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Background <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusions <p>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.</p>

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

  • 期刊论文

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  • 发表日期：

    2026年4月10日

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  • Md. Sabbir Ahmed Mayen,
  • Salwa Nawsheen Nisha,
  • Sumya Afrin,
  • Tanvir Ahammed,
  • Muhammad Abdul Baker Chowdhury,
  • Md. Jamal Uddin

摘要

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.