The EMERGE Framework to Measure Empowerment for Health and Development

"This work was developed to meet calls for action to improve empowerment measures."

Researchers and theorists have posited that women's empowerment can improve global health and development, as well as eliminate gender inequalities. This paper offers a new, holistic conceptual framework - the EMERGE Framework to Measure Empowerment - to guide development and selection of more precise measures of empowerment for survey research. It applies this framework to understand women's empowerment in family planning (FP).

The framework is designed for use by researchers, implementers, and gender data experts to identify and code empowerment measures for a given health or development issue and recognise gaps and opportunities to create new measures. Specifically, the purpose is to guide large-scale surveys that can offer national and subnational data to strengthen and track gender empowerment indicators and targets. While the original intent was focus on women's empowerment, the framework can be applied to empowerment more broadly and with an intersectional lens (i.e., considering how both disempowerment and the empowerment process are affected by intersecting forms of social marginalisation, such as gender and race/ethnicity).

The framework is guided by existing theories of empowerment, evidence, and expert input. Largely, this work arises from two distinct lineages:

1. Community psychology and public health, which developed in high-income nations for use with low-resource and marginalised communities and focused on empowerment more generally rather than on women's empowerment specifically. This work is rooted in Paolo Freire's political philosophy from the 1960s and 1970s, which viewed empowerment as a process whereby the oppressed, who have been systematically dehumanised under oppressive power structures, move from being an object of oppression, where others determine one's actions or opportunities, to being a subject with agency (an actor) to enact change in one's life to achieve self-determined goals. This process requires the oppressed to recognise the constraints of their oppression (i.e., gain critical consciousness), challenge these constraints and demand social and political change toward their equality (agency), and achieve emancipation and humanisation (self-determined goals).
2. Development economics, with a focus on operating in low- and middle-income countries (LMICs) at scale and focusing on women's empowerment specifically. One emphasis here is on women's capabilities (resources to create change and agency [internal capacities and actions]) to use these resources toward change and self-actualisation via a process that can occur for women individually or as part of women's collectives and movements.

Using these lines of theory and evidence on empowerment, the researchers offer the EMERGE framework for measurement of empowerment and provide detailed constructs to help survey researchers and implementers select or create empowerment measures and data for monitoring and evaluation.



First, they offer concrete measurable constructs to assess critical consciousness and choice, agency and backlash, and goal achievement as the empowerment process, recognising its operation at multiple levels - from the individual to the collective. For example:

• Measurable constructs of critical consciousness should address choice, desire, preference, intention, level of motivation, and conviction to achieve self-determined goals and to ascertain those goals.
• Agency is measured by highlighting its elements as Can-Act-Resist, which has been adapted for use in FP research across national settings. Agency includes autonomy, which focuses is on internally driven actions designed to achieve self-determined goals, but it also includes bargaining power, which focuses on relative influence or control of parties over each other.
• In the context of the empowerment theory, the researchers consider self-determination to be the freedom of individuals or collectives to live or act without consultation or approval from others. It is more feasible to measure aspirations and achievement of self-determined goals that are clearly defined and able to be captured within shorter intervals.

Second, the researchers elucidate constructs of social norms, and they highlight gender norms specifically, as the driver of contexts and structures that prevent self-actualisation. They operationalise social norms into measurable constructs of Learn-Adhere-Enforce;

• Learn: People learn norms from infancy throughout the life cycle as they observe how others behave and internalise social expectations.
• Adhere: People typically adhere to these learned social norms, often without being told to do so or being warned against non-adherence.
• Enforce: Enforcement of a norm occurs through sanctions (rewards or punishments) for adhering to or deviating from a social norm.

Third, the researchers showcase proximal internal and external factors affecting empowerment (inclusive of resources), which are shaped by norms and structures. Notably, empowerment of individuals and collectives has the potential to influence the internal attributes and transform external contexts and norms as well.

• Internal attributes include psychological and emotional attributes of the individual or collective and intra-group dynamics of the collective. Psychological and emotional attributes of the individual or collective can act as facilitators when they involve less restrictive attitudes or beliefs, knowledge of choices, positive internal affect (e.g., optimism, trust, empathy) and psychological resilience (e.g., coping, intrinsic motivation). A lack of these attributes, however, can act as inhibitors to the process.
• External factors that influence empowerment are multilevel and include: a) the social structures and institutions in which individuals and collectives operate, including the policy environment and b) more proximal community and household dynamics.

Programmes and policies can target these factors to promote empowerment, support health and development, and contribute to social justice and human rights.

To obtain insight into measures on women's empowerment in FP, the researchers apply the constructs from the EMERGE Framework to Measure Empowerment to understand existing measures and measurement gaps. To identify best evidence existing measures on this topic, they first reviewed the most recent version of the Demographic and Health Survey (DHS8). A Google scholar search on DHS papers that included focus on empowerment and family planning yielded over 4,000 papers. The researchers then reviewed peer-reviewed professional publications focused on empowerment measurement in the area of FP published in the past decade.

This review of best evidence FP measures assessing empowerment constructs, social norms, and key influencers (e.g., partners and providers) shows a strong landscape of measures, including those with women, partners, and providers. However, these measures are limited in assessing translation of choice to agency to achievement of women's self-determined fertility or contraceptive goals, instead relying on assumption of contraceptive use as the goal. Going forward, the researchers recommend prioritising local voices in defining the concept and identifying appropriate intervention outcomes related to empowerment and building measures from these voices. Top-down conceptualisation approaches are likely to miss cultural cues inherent to the very notion of empowerment.

The researchers conclude: "Collectively, we must begin to fill measurement gaps and deepen our overall understanding of how and why empowerment matters and works. While this process is inherently developmental and ongoing, the pace of this work must be greatly accelerated, hopefully with support from this framework."