TABLE.

Landscape of Validated Scales for Reproductive Empowerment

Name of Scale and Year Developed	Description	Number of Items and Subscales	Context and Validation	Scale Use and Interpretation
Reproductive Autonomy Scale, 2014⁴	Assess a woman's interpersonal power over reproductive matters including contraception use, pregnancy, and childbearing.	The full scale has 14 items and includes 3 subscales (decision-making index, coercion subscale, and communication subscale).	Developed and validated with women ages 15–60 years in family planning and abortion facilities across the United States.³ The construct validation study analyzed the subscales association with unprotected sex. The decision-making subscale was not significantly associated with unprotected sex, but the odds ratio was in the expected direction of higher decision-making capacity associating with lower levels of unprotected sex. The communication and coercion subscales were significantly associated with unprotected sex within the past 3 months in an inverse direction.	Assign scores for each of the 3 subscales: decision-making index (my partner=1; both me and my partner=2; me=3); coercion subscale (strongly disagree=4; disagree=3; agree=2; strongly agree=1); communication subscale (strongly disagree=1; disagree=2; agree=3; strongly agree=4). Sum the scores for each of the 3 subscales. A higher score indicates higher levels of reproductive autonomy.
Reproductive Empowerment Scale, 2019⁵^,⁶	Assess a woman's ability to make reproductive choices about contraception and sexual relations at interpersonal and community levels.	The full scale has 20 items and includes 5 subscales (RH health care provider communication, RH partner communication, RH decision making, RH social support, and RH social norms).	Developed in the United States and Zambia and validated in Kenya with women aged 15–49 years and men aged 18–59 years and in Nigeria with women aged 18–35 years and male partners of any age.⁴^,⁵ The construct validity of the subscales was tested for association with the following variables: currently doing something to prevent pregnancy; currently using a method of modern contraception; and likely to use a modern method of contraception in the future. The full scale and subscales were associated with all 3 variables.	Assign scores for the 4 Likert responses (strongly disagree=1; disagree=2; agree=3; strongly agree=4). Sum the scores for each subscale, except for item numbers 13 and 14, and divide the sum by the number of items in the subscale(s). A higher sum represents greater empowerment. Items 13 and 14 will depend on the perception of empowerment in the context of implementation. The authors give this example: “If joint decision making is considered most empowering and decision making by non-partners is considered least empowering, one option for scoring is 4=my partner and myself jointly; 3=myself; 2=my partner; 1=all other options.”
CSESSA scale 2018⁷	Assess a woman's certainty in her ability to initiate, manage, and continue use of contraception.	The full scale has 11 items for Kenya and 10 items for Nigeria within 3 subscales (husband/partner communication, choosing and managing a method, and provider communication).	Based on Levinson's Contraceptive Self-Efficacy scale¹⁷ and validated in Kenya and Nigeria⁶ with women ages 15 and older. The scale and subscales were all significantly associated with the measure of current modern contraception use. The validation study found that the “choosing and managing a method” subscale varied between the 2 country contexts indicating that the subscale might be more relevant in contexts with low contraceptive prevalence compared to high.	Response options range from 0–10 with 0=cannot do at all and 10=highly certain can do. Sum the scores for each subscale and divide by the number of items in each scale. A higher score indicates higher levels of contraceptive self-efficacy.
WGE-SRH index, 2018⁸	Assess women's constraints and motivations related to the existence of choice and exercise of choice to have sex, use contraceptives, or become pregnant.	The full index has 22 items in 2 subscales (existence of choice and exercise of choice).	Developed and validated in Ethiopia, Nigeria, and Uganda with women aged 15–49 years.⁷ Construct validity for the scale and subscales were tested against measures of volitional sex and contraceptive use. The subscales were associated with the measures for most sites, but there was an unexpected inverse association in Kano State (Nigeria) between exercise of choice and volitional sex.	All items are scored 1 (strongly disagree) to 10 (strongly agree). Sum the scores for all items. The scale authors suggest using additive scores since the measures are meant to indicate “the level of women's SRH empowerment at the population level.” Higher scores indicate higher levels of sexual and reproductive health empowerment.
Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults, 2019⁹	Assess a youth's sexual and reproductive autonomy through self and social support, bodily safety, and sexual pleasure.	The full scale has 23 items in 7 subscales (comfort talking with partner; choice of partners, marriage, and children; parental support; sexual safety; self-love; sense of future; and sexual pleasure).	Developed and validated in the United States with adolescents and young women and men aged 15–24 years.⁸ The scale and subscales were associated with sexual and reproductive health information and access to sexual and reproductive health services measured at baseline and moderately associated with the use of desired contraceptive methods at 3-month follow-up.	The total score ranges from 0 to 92. Response options for each question range from not at all true=0, a little true=1, moderately true=2, very true=3, and extremely true=4. Sum the scores for each subscale. A higher score indicates higher level of sexual and reproductive empowerment. The subscales are independent of each other, so they can be used on their own or the entire scale can be used as a composite measure.

Abbreviations: CSESSA, Contraceptive Self-Efficacy among women in sub-Saharan Africa; RH, reproductive health; RH, reproductive health; WGE-SRH, Women's and Girls' Empowerment in Sexual and Reproductive Health.