Peer-reviewed article
Women’s health and well-being in five birth cohorts from low- and middle-income countries: Domains and their associations with early-life conditions
Fernando Pires Hartwig, Anushka Ataullahjan, Linda S. Adair, Helen Gonçalves, Bernardo Lessa Horta et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined women's health and well-being across five birth cohorts in Brazil, Guatemala, the Philippines, and South Africa by identifying three key domains: human capital (education and cognitive ability), metabolic health (body weight and metabolism), and psychological health (happiness and mental well-being). The researchers found these domains were largely independent of each other, with early-life conditions like family wealth and maternal education influencing human capital outcomes most strongly. The study reveals that most women in these cohorts experience compromised health in at least one domain, highlighting the multidimensional nature of women's well-being in low- and middle-income countries.
Key points
- Women's health and well-being consists of three largely uncorrelated domains: human capital, metabolic health, and psychological health
- Early-life wealth and maternal education were positively associated with human capital outcomes, while higher birth order was negatively associated
- Lower birthweight and weight at age two years were associated with poorer metabolic health in adulthood
- Maternal education was the strongest early-life predictor of better psychological health
- Few women scored highly across all three domains, with most compromised in at least one area
Limitations
The study lacks data on adolescent exposures and several important well-being dimensions including safety, agency, empowerment, and experience of violence. The analysis is limited to outcomes available in existing birth cohort datasets, which may not capture all relevant aspects of women's health and well-being.
Abstract
Background: Women's health and well-being (WHW) have been receiving growing attention, but limited progress has been made on how to measure its different domains in low- and middle-income countries (LMICs). 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. Methods: Based upon an a priori conceptualisation of eight postulated WHW outcomes available in the data, we grouped them as follows: human capital (intelligence quotient, schooling, height, and teenage childbearing), metabolic health (body mass index and metabolic syndrome score), and psychological (happiness and Self-Reported Questionnaire (SRQ) scores). Correlation analyses confirmed the variables theoretically belonging to the same dimension of WHW were statistically related. We then applied principal component analysis to each group of variables separately and used the first principal component as a summary quantitative measure of the corresponding WHW dimension. Finally, we assessed the association of each domain with a range of early-life factors: wealth, maternal education, maternal height, water, and sanitation, birthweight, length at two years and development quotient in mid-childhood. Results: The three domains were largely uncorrelated. Early determinants were positively associated with human capital, while birth order was negatively associated. Fewer associations were found for the metabolic or psychological components. Birthweight and weight at age two years were inversely associated with metabolic health. Maternal education was associated with better psychological health. Conclusions: 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. 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.