Association between women’s empowerment and mental health in Sub-Saharan Africa and South Asia: Evidence from the Survey-based Women’s Empowerment index

Abstract

Women’s empowerment is a key social determinant of health; however, its association with mental health, evaluated in this study through symptoms of anxiety and depression, remains insufficiently explored across low- and middle-income countries (LMICs). This study aimed to estimate the prevalence of depression and anxiety among ever-married women aged 15–49 years, examine their associations with women’s empowerment and assess cross-country inequalities in five LMICs. We analyzed nationally representative Demographic and Health Survey data from Bangladesh, Lesotho, Mozambique, Nepal and Zambia. Women’s empowerment was measured across three Survey-based Women’s Empowerment domains: attitude toward violence, social independence and decision-making autonomy. Survey-weighted descriptive statistics and multivariable logistic regression models were used, adjusting for sociodemographic and household covariates. The prevalence of depression and anxiety was low (~4–6%) and showed minimal variation across empowerment levels. In adjusted analyses, decision-making autonomy was consistently associated with lower odds of both depression and anxiety. In contrast, social independence was associated with higher odds of mental health symptoms in Bangladesh, Mozambique and Nepal. Attitudes toward violence showed limited and inconsistent associations. Country-specific analyses revealed substantial heterogeneity, with Mozambique indicating significant associations with autonomy, Nepal demonstrating mixed associations across domains and Bangladesh showing increased depression with higher social independence. These findings reveal how various components of women’s empowerment are associated with depression and anxiety across various sociocultural settings. In Mozambique, policy efforts should be prioritized for strengthening decision-making autonomy and social independence. In Addition, social independence and attitudes toward violence should be enhanced in Bangladesh; however, every domain of women empowerment needs to be improved in Nepal. These strategies are essential for improving women’s mental health and advancing Sustainable Development Goals 3 and 5 in LMICs.