Peer-reviewed article
Functional Difficulty Among Women Aged 18-49 Years in 22 Low-and Middle-Income Countries: Multiple Indicator Cluster Surveys, 2017-2022.
Mayen MSA, Nisha SN, Afrin S, Ahammed T, Chowdhury MAB et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from 22 low- and middle-income countries to estimate how common functional difficulty is among women aged 18-49 years and what factors are associated with it. The researchers found that about 5% of women in these countries experience functional difficulty, with rates varying significantly by country. Women who are older, have less education, live in urban areas, have experienced intimate partner violence, or lack access to mobile phones are at higher risk. The findings highlight inequalities in women's health and functioning across different regions.
Key points
- Pooled prevalence of functional difficulty among women aged 18-49 in 22 LMICs was 5.15%, ranging from 1.33% in Sierra Leone to 13.39% in Central African Republic
- Higher odds of functional difficulty were associated with age 42-49 years (AOR=4.75), no/pre-primary/primary education (AOR=1.95), urban residence (AOR=1.60), and never being in union (AOR=1.34)
- Intimate partner violence exposure, high parity (≥7 children), unimproved sanitation, low life satisfaction, and lack of mobile phone ownership were additional risk factors
- Women in African countries had higher odds of functional difficulty (AOR=2.24) compared to those in Asia
- The findings demonstrate substantial cross-country variation and persistent inequalities affecting women's functioning and well-being
Limitations
This study describes the prevalence and associations of functional difficulty but does not evaluate the effectiveness of any intervention to address it. The cross-sectional design cannot establish causal relationships between the identified factors and functional difficulty.
Abstract
BACKGROUND: Women with functional difficulty often experience activity limitations due to their increased vulnerability compared to men. Although prevalence estimates exist, cross-country evidence on determinants in low- and middle-income countries (LMICs) remains limited. This study estimated the pooled prevalence and identified factors associated with functional difficulty among women of reproductive age in LMICs. METHODS: We analyzed data from the most recent Multiple Indicator Cluster Surveys conducted between 2017 and 2022 in 22 LMICs. The outcome variable was functional difficulty among women aged 18–49 years. Survey-weighted pooled prevalence estimates were calculated. A multivariable multilevel logistic regression model was used to estimate adjusted odds ratios and 95% confidence intervals. RESULTS: The pooled prevalence of functional difficulty was 5.15%, ranging from 1.33% in Sierra Leone to 13.39% in the Central African Republic. Higher odds of difficulty were observed among women of higher reproductive age (42–49 years; AOR = 4.75), those with no/pre-primary/primary education (AOR = 1.95), urban residents (AOR = 1.60), and women never in union (AOR = 1.34). Additional risk factors included exposure to intimate partner violence (AOR = 1.14), high parity (≥ 7 children; AOR = 1.44), unimproved sanitation (AOR = 1.17), low life satisfaction (AOR = 2.09), and lack of mobile phone ownership (AOR = 1.33). Regionally, women residing in African countries had higher odds of difficulty (AOR = 2.24) than those in Asia. CONCLUSIONS: Functional difficulty affects one in 20 women of reproductive age in LMICs, with substantial cross-country variation. The burden is patterned by sociodemographic, reproductive, psychosocial, household, and digital access factors, highlighting persistent inequalities and the need for targeted, equity-focused interventions to improve women’s functioning and well-being.