust for age and parental awareness due to collinearity.

* - p<0.05 ** - p<0.01 *** -

p<0.001

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MultivariateDecision - Overall




Sexual Relationships 1.31a (1.00, 1.72) 1.45a (0.95, 2.22) 1.01 (0.79, 1.30)

Pregnancy 1.08a (0.77, 1.53) 1.23** ab (1.07, 1.42) 1.36 (0.73, 2.52)

Contraception 1.16a (0.93, 1.44) 1.26*** a (1.16, 1.38) 1.33 (1.00, 1.76)

a = model did not adjust for age and parental awareness due to collinearity

b = model did not adjust for age and parental awareness due to collinearity but additionally adjusted for interaction between decision meanscore

and sex.

* - p<0.05 ** - p<0.01 *** -

p<0.001

29

MultivariateDecision - Boys




Sexual Relationships 1.14 (0.81, 1.62) 1.39 a (0.98, 1.96) 1.22 (0.86, 1.75)

Pregnancy 1.05 (0.76, 1.45) 1.23** a (1.07, 1.40) 1.37 (0.75, 2.50)

Contraception 1.05 (0.79, 1.38) 1.15 a (0.93, 1.42) 1.43 (0.83, 2.46)


* - p<0.05 ** - p<0.01 *** -

p<0.001

30

MultivariateDecision - Girls




Sexual

Relationships 1.53* a (1.01, 2.30) 1.44 (0.91, 2.27) 0.76 a (0.52, 1.10)

Pregnancy 1.78** a (1.30, 2.43) 1.37*** (1.18, 1.58) 1.35 a (0.99, 1.84)

Contraception 1.24 a (0.92, 1.68) 1.36* (1.08, 1.73) 1.26 a (0.72, 2.19)


* - p<0.05 ** - p<0.01 *** - p<0.001

Discussion

▪Voice was found related to with communication about SRH

topics across overall samples in all three sites

▪Relationship between decision and SRH communication

inconsistent across sites, sex, and communication topics

• Influence of cultural norms about sexual activity and

topics

▪Limitations

• This analysis does not explore who adolescents talked to

or the direction of who initiated the conversation

• Cross-sectional data


The Global Early Adolescent Study: Associations of Empowerment and Perceived FP Access in Shanghai

Associations of Freedom of Movement and Violence Perpetration

Leah R. Koenig, MSPH

GEAS Assistant Study Director

Research Associate, Johns Hopkins Bloomberg School of Public Health

USA

Findings from baseline of the Global Early Adolescent Study in Kinshasa, Shanghai, and Cuenca

32The Global Early Adolescent Study: Associations of Freedom of Movement and Violence Perpetration

33

Objective

To assess associations of violence

perpetration with levels of freedom of

movement among adolescent girls and

boys in 3 cities

The Global Early Adolescent Study: Associations of Freedom of Movement and Violence Perpetration

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Measures

Key Predictor:

Freedom of Movement (FoM)

Can you tell me how often

you are allowed to do the

following alone (without

an adult present)?

ㆹGo to a community

center/movie

ㆹMeet with friends after

school

Outcome:

Incidence of Violence

Perpetration

During the last 6 months,

have you slapped, hit or

otherwise physically hurt

another boy or girl in a

way that they did not

want?

Covariates:

Contextual Factors

Represent Opportunity

Structures

Levels:

ㆹ Individual

ㆹFamily

ㆹPeer

ㆹNeighborhood


Sample

35

KinshasaN=2,715

ShanghaiN=1,424

CuencaN=667

Analysis


Sample

Distributions

Chi2 and Student’s t-

tests

■ Differences by Site

■ Violence Perp. by FoM

Bivariate analyses Simple logistic

regressions

■ Crude Odds Ratios

Multivariate

analyses

Multivariable logistic

regressions

■ Adjusted Odds Ratios

○ Overall

○ Stratified by Sex


Results: Key Predictors and Outcomes



Violence Perpetration by Freedom of Movement


* ** ***

* - p<0.05 ** - p<0.01 *** - p<0.001


Results: Bivariate Analyses


**

**

*****

**

*

***

* - p<0.05 ** - p<0.01 *** - p<0.001


Overall Multivariate Analyses

Violence Perpetration

aOR 95% CI

Freedom of Movement

Shanghai 1.53** [1.14, 2.06]

Cuenca 1.46** [1.10, 1.93]

Kinshasa 1.56*** [1.34, 1.82]

Multivariate analyses adjusted for ecological factors at individual, family, peer, and

neighborhood factors

* p<0.05 - ** p<0.01 - *** p<0.001



Overall Multivariate AnalysesSex Comparison


aOR 95% CI

Freedom of

Movement

Girls vs. Boys

Shanghai 0.53* [0.32, 0.89]

Cuenca 0.49** [0.29, 0.81]

Kinshasa^ 1.68 [0.86, 3.29]

^Multivariate model for Kinshasa included interaction term for freedom of movement and

gender

* p<0.05 - ** p<0.01 - *** p<0.001



Results: Sex-Stratified Multivariable Analyses


Boys Girls

aOR 95% CI aOR 95% CI

Freedom of

Movement

Shanghai 1.30 [0.79, 2.15] 1.95 [0.95, 4.00]

Cuenca 1.66* [1.10, 2.50] 1.38 [0.85, 2.25]

Kinshasa 1.62*** [1.37, 1.89] 1.15 [0.91, 1.44]

* p<0.05 - ** p<0.01 - *** p<0.001


42

● Freedom of movement associated with violence perpetration in all sites

● Sex comparison: Reduced odds of violence perpetration for girls vs. boys

at similar levels of FoM in Shanghai and Cuenca

Discussion


Sex-

Stratified

Models

Next Steps

Overall

Models

● Incorporate gender of violence victim into analyses

● Examine role of gender stereotypical traits in the relationship between

agency and violence perpetration

● Boys: Association of FoM and Violence Perpetration was found among

boys in Cuenca and Kinshasa

● Girls: No link found in any site

The Global Early Adolescent Study: Associations of Empowerment and Perceived FP Access in Shanghai

Discussions & Questions

43The Global Early Adolescent Study: Associations of Freedom of Movement and Violence Perpetration

www.geastudy.org

@geastudy

Thank You

The Global Early Adolescent Study

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