Functional Difficulty Among Women Aged 18-49 Years in 22 Low-and Middle-Income Countries: Multiple Indicator Cluster Surveys, 2017-2022.

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.