Assessing Women's Quality of Life in Rural Malawi: a Capabilities Index

Abstract

The MaiMwana Project is a community-based intervention that organises women's groups (WG) in rural villages in Malawi. During the meetings, women discuss, develop and implement strategies to overcome maternal and neonatal issues. This intervention combines social strategies with empowerment, capacity building and knowledge across different sectors. It emphasises health promotion activities that rely on community engagement and participation aimed at changing behaviour of healthy individuals. The effectiveness of MaiMwana WGs is measured through a cluster randomised controlled trial design on maternal and neonatal mortality rates. However, the impact of the intervention is likely to occur on different aspects of women's wellbeing, not only on health. Conventional economic evaluation techniques might fail to address comprehensively the complexity of community-based interventions such as the MaiMwana Project. Applying Sen's capability framework may provide an appropriate response to address this shortcoming. A crucial argument of Sen's approach is that wellbeing is the freedoms people have to pursue the kind of life they have reason to value. Social policies should aim to expand people's capabilities, and a policy is considered successful if it leads to an expansion of people's capability set. In order to assess and monitor progress in society, there is a need for developing multidimensional measures of wellbeing based on a broader evaluative space. This thesis develops an outcome measure inspired by Sen's capabilities approach to assess women's wellbeing in rural Malawi. To achieve this, the study has five objectives: i. Identify a set of capabilities relevant to the context ii. Propose a methodology to measure robustly these capabilities iii. Aggregate the capabilities into a single metric (index) iv. Validate and test the index. During the exploratory phase, a series of focus groups was held in order to identify and value locally relevant dimensions of quality of life, or capabilities. The capabilities were assessed with a household survey on a sample of 345 women of reproductive age in Mchinji District, Malawi. The capabilities were aggregated into an index using four different methods: data-driven (principal component analysis), normative (equal weights and participatory exercise) and hybrid (survey ranking). The index was validated against the criteria of content validity, construct validity and reliability.