Women's Empowerment, Population Dynamics, and Socioeconomic Development (2024)

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Women’s Empowerment, Population Dynamics, and Socioeconomic Development Anita Raj and Susan C. Scrimshaw, Editors Committee on Women's Empowerment, Population Dynamics, and Socioeconomic Development Committee on Population Division of Behavioral and Social Sciences and Education Consensus Study Report Prepublication copy - uncorrected proofs 

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the Bill & Melinda Gates Foundation (INV-039679). Additional support was provided by the National Academy of Sciences W. K. Kellogg Foundation Fund. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/27955 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242; http://www.nap.edu. Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Women’s Empowerment, Population Dynamics, and Socioeconomic Development. Washington, DC: National Academies Press. https://doi.org/10.17226/27955. 

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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. Prepublication copy, uncorrected proofs 

COMMITTEE ON WOMEN’S EMPOWERMENT, POPULATION DYNAMICS, AND SOCIOECONOMIC DEVELOPMENT ANITA RAJ (Co-Chair), Executive Director of Newcomb Institute, Nancy Reeves Dreux Endowed Chair and Professor in the School of Public Health and Tropical Medicine, Tulane University SUSAN CROSBY SCRIMSHAW (Co-Chair), President, Russell Sage College (retired) RAGUI ASSAAD, Professor of Planning and Public Affairs, University of Minnesota SONALDE DESAI, Professor of Sociology, University of Maryland ALETHEIA DONALD, Senior Economist, Gender Innovation Lab, World Bank PASCALINE DUPAS, Professor of Economics and Public Affairs, Princeton University KELLI STIDHAM HALL, Associate Dean of Research, Tulane University School of Public Health and Tropical Medicine (committee member from September 29, 2023) POONAM MUTTREJA, Executive Director, Population Foundation of India LUCA MARIA PESANDO, Associate Professor of Social Research and Public Policy, New York University Abu Dhabi GOLEEN SAMARI, Associate Professor of Population and Public Health Sciences, University of Southern California TOM VOGL, Associate Professor of Economics, University of California, San Diego YOHANNES DIBABA WADO, Research Scientist, African Population and Health Research Center KATHRYN M. YOUNT, Asa Griggs Candler Professor of Global Health and Professor of Sociology, Emory University Study Staff KRISZTINA MARTON, Study Director ALEX HENDERSON, Senior Program Assistant MALAY MAJMUNDAR, Director, Committee on Population Consultants KELLI STIDHAM HALL, Associate Professor of Population and Family Health, Columbia University (between July 1, 2023–September 29, 2023) DENNIS HODGSON, Professor Emeritus of Sociology, Fairfield University National Academy of Medicine Emerging Leaders in Health and Medicine Fellow KELLI STIDHAM HALL, Associate Professor of Population and Family Health, Columbia University (between December 14, 2022–July 1, 2023) v Prepublication copy, uncorrected proofs 

COMMITTEE ON POPULATION ANNE R. PEBLEY (Chair), Fielding School of Public Health and California Center for Population Research, University of California, Los Angeles EMILY M. AGREE, Johns Hopkins University RANDALL K. AKEE, Department of Public Policy and American Indian Studies, University of California, Los Angeles DEBORAH BALK, Institute of Demographic Research, City University of New York COURTNEY C. COILE, Wellesley College SONALDE DESAI, University of Maryland KATHARINE M. DONATO, Institute for the Study of International Migration, Georgetown University ROBERT A. HUMMER, Carolina Population Center, University of North Carolina, Chapel Hill SEEMA JAYACHANDRAN, Princeton University HEDWIG LEE, Duke University TREVON D. LOGAN, College of Arts and Sciences, The Ohio State University JENNIFER J. MANLY, Department of Neurology, Columbia University Irving Medical Center JENNA NOBLES, University of Wisconsin-Madison FERNANDO RIOSMENA, Institute for Health Disparities Research, University of Texas, San Antonio DAVID T. TAKEUCHI, School of Social Work, University of Washington MALAY MAJMUNDAR, Director vi Prepublication copy, uncorrected proofs 

Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: SARAH BAIRD, Milken Institute School of Global Health, George Washington University JOHN BONGAARTS, Vice President and Distinguished Scholar, The Population Council SEEMA JAYACHANDRAN, Department of Economics and School of Public and International Affairs, Princeton University SUNITA KISHOR, Demographic and Health Surveys, ICF AGNES QUISUMBING, Poverty, Gender, and Inclusion Unit, International Food Policy Research Institute MARY K. SHENK, Anthropology, Demography, and Asian Studies, Pennsylvania State University AMY O. TSUI, Population, Family and Reproductive Health Department, Johns Hopkins Bloomberg School of Public Health RUTH E. ZAMBRANA, Harriet Tubman Department of Women, Gender and Sexuality Studies, and Consortium on Race, Gender and Ethnicity, University of Maryland Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by JERE R. BEHRMAN, University of Pennsylvania, and CYNTHIA M. BEALL, Case Western Reserve University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. vii Prepublication copy, uncorrected proofs 

Preface and Acknowledgments We were charged with leading a committee to examine the evidence on the relationships between population dynamics, socioeconomic development, and women’s empowerment in a rapidly changing world. We conducted this work in the contexts of change, persistence, great complexity, and wide variations between countries, regions, and cultural groups. Throughout human history, cultures have established norms or expectations of women and men (i.e., socially constructed gender norms), in terms of their roles, behaviors, and presentation. These social norms govern key behaviors of population dynamics including women’s agency, sexual activity, relationship formation, control over fertility, number and spacing of children, and gender preferences. Gender norms influence socioeconomic development and domestic life including access to education, occupational opportunities, expectations around responsibilities for cooking, childcare, and maintenance of the home, and leadership opportunities. We sought to understand these issues through analysis of women’s experiences of restriction but also via exploration of women’s empowerment and how women’s empowerment across diverse populations can influence socioeconomic development—directly or via increases in women’s control over their reproductive and all other domains of their lives. We had the advantage of a multidisciplinary committee that brought diverse perspectives and evidence to the task at hand. It was obvious that no one disciplinary approach can fully explain the complexities across women’s empowerment, population dynamics, and socioeconomic development in our changing world, and that interdisciplinary work is essential to understanding these dynamics. This interdisciplinary approach requires understanding and appreciating the methodologies and theoretical approaches of diverse disciplines and how these can inform the questions at hand. It also requires compromise. As cochairs, we wish to express our profound appreciation to the committee members who listened to each other, learned from each other’s disciplines, and came together with this report. We would also like to thank the experts who participated in the committee’s public meetings and provided valuable input: Daniela Behr, Amanda Clayton, Michele Decker, Arjan De Haan, Nadia Diamond-Smith, Jocelyn Finlay, Margaret Greene, Mala Htun, Jody Heymann, Sandra Pepera, Ndola Prata, Elizabeth Sully, Jakana Thomas, and Aili Mari Tripp. The committee is also grateful for the research assistance provided by Namratha Rao and Edwin Thomas of Newcomb Institute at Tulane University. Nafeesa Andrabi, Christine Mirzayan Science & Technology Policy Graduate Fellow, also participated with the project. This report would not have been possible without the strong support of our study director, Krisztina Marton, the steady presence of Malay K. Majmundar, Director of the Committee on Population, and the logistical support of Alex Henderson. We are also grateful to our sponsors, the Bill & Melinda Gates Foundation. viii Prepublication copy, uncorrected proofs 

It is our hope that this report will improve understanding of the complex relationships between women’s empowerment, population dynamics and socioeconomic development by generating more multidisciplinary collaboratives, building theory-driven identification of best evidence measures to help advance the field, and creating and evaluating empowerment-focused interventions and policies for their impact. Future work can inform strategies around women’s empowerment approaches for women’s choice and agency and also for socioeconomic development. Anita Raj and Susan C. Scrimshaw, Co-Chairs Committee on Women’s Empowerment, Population Dynamics, and Socioeconomic Development ix Prepublication copy, uncorrected proofs 

Contents Summary 1 Introduction CHARGE TO THE COMMITTEE COMMITTEE APPROACH TO THE STUDY ORGANIZATION OF THE REPORT 2 Review of Women’s Empowerment Frameworks and Measures A BRIEF HISTORY OF WOMEN’S EMPOWERMENT IN POPULATION DYNAMICS AND SOCIOECONOMIC DEVELOPMENT REVIEW OF EXISTING FRAMEWORKS ON WOMEN’S EMPOWERMENT SUMMARY AND CONCLUSIONS 3 A New Conceptual Framework to Understand Women’s Empowerment, Population Dynamics, and Socioeconomic Development MULTILEVEL UNDERSTANDING OF WOMEN’S AGENCY IN EMPOWERMENT SUMMARY AND CONCLUSIONS 4 Women’s Empowerment and Population Dynamics WOMEN’S EMPOWERMENT AND UNION, FAMILY FORMATION, AND FERTILITY WOMEN’S EMPOWERMENT AND MIGRATION WOMEN’S EMPOWERMENT AND MORTALITY SUMMARY AND CONCLUSIONS 5 Women’s Empowerment and Women’s and Children’s Health WOMEN’S EMPOWERMENT AND ACCESS TO FAMILY PLANNING WOMEN’S EMPOWERMENT AND ACCESS TO ABORTION WOMEN’S EMPOWERMENT AND WOMEN’S ACCESS TO HEALTHCARE AND SERVICE UTILIZATION WOMEN’S EMPOWERMENT AND HEALTH OUTCOMES SUMMARY AND CONCLUSIONS 6 Women’s Empowerment and Socioeconomic Development CHILD NUTRITIONAL STATUS AND SCHOOLING x Prepublication copy, uncorrected proofs 

DECENT WORK AND SUSTAINABLE LIVELIHOODS SOCIAL CAPITAL AND CONNECTION SOCIAL PROTECTION POLITICAL PARTICIPATION AND GOOD GOVERNANCE PEACE, SECURITY, AND SAFETY FROM VIOLENCE CLIMATE RESILIENCE MACROECONOMIC CONSIDERATIONS SUMMARY AND CONCLUSIONS 7 Levers for Change: Evidence on Effective Programs and Policies to Increase Women’s Agency in the Empowerment Process FINANCIAL AND EMPLOYMENT PROGRAMS FOR WOMEN WOMEN’S COLLECTIVES WOMEN’S HEALTH INITIATIVES YOUTH DEVELOPMENT INTERVENTIONS SOCIAL AND LEGAL PROTECTIONS AND POLICIES SUMMARY AND CONCLUSIONS 8 Conclusions and Recommendations RECOMMENDATIONS References Appendixes A Biographical Sketches of Committee Members B Frameworks of Women’s Empowerment xi Prepublication copy, uncorrected proofs 

Boxes and Figures BOXES 1-1 Statement of Task 1-2 Working Definitions of Women’s Empowerment, Population Dynamics, and Socioeconomic Development for this Report 3-1 Key Constructs of Agency 3-2 Equitable Development Goals FIGURES S-1 New conceptual framework of women’s empowerment, population dynamics, and socioeconomic development 2-1 Visualization of women’s empowerment, building on existing theories 3-1 New conceptual framework of women’s empowerment, population dynamics, and socioeconomic development 3-2 Women’s empowerment and the life course 4-1 New conceptual framework of women’s empowerment, population dynamics, and socioeconomic development, highlighting this chapter’s area of emphasis 5-1 New conceptual framework of women’s empowerment, population dynamics, and socioeconomic development, highlighting this chapter’s areas of emphasis 6-1 New conceptual framework of women’s empowerment, population dynamics, and socioeconomic development, highlighting this chapter’s area of emphasis 7-1 New conceptual framework of women’s empowerment, population dynamics, and socioeconomic development, highlighting this chapter’s area of emphasis xii Prepublication copy, uncorrected proofs