Women's Empowerment Measurement in Quantitative Reproductive Health Studies: From Unidimensional Proxies to a Multidimensional Framework

Women's empowerment is among the most studied determinants of reproductive health in low-and middle-income countries, yet quantitative reproductive health research continues to operationalise it through single proxies even though the construct is theoretically established as multidimensional.This reliance on unidimensional measurement misrepresents the construct and produces findings that are often inconsistent across settings.This review develops and defends a transparent, multidimensional framework for measuring women's empowerment from Demographic and Health Survey (DHS) data, grounded in Kabeer's resources, agency, and achievements model, and illustrates it using Cameroon DHS data.A structured narrative review informed the synthesis of six dimensions recurrent in reproductive health studies: economic, educational, sociocultural, reproductive, normative, and digital, each operationalised from standard DHS variables through a standardised additive scoring protocol.Measurement quality was assessed by distinguishing reflective from formative indices and by multicollinearity diagnostics.The framework was constructed on the 2018 Cameroon DHS (n = 4,449 partnered women aged 15-49 with a recent birth or pregnancy).The two reflective dimensions (educational, digital) met the α ≥ 0.70 threshold, the four formative dimensions were validated by construct coverage, and correlation and variance-inflation diagnostics confirmed that all six dimensions are statistically independent.Sub-dimension analysis revealed heterogeneity that a single index conceals, including a substantial digital access-and-use gap.A domain-differentiated additive framework is theoretically necessary, operationally achievable, and internally consistent within existing DHS infrastructure, preserving the dimension-specific effects essential for intervention design.