YEAR 3 GLOBAL REPORTThe Hologic
Global Women’s
Health Index
Pathways to a Healthy
Future for WomenR E LE ASE D 2 02 4

MEASURED BY

Table of Contents
3

A Letter From Hologic’s CEO

5

Introduction to Year 3

6

Key Global Findings

8

About the Hologic Global Women’s Health Index

11

Global Results and Rankings

20

The Five Building Blocks for Improving Women’s Health23

Preventive Care: Testing for Deadly Diseases Remains Low

43

Emotional Health: Negative Emotions Rising, With Notable Gaps Between Women and Men

53

Opinions of Health and Safety: Women Feel No Safer, No More Satisfied With Healthcare

63

Basic Needs: Nearly 1 Billion Women Still Struggling to Afford Food71

Individual Health: Physical Pain Is a Significant Problem

78

Conclusion

85

Appendix 1: Developing the Hologic Global Women’s Health Index

107

Appendix 2: Hologic Global Women’s Health Index: Methodology and Data Analysis

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“A scarcity of data persists across women’s
health — first in defining women’s health,then in diagnosing illness, tracking conditions
at the national level, and translating data
into global insights through epidemiologicalstudies. As a result, there are important
gaps in our understanding that influence
research design, investment decisions,and pipeline priorities, threatening
health outcomes for women globally.
T H E L A N C E T , J U LY 2 0 2 3 1

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A Letter From Hologic’s CEO
Last year, more than 1 billion women never visited ahealthcare professional. Only 11% were screened forcancers that take millions of lives each year. And just
10% were tested for sexually transmitted diseases
and infections, raising the risk of maternal andfetal mortality.

As a company focused on early detection,
diagnosis and treatment of women’s healthconditions, Hologic knows firsthand that you
can’t improve what you don’t measure.
That’s why we joined forces with leading independent
research firm Gallup in 2019 to create the Hologic
Global Women’s Health Index.

While many women felt unsafe walking alone at night,
many others struggled to simply put food on the table
and a roof over their family’s heads. At the same time,
the gaps between rich and poor nations and urban andrural communities remained as wide as ever. It is anexperience that the United Nations has characterized
as a “staggering backsliding” in women’s health.

This annual survey, now in its third year, is one of themost comprehensive initiatives measuring the state ofhealth for 97% of the world’s women and girls aged 15
and older.
The Hologic Global Women’s Health Index serves
as an enduring benchmark to measure and monitorchanges in the behaviors and attitudes that influence
women’s access to quality healthcare in every cornerof the world.

It’s no wonder so many women in the world areworried, stressed, angry and sad.
While the most recent Hologic Global Women’s HealthIndex survey results give us cause for concern, theyalso inspire us to redouble our efforts to enable
healthier lives everywhere, every day, no matter where
women live, how much money they have or their levelof education. This is our reason for being and we neverlose sight of that purpose.

It provides global leaders, countries and advocateswith the data and insights to fuel breakthrough healthpolicies and life-changing care programs. Often, it
ignites ideas and innovations designed to improve thelives and well-being of women who are the backboneof families, communities, nations and those they love.

Working together, I am confident that we can do better— by any measure.

Our Year 3 Hologic Global Women’s Health Index
report reflects the real-life experiences and opinions
of more than 147,000 women and men from 143
countries and territories, surveyed in more than
140 languages — captured in their own words
during one-on-one interviews.

I invite you to read our report and join us in our quest.

Stephen P. MacMillan

Regrettably, this year’s findings reveal that women’s
global health has stagnated, especially in criticaldimensions like Preventive Care and Basic Needs,
two factors that have a major impact on a woman’s
average life expectancy at birth.

The Hologic Global Women’s Health Index | Year 3 Global ReportChairman, President andChief Executive Officer of Hologic

3© 2024 Hologic, Inc. All rights expressly reserved.
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Introduction to Year 3
In 2020, Hologic and Gallup launched the Hologic
Global Women’s Health Index in response to the urgent
need for more timely, comprehensive and actionable
data on global women’s health.

The findings show that women are no better off
today in the five dimensions of health than they
were three years ago. And in several importantways, women’s health is now worse. However,as the country spotlights in this report show,
there are examples of how systems can
successfully care for women.

The inaugural report, released in 2021, provided a
troubling baseline account of the state of women’s
health worldwide. It showed that every country in
the world — even the wealthiest — had work to do
regarding women’s health.

Together, these findings provide compelling new
evidence that bold and urgent action is needed to
improve women’s health.

In their own words, women told interviewers they were
struggling. Many couldn’t meet their basic daily needs
or were in poor physical or emotional health. And far
too few were receiving needed tests for high bloodpressure, cancer, diabetes, or sexually transmitted
diseases and infections.

The findings also align with and reinforce the results ofother key studies and reports. For example, a United
Nations (UN) report recently warned about “staggering
backsliding” in global women’s health as a result of the
COVID-19 pandemic, political conflict, global economic
challenges and climate crises.4

While these findings raised alarms, they also revealed
five dimensions of health that provide a pathway forunderstanding, and ultimately transforming, women’s
health and lives.

Hologic’s commitment to the Index and partnershipwith Gallup ensure the Index will inspire action andallow decision-makers to track key trends at thecountry, regional and global levels. Hologic is also
committed to ensuring that the Index has a meaningful
real-world impact — and engaging global partners in
the pursuit of better health for all women.

Hologic and researchers at Gallup discovered that
improvements in any one of five dimensions of health —Preventive Care, Emotional Health, Opinions of Healthand Safety, Basic Needs, and Individual Health — could
potentially help women live healthier and longer lives.
The latest survey, conducted in 2022,2 includes
participants from 143 countries and territories3 — up
from 122 in the previous year. It represents the voicesof 97% of the global population of women and girls
aged 15 and older. Men and boys aged 15 and older
were also surveyed to help identify gender gaps andmake comparisons.

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Key Global Findings
Women’s health is stagnating around the world, even as the COVID-19
pandemic wanes.
Across key health measures, women are no better off today than they were in the first year of the survey,
which was conducted at the height of the COVID-19 pandemic. In some cases, their health is worse.
Billions of women have physical or emotional health issues, aren’t getting tested for deadly diseases, orare struggling to afford food.

Testing for deadly diseases remains low.
Most women haven’t been tested for cancer, diabetes, high blood pressure, or sexually transmitted diseases
or infections (STDs/STIs) in the past 12 months, meaning that billions of women went untested for potentiallylife-threatening conditions.

HIGH BLOOD PRESSURE TESTINGCANCER TESTING

36% of women were tested for high bloodpressure — a major risk factor for heartdisease and stroke.

Just 11% of women say they were
tested for any type of cancer.

DIABETES TESTING

STD/STI TESTING

Although diabetes is a leading cause ofdeath for women, only 19% of women
were tested.

Just 10% of women were tested for
an STD/STI — leaving nearly 2 billion
women of reproductive age at risk ofinfertility, increased maternal and fetal
mortality, and deadly diseases.

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Emotional health is getting worse, with notable gaps between men and women.
More women say they are sad, angry and worried now than three years ago, at the height of the
COVID-19 pandemic.
When asked about the emotions they experienced a lot of the previous day, women said:

1 in 43 in 10

ABOUT

ABOUT

EXPERIENCED STRESSEXPERIENCED WORRY

EXPERIENCED ANGER

4 in 10EXPERIENCED SADNESS

4 in 10

These negative emotions were rising before the pandemic, but COVID-19 exacerbated them.
Women are more likely than men to feel these negative emotions; for example, women are 20% more likely
than men to say they experienced sadness a lot of the previous day.

Other striking global findings:
More women say they are in pain now than three years ago. Nearly a billion women —about one in three worldwide — say they spent a lot of the previous day in physical pain.

Fewer women are able to afford housing. Although numbers have remained stable over the past
three years, the percentage of women struggling to afford shelter has increased by nearly half in thepast decade.

Many young women don’t feel safe. More than four in 10 women aged 15 to 24 say they do not feelsafe walking alone at night in the area where they live.

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About the Hologic Global
Women’s Health Index
What do the scores mean?

The Index is a multiyear survey of women and men
worldwide that annually tracks multiple comprehensive
factors related to health. It is designed to fill a critical
gap in what the world understands about the health,safety and well-being of women — informed by
women’s own experiences and opinions — while
shedding light on relevant gender differences.

The Index score is a single-number summary
indicator of women’s answers to survey
questions that, taken together, accountfor approximately 70% of the variance in awoman’s average life expectancy at birth.

Please see the Appendix 1 for more details on how theIndex was developed and scored.

Scores on the Index and each of the five dimensions
range from 0 (worst) to 100 (best). Although the survey
includes men, Index and individual dimension scores
are based only on responses from women and girls.

Why is the Index important?
The Index is one of the world’s largest andmost comprehensive measures of women’s
health, providing actionable insights that canbe used to rapidly improve health policies andpractices worldwide.

While some of the questions used to calculate thesescores ask about negative experiences, such as dailystress, the scores are based on the positive response.
For example, if a woman says “no” when asked
whether she experienced stress during much of theprevious day, that is scored positively.

The Index survey stands out for its annual cadence,
its collection of the voices of women (as well as men
for gender-gap analysis), its broad and intersectional
definition of women’s health, and its extensive global
coverage, including countries and territories where
national statistics and gender-disaggregated data
are limited or unavailable. In addition, because of
Hologic’s commitment to collecting and sharing
these data annually, the Index makes it possiblefor decision-makers to track key trends in women’s
health over time.

What does the Index measure?
The Gallup research team, Hologic and external
experts designed the survey questions to capture
a comprehensive view of women’s health acrossfive dimensions:

Preventive Care
Preventive
Care

Individual Health
Individual
HealthBasic Needs
Needs
Basic

The Hologic Global Women’s Health Index | Year 3 Global Report8

Emotional Health
Emotional
HealthOpinions ofof
Opinions
Health andand Safety
HealthSafety© 2024 Hologic, Inc. All rights expressly reserved.
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Dimension of Women’s Health

Survey Item

Preventive CareTo the best of your knowledge, were you tested for any of the following in the past 12 months?
• High blood pressure• Cancer• Diabetes• Sexually transmitted diseases or infections

Emotional Health

Did you experience the following feelings during a lot of the day yesterday?
• How about worry?
• How about sadness?
• How about stress?
• How about anger?

Opinions of Health and Safety• In the city or area where you live, are you satisfied or dissatisfied with the availabilityof quality healthcare?
• Do you think most pregnant women in the city or area where you live receivehigh-quality healthcare during their pregnancies, or not?
• Do you feel safe walking alone at night in the city or area where you live?

Basic Needs• Have there been times in the past 12 months when you did not have enough money tobuy food that you or your family needed?
• Have there been times in the past 12 months when you did not have enough money toprovide adequate shelter or housing for you and your family?

Individual Health• Do you have any health problems that prevent you from doing any of the things
people your age normally can do?
• Did you experience the following feelings during a lot of the day yesterday?
How about physical pain?

Gallup calculates dimension scores by averaging the responses to the questions in each dimension and creating aweighted average.
Then, each dimension is weighted depending on how much it accounts for the variance in the Index score. For
example, the Preventive Care dimension explains more of the variance in the Index score than the other dimensions,
so it is given more weight. The Index score is the weighted sum of each dimension score.
For more information on the methodology, see the Appendix 2.

When were the data collected?
Year 1, Year 2 and Year 3 refer to the surveys that Hologic and Gallup have conducted annually since 2020. In tables
and charts throughout the report, these are abbreviated as Y1, Y2 and Y3.
Report Year

Data Collection and Analysis

Inaugural report (Year 1)

Year 1 data were gathered in 2020 and analyzed in 2021.

Year 2

Year 2 data were gathered in 2021 and analyzed in 2022.

Year 3

Year 3 data were gathered in 2022 and analyzed in 2023.

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Global Results and Rankings
Women’s global health is no better now than it was at the height of the
COVID-19 pandemic.
Overall, the world scored 54 out of 100 on the Index in Year 3. That’s just one point higher than in Year 2, andthe same as in Year 1. That means the health of women and girls has not meaningfully5 improved since the heightof the COVID-19 pandemic.
At the country level, the picture is more mixed. From Year 1 to Year 3, Index scores increased in 16 countries
and decreased in eight. But all countries — even the best-scoring ones — have work to do: Not one country or
territory scored higher than 72 out of 100.
Index scores for Year 3 range from a high of 72 in Taiwan, which led the world for the third consecutive
year, to a low of 26 in Afghanistan.
Rank

Country/Territory

Hologic Global Women’s Health Index Score

1

Taiwan, Province of China

72

2

Kuwait68

3Austria

67

4

Germany

67

5

Switzerland

66

6

Israel

66

7

Japan

65

8

Denmark

64

9Poland64

10Czech Republic

64

11

Finland

64

12

Netherlands

64

13South Korea

64

14

Belgium

64

15

Vietnam64

16

Norway64

17Singapore

64

18

United Arab Emirates

63

19

China

63

20

Latvia63

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RankCountry/Territory

21

Sweden63

22

Luxembourg

62

23

Estonia62

24

Ireland

62

25

Australia

62

26

Iceland

62

27

Hong Kong, S.A.R. of China

62

28

Greece62

29

Mauritius

61

30

United States of America

61

31

Kazakhstan

61

32

Thailand60

33

Lithuania

60

34

Slovakia

60

35

Kosovo60

36

Slovenia

60

37

United Kingdom of Great Britain and Northern Ireland

60

38

Puerto Rico

60

39

New Zealand

60

40

France60

41

Malaysia

60

42

Bulgaria

60

43

Indonesia

59

44

Saudi Arabia

59

45South Africa

59

46

Croatia

59

47

Hungary

59

48

Portugal

58

49

Cyprus

58

50

Spain

58

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RankCountry/Territory

51

Uruguay

57

52

Uzbekistan

57

53

Malta

57

54

Montenegro

57

55

Tajikistan

57

56

Jamaica

56

57

Italy

56

58

North Macedonia

56

59

Russian Federation

55

60

Costa Rica

55

61

Canada55

62

Serbia

55

63

Chile

54

64

Paraguay

54

65

Romania

54

66

Kyrgyzstan

54

67

Mongolia

54

68

Bosnia and Herzegovina

54

69

Mexico53

70

Algeria

53

71

Tanzania

53

72

Argentina

5273

El Salvador

52

74

Republic of Moldova

52

75

Zambia52

76

Albania51

77

Georgia

51

78

Egypt

51

79

Palestinian Territories

5080

Zimbabwe

49

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RankCountry/Territory81

Lao People's Democratic Republic

49

82

Tunisia

49

83

Botswana

49

84

Eswatini

49

85

Namibia

49

86

Guatemala49

87

Cambodia49

88

Panama49

89

Lesotho49

90

Mozambique

49

91

Nicaragua

48

92

Ghana

48

93

Philippines

48

94

Nigeria

47

95

Iran

47

96

Kenya

47

97

India

47

98

Pakistan

47

99

The Dominican Republic

47

100

Colombia

46

101

Nepal

46

102

Libya

46

103

Türkiye46

104

Brazil46

105

Honduras

46

106

Mali

46

107

Yemen

45

108

Ethiopia

45

109

Jordan45

110

Lebanon45

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RankCountry/Territory

Hologic Global Women’s Health Index Score

111

Bangladesh

45

112

Sri Lanka

45

113

Malawi44

114

Senegal44

115

Armenia

44

116

Azerbaijan

43

117

Myanmar43

118

Uganda43

119

Madagascar

42

120

Venezuela

42

121

Bolivia42

122

Northern Cyprus

42

123

Cameroon

42

124

Peru

41

125

Niger

41

126

Ecuador

41

127

Togo

41

128

Mauritania

41

129

Gambia

40

130

Iraq

40

131

Côte d'Ivoire

40

132

The Comoros

40

133

Guinea40

134

Morocco

39

135

Gabon

39

136

Liberia

38

137

Chad

37

138

Benin

37

139

The Democratic Republic of the Congo

36

140

The Republic of the Congo

35

141

Sierra Leone

34

142*

Afghanistan

26*The Year 3 survey includes 143 countries. Several questions could not be asked in Ukraine due to the ongoing conflict. Because of these missing questions,Gallup could not calculate Ukraine’s overall Index score and certain dimension scores. Some rankings in this report only include 142 countries.

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INSIGHT

G20 member countries, as a whole, perform better than the global average when it comes toopinions of women’s health and safety and meeting women’s basic needs of food and shelter.
Generally, European and Asian countries within the G20 perform best across the Index and on the individual dimensions.
Countries in Latin America, India and Türkiye perform, on average, more poorly than their G20 counterparts.

G20 Country Index Results, Ranked by Overall Score
OverallIndex Score

Preventive
Care

Emotional
HealthOpinions of Healthand Safety

Basic Needs

Individual
HealthGermany

67

36

73

84

90

74

Japan

65

22

78

85

93

78

South Korea

64

37

74

78

75

74

China*

63

19

72

88

86

85

Australia

62

29

71

72

90

71

United States of America

61

36

65

69

82

72

U
 nited Kingdom of GreatBritain and Northern Ireland

60

23

69

73

91

74

France

60

22

69

79

84

73

Indonesia

59

19

75

84

63

83

Saudi Arabia

59

15

71

86

82

73

South Africa

59

42

74

57

57

75

G2 0 AV ERAGE

56

20

67

74

74

73

Italy

56

17

64

68

92

71

Russian Federation

55

24

77

53

69

69

Canada

55

23

60

68

83

67

54

19

66

70

67

71

Mexico

53

23

72

48

65

80

Argentina

52

31

64

51

64

68

India

47

12

57

71

57

59

Türkiye

46

13

55

51

62

79

Brazil

46

18

57

45

69

65

G20 Member Countries

GLO B AL AVER AGE*China data collected in 2021.

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INSIGHT

High incomes and healthcare spending per capita do not guarantee high Index scores.
Many other factors influence women’s health, including laws, cultural norms and climate change.

The U.S. is a case in point. While it is a high-income country with high spending on healthcare per capita, it has fallen
seven places to No. 30 in the overall country rankings, on par with Kazakhstan. Other countries with relatively low rankings
include the United Kingdom (No. 37), France (No. 40) and Canada (No. 61).

Healthcare Spending per Capita by Hologic Global Women’s Health Index Score
75

Hologic Global Women's
Health Index Year 3

Kazakhstan

Austria

IsraelFranceFranceSwitzerland

United Kingdom

United States

Canada50

Sierra Leone
Afghanistan

25

0

Healthcare Spending per Capita (U.S. dollars)

0

2,000

4,000

6,000

8,000

10,000

Possible Index scores range from 0 to 100.

The countries with the lowest Index scores are a mix of mostly low- and lower-middle-income economies. These
countries tend to spend the least on healthcare and have weak or destabilized healthcare infrastructure.
Notably, all countries that rank in the bottom 10 have scores below the global average on the Preventive Caredimension of health — a critical dimension where, as this report shows, the world has the most work to do.

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Highest-Ranking Countries/Territories
OverallIndex Score

ChangeY3-Y1

Preventive
Care
Score

Emotional
HealthScore

Opinions of
Health and
Safety Score

Basic
Needs
Score

Individual
HealthScore

GLOB AL AVE RAG E

54

0

19

66

70

67

71

1


Taiwan,Province of China

72

3

32

86

89

94

85

2

Kuwait*

68

N/A

16

84

97

89

86

3

Austria

67

0

35

74

88

91

74

4

Germany

67

2

36

73

84

90

74

5

Switzerland

66

2

24

80

89

91

72

6

Israel

66

4

21

80

77

96

87

7

Japan

65

4

22

78

85

93

78

8

Denmark

64

0

27

73

88

92

70

9

Poland

64

9

19

84

67

94

87

10

Czech Republic

64

2

33

71

80

91

70

*First appearance in the Index. N/A = Not asked in the comparison year. At the country level, changes must be at least five points higher or lower to be considered meaningful.

Lowest-Ranking Countries/Territories
OverallIndex Score

ChangeY3-Y1

Preventive
Care
Score

Emotional
HealthScore

Opinions of
Health and
Safety Score

Basic
Needs
Score

Individual
Health
Score

54

0

19

66

70

67

71

GLOB AL AVE RAG E

133Guinea

40

-2

16

52

59

34

49

134

Morocco

39

-9

13

51

42

56

52

135

Gabon

39

1

16

58

33

40

60

136

Liberia*

38

N/A

18

52

42

34

53

137

Chad*

37

N/A

17

48

52

39

39

138

Benin

37

-9

8

56

57

27

48

139

T
 he Democratic Republicof the Congo*

36

N/A

14

52

41

30

55

140

The Republic of the Congo

35

-3

11

50

46

33

50

141

Sierra Leone

34

N/A

18

46

39

32

41

142

Afghanistan

26

N/A

10

38

22

19

55

*First appearance in the Index. N/A = Not asked in the comparison year. At the country level, changes must be at least five points higher or lower to be considered meaningful.

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The Five Building Blocks for
Improving Women’s HealthTogether, the five dimensions of the Hologic Global Women’s Health Index —Preventive Care, Emotional Health, Opinions of Health and Safety, Basic Needs,
and Individual Health — paint a comprehensive picture of women’s health.

The State of Global Women’s Health
PREVENTIVE CARE
Year 3Year-OverYear Change
Since Year 2

ChangeSince Year 1

Dimension Score

19

0

0

% Women tested for high blood pressure

36

2

3

% Women tested for cancer

11

-1

-1

% Women tested for diabetes

19

0

0

% Women tested for STDs/STIs

10

-1

-1

Year 3Year-OverYear Change
Since Year 2

ChangeSince Year 1

Dimension Score

66

2

-2

% Women experienced anger previous day

25

-1

2

% Women experienced stress previous day

39

-2

1

% Women experienced sadness previous day

30

-2

4

% Women experienced worry previous day

42

-1

2

Scores in Preventive Care have been flat. Only testing forhigh blood pressure increased in Year 3.

EMOTIONAL HEALTH
Women experience negative emotions — except stress —at higher rates now than in Year 1.

Changes between years for dimension scores are measured in points. Changes between years for individual survey items are measured in percentage points.
At the global level, changes must be at least two points higher or lower to be considered significant.

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OPINIONS OF HEALTH AND SAFETY
Women’s assessments of pregnancy care and healthcare in theirareas now are better than they were in Year 2, and more women feelsafe. Even with these gains, opinions of health and safety today are
no better than what they were in Year 1.

Year 3Year-OverYear Change
Since Year 2

ChangeSince Year 1

Dimension Score

70

4

0

% Women think their area has high-quality pregnancy care

69

4

0

% Women satisfied with the availability of quality healthcare in their area

68

3

0

% Women feel safe walking alone at night where they live

65

4

0

Year 3Year-OverYear Change
Since Year 2

ChangeSince Year 1

Dimension Score

67

1

-1

% Women could not afford food

36

-1

2

% Women could not afford shelter

30

0

1

Year 3Year-OverYear Change
Since Year 2

ChangeSince Year 1

Dimension Score

71

0

-4

% Women with health problems

24

-1

4

% Women experienced physical pain previous day

34

0

4

BASIC NEEDS
Women are as likely to struggle to afford food now as they were inYear 2, but more are struggling today than in Year 1.

INDIVIDUAL HEALTH
Women are as likely to experience pain and have health problems
now as they were in Year 2, but they are more likely to be in pain andhave health problems today than they were in Year 1.

Changes between years for dimension scores are measured in points. Changes between years for individual survey items are measured in percentage points.
At the global level, changes must be at least two points higher or lower to be considered significant.

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SECTION 1

Preventive Care
Testing for Deadly Diseases Remains Low
Preventive care aims to help people avoid illnesses
and detect health problems early, ideally before theonset of symptoms. The right test at the right timehelps make it possible for women to be treated andlive healthier and potentially longer lives.

Testing or screening recommendations for these four
diseases and conditions vary based on a person’s age,gender and the healthcare resources available to themin their community. The 12-month period in the survey
question is not a globally agreed-upon cadence, but
because the Index has been conducted for three years
in a row, it captures testing that may be recommended
in a three-year period at a variety of ages.

Most women say they haven’t been tested 6
for cancer, diabetes, high blood pressure or an
STD/STI in the past 12 months, meaning thatbillions of women went untested for potentiallylife-threatening conditions for the third
consecutive year.

Percentage of Women Tested in Past 12 Months

40
30

Year 1

Year 233

Year 334

36

20

19 19 19

10
0

12 12

High blood pressure

The Hologic Global Women’s Health Index | Year 3 Global Report

1111

CancerDiabetes

23

11

10

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SEC T I O N 1| Preventive Care Dimension

Measuring Preventive Care
The Hologic Global Women’s Health Index’s Preventive Care dimension measures whether women in the past year havebeen tested for any of these serious health conditions by asking:
To the best of your knowledge, were you tested for any of the following in the past 12 months?
• High blood pressure• Cancer• Diabetes• Sexually transmitted diseases or infections
Scores on this dimension are calculated at the individual level. To get a score, individuals need to answer at least
three of the four questions. The resulting score is a simple mean of the positive answers. Higher scores on thePreventive Care dimension mean more women are getting tested for these health factors.

Preventive Care Dimension: Scores and Rankings
Higher scores on the Preventive Care dimension of the Index mean more women are getting tested for these conditions.
The global score for Preventive Care in Year 3 is 19 out of 100 — lower than any other dimension ofhealth. This score has not changed since the first year of the Index — a time when many women could
not access health testing because of COVID-19 restrictions.
The story is not the same everywhere in the world, however. The U.S. and Canada score highest on the Preventive
Care dimension with a score of 35, up four points from Year 1. Scores in sub-Saharan Africa and Northern Africa,
which are easily half as high as those in the U.S. and Canada, are significantly lower in Year 3 than in Year 1.

Preventive Care Dimension Scores by Region
Preventive Care

Change Y3-Y1

Change Y3-Y2

U.S. and Canada

35

4

-3

Caribbean

33

2

8

Australia and New Zealand

29

-2

0

Europe2400Central America

23

-1

-10

South America

21

3

-1

Eastern Asia

20

2

0

Central Asia

20

3

2

Sub-Saharan Africa

18

-4

0

South-eastern Asia

17

-2

3

Northern Africa

15

-7

-1

Western Asia

15

0

0

Southern Asia

13

1

2

At the regional level, changes must be at least two points higher or lower to be considered significant.

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SEC T I O N 1| Preventive Care Dimension

Country Data Within the Preventive Care Dimension
Highest-Ranking Countries/Territories

Preventive
Care Rank

Overall
Index
Rank

Country/Territory

Preventive
Care Score

Overall
Index
Score

Preventive Care
Score Change
Y3-Y1

Preventive Care
Score Change
Y3-Y2

19

54

0

0

GLOBAL AVER AGE

1

38

Puerto Rico*

51

60

N/A

N/A

2

45

South Africa

42

59

-1

11

3

84

Eswatini*

40

49

N/A

N/A

4

89

Lesotho*

38

49

N/A

N/A

5

48

Portugal

38

58

-4

1

42

55

-3

-5

Average of Highest Ranked

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

Lowest-Ranking Countries/Territories

Preventive
Care Rank

Overall
Index
Rank

Preventive
Care Score

Overall
Index
Score

Preventive Care
Score Change
Y3-Y1

Preventive Care
Score Change
Y3-Y2

GLOBAL AVER AGE

19

54

0

0

Country/Territory

139

142

Afghanistan

10

26

N/A

-3

140

15

Vietnam

9

64

-23

-8

141

127

Togo

9

41

N/A

2

142

138

Benin

8

37

-4

0

143

131

Côte d’Ivoire

8

40

0

3

9

42

-9

-1

Average of Lowest Ranked

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

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SEC T I O N 1| Preventive Care Dimension

Countries/Territories With Largest Increases and Declines From Year 2 to Year 3
Two of the countries and territories that saw double-digit gains on the Preventive Care dimension between
Years 2 and 3 — Thailand and South Africa — rank among the top 10 countries in the world on this dimension.
Reported testing increased substantially for all four conditions. For the first time since Year 1, majorities of women in
South Africa (61%) and Thailand (56%) report being tested for high blood pressure.

+

Largest Increases

Preventive
Care Rank

Overall
Index
Rank

8

32

21

Preventive
Care Score

Preventive Care
Score Change Y3-Y2

Thailand

37

13

1

Taiwan, Province of China

32

11

2

45

South Africa

42

11

85

17

Singapore

18

8

14

56

Jamaica34

8Country/Territory

Among the countries and territories that saw meaningful losses on the Preventive Care dimension between Years
2 and 3, Lithuania and Vietnam saw their scores drop well below the global average. Neither country scoredhighly in Year 2, but the losses in Vietnam in Year 3 dropped the country almost to the bottom of rankings globally. In
Vietnam, far fewer women were tested for cancer, diabetes and STDs/STIs compared with the previous year.

–

Largest Declines

Preventive
Care Rank

Overall
Index
Rank

140

15

124

Preventive
Care Score

Preventive Care
Score Change Y3-Y2

Vietnam9-833

Lithuania

13

-9

7

20

Latvia

37

-9

79

9

Poland

19

-12

47

69

Mexico23-12Country/Territory

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SEC T I O N 1| Preventive Care Dimension

Demographic Data Within the Preventive Care Dimension% Yes
Preventive
Care Score

Y3-Y1
ChangeY3-Y2
ChangeTested for highblood pressure

Tested forcancerTested fordiabetes

Tested for
STDs/STIs

15-24

10

0

0

20

4

8

10

25-30

15

-1

0

29

7

13

11

31-40

17

0

1

32

9

16

11

41-50

21

-3

0

38

13

21

10

51-60

28

3

1

51

19

33

9

61-70

30

-1

0

55

18

36

9

71+

33

3

0

64

23

40

6

Age

Area

Urban

20

1

-1

36

13

22

11

Rural

18

0

1

36

10

18

9

Poorest 20%

17

-1

0

34

9

18

9

Second 20%

18

0

0

35

11

18

9

Middle 20%

20

2

0

37

12

20

11

Fourth 20%

20

0

0

36

12

20

9

Richest 20%

21

1

0

38

11

21

12

Per Capita Income Quintiles

At the global level, changes must be at least two points higher or lower to be considered significant.
Quintiles based on respondent-reported income.

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A woman in Cambodia talks about her views during asurvey with a Gallup World Poll interviewer.

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SEC T I O N 1| Preventive Care Dimension

HIGH B LO O D P RESSU R E

Testing Increased Slightly in 2022
Blood pressure tests detect high blood pressure —or hypertension — which is a major risk factor forheart disease and stroke.7 Hypertension has beencalled “the most serious, neglected health problem for
women in both developing and developed worlds,”
because while it is relatively easy to treat, it often
goes undiagnosed.8

In the Year 3 survey, 36% of women were
tested for high blood pressure in the previous
12 months — which is a small but statisticallysignificant increase from 33% in Year 1.
However, this still means that nearly 2 billion
women did not get tested, including morethan half a billion women over the age of 40,
who are recommended to get tested yearly.10

A recent global analysis showed that in thepast 30 years, the number of women withhypertension has almost doubled, with muchof the disease burden shifting from high-income
countries to low- and middle-income countries.9

Reported testing for high blood pressure varies
across the globe, from a low of 13% in Togo to ahigh of 70% in Puerto Rico. Although Togo ranks
the lowest in the world for the second consecutive
year, the 13% of women who report being tested forhigh blood pressure in Year 3 is up slightly from 8% inYear 2, which may reflect the country’s recent efforts
to improve healthcare.11

Countries/Territories With the Highest and Lowest Ratesof High Blood Pressure Testing
Percentage of women tested for high blood pressure in past 12 months

Highest-Ranking Countries/Territories

Lowest-Ranking Countries/Territories

Puerto Rico

70

Afghanistan

18

Latvia68

The Comoros

18

Costa Rica

67

Niger

18

United States of America

65

Benin

16

Uruguay

65

Côte d’Ivoire

15

Togo

13

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SEC T I O N 1| Preventive Care Dimension

INSIGHT INTO PREVENTIVE CARE

Reports of testing increased statistically among women in almost all age groups between
Year 1 and Year 3, except in the 41 to 50 and 61 to 70 age groups.
The largest increase was eight points among women aged 51 to 60, the age group mostclosely associated with the typical onset of menopause.

Percentage of Women Worldwide Tested for High Blood Pressure in Past 12 Months by Age

80
70
60
50
40
30
20
10
0

Year 1

Year 2

Year 3

58

41

26 27

29

28 29

32

37 38

43

48

51

53

55

58

63 64

20
18 19

15-24

25-30

31-40

The Hologic Global Women’s Health Index | Year 3 Global Report

41-50

31

51-60

61-70

71+

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SEC T I O N 1| Preventive Care Dimension

C OUN TRY SPOTL IG HT ON P RE VE N TIVE CARE

Costa Rica
High Rates of Blood Pressure
Testing With Low Healthcare Costs

67%

Costa Rica has one of the highest blood pressure testing
rates in the world, with 67% of women in Year 3 reportingthat they had been tested.
This is 18 points higher than the median for countries in
Latin America and the Caribbean (49%).

Costa Rica’s reported testing rates are on parwith those in the U.S. (65%), even though Costa
Rica spends one-sixth the GDP per capita on
healthcare that the U.S. does and far less than
the global average.12 However, the country
has prioritized public health for decades andinvested heavily in targeting “the most readily
preventable kinds of death and disability.” 13
Today, universal primary care is delivered bythousands of local teams across the country, with
an emphasis on prevention and public health.14

The Hologic Global Women’s Health Index | Year 3 Global Report

Costa Rica also has higher hypertension
treatment rates than most high-income countries,
including the U.S.,15 which helps explain why
mortality from heart disease in the country is 12%
lower for women than it is in the U.S.16 Anotherfactor could be that in Costa Rica, about half ofdoctors are women, compared with about a third
in the U.S.17 Studies have found that a woman ismore likely to survive a heart attack when her
doctor is a woman.18

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SEC T I O N 1| Preventive Care Dimension

CA NCER TESTING

Rates Are No Better Than at the
Height of the Pandemic
The International Agency for Research on Cancer
estimates that globally, one in five people develop
cancer in their lifetime, with one in 11 women dying fromthe disease.19 The burden of cancer is rising globally, inpart related to aging, population growth and expanding
risk factors related to socioeconomic development.
Cancer incidence and deaths have also increased
dramatically in low- and middle-income countries, which
now bear 70% of the global cancer burden.20

In Year 3, just 11% of women were tested forany type of cancer in the past 12 months —which is statistically unchanged from the 12%reported in Years 1 and 2. This means 89%— more than 2 billion women worldwide —went untested.
Cancer testing rates vary widely acrossthe globe, from a low of 0% in Kuwait to ahigh of 46% in Puerto Rico. Notably, testing rates
for women in Pakistan, where only 1% of womenreport being tested, have remained unchanged
since Year 1 — underscoring the sociocultural andstructural barriers that keep women from getting
testing and treatment.23

In all countries, regardless of income level, early
detection and diagnosis improve health outcomesfor many cancers. According to the World HealthOrganization (WHO), between 30% and 50% ofcancers are preventable, with early detection playing
an important role.21 If women have access to treatment
at the earliest possible time, it gives them the best
chance for less aggressive, less costly and more
effective treatment.22

Countries/Territories With the Highest and Lowest Rates of Cancer Testing
Percentage of women tested for cancer in past 12 months

Lowest-Ranking Countries/Territories

Highest-Ranking Countries/Territories

Puerto Rico

46

Philippines

1

South Korea

42

Bangladesh

1Germany37

Afghanistan

1

Eswatini

36

Pakistan

1

Austria

34

Kuwait0

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SEC T I O N 1| Preventive Care Dimension

INSIGHT INTO PREVENTIVE CARE

Concerningly, the cancer testing rate for women in the key 40 to 49 age group — the age
at which women at average risk should be tested for breast and colorectal cancers24 — isjust 11% in Year 3, down from 17% in Year 1 and unchanged from Year 2.25

Percentage of Women Worldwide Tested for Cancer in Past 12 Months by Age

40Year 1

Year 2

Year 3

32
24

26

16

17

8
0

19

9
4

3
15-21

11
8

20

18

24

18

11

8

3
22-39

The Hologic Global Women’s Health Index | Year 3 Global Report

40-49

34

50-74

75+

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SEC T I O N 1| Preventive Care Dimension

C OUN TRY SPOT L IG HT ON P RE VE N TIVE CARE

South Korea
Consistent Top Performer
in Cancer TestingSouth Korea has been a leader in cancer testing among
women for three years in a row: Forty-two percent of South
Korean women report in Year 3 that they were tested for any
type of cancer in the past 12 months.

42%

In 1999, the South Korean government
established the National Cancer Screening
Program (NCSP) to provide clear guidance on
testing protocols and free or low-cost cancer
testing for qualifying women. In 2002, the
NCSP instituted a recommendation for biannual
mammogram screenings beginning at age 40.
This helped to double participation in breast
cancer screening between 2004 and 2018.26

Today, more than 50% of South Korean women
aged 51 and older report they have been tested
for cancer. Given the biannual recommendation
for breast cancer screening, over 50% annual
screenings is an important marker of success forSouth Korea, where breast cancer is the mostcommon cancer for women and a leading causeof cancer death.27

Percentage of South Korean Women Tested for Any Cancer in Past 12 Months

31

Age 15 to 50

54

Age 51 or older

020

The Hologic Global Women’s Health Index | Year 3 Global Report

40

60

35

80

100

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A woman in The Republic of the Congo talks about her
views during a survey with a Gallup World Poll interviewer.

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SEC T I O N 1| Preventive Care Dimension

DIA B ETES TESTING

Diabetes Among Fastest-Growing Killers,
But Testing Remains Flat
Diabetes is a leading cause of death for women — and one of the fastest-growing chronic diseases in the world.
When a person has diabetes, their body doesn’t make enough insulin to regulate blood sugar, or it can’t use theinsulin as well as it should. Over time, this can cause health problems such as heart disease, small vessel disease,vision loss and kidney disease. It is estimated that 537 million adults worldwide were living with diabetes in 2021,
and this number could rise to 643 million by 2030.28
There are three main types of diabetes:29
Type

Age Cohort

Percentage of Diagnoses

Preventable

Type 1Children, teens, young adults

5% to 10%

No, mutation based

Type 2

Adults

90% to 95%

In most cases, with lifestyle changes
in diet and exercise

Gestational

Pregnant women

2% to 10% of pregnancies (U.S.)No, diet and exercise will change thisIn Year 3, fewer than one in five women worldwide(19%) were tested for diabetes in the past 12
months — unchanged from levels in Years 1 and 2.
This means 81% — more than 2 billion women —went untested in each of the past three years.

Testing for diabetes among women varies across theglobe, from a low of 4% in Côte d’Ivoire and Benin toa high of 57% in Puerto Rico.

Countries/Territories With the Highest and Lowest Rates of Diabetes Testing
Percentage of women tested for diabetes in past 12 months

Lowest-Ranking Countries/Territories

Highest-Ranking Countries/Territories

Puerto Rico

57

Tajikistan

7

Greece47

The Republic of the Congo

7

Thailand

45

Mali

6

South Africa

44

Malawi5South Korea

43

Benin

4

Côte d’Ivoire

4

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SEC T I O N 1| Preventive Care Dimension

INSIGHT INTO PREVENTIVE CARE

Globally, women aged 51 to 60 and 71+ have seen the largest increases in reported
testing rates since the Index’s inaugural report, with rates in each age group increasing
four points in Year 3. The increases in testing among these age cohorts are important
to monitor, as age 55 marks the peak age for detection of diabetes globally.30

Percentage of Women Worldwide Tested for Diabetes in Past 12 Months by Age
Year 1

Year 2

Year 3

40

40
37

30

32

36 36

36 36

33

29
25

20
10
0

21 21

14 14
8

7

15-24

16

14

13

16

8

25-30

31-40

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41-50

38

51-60

61-70

71+

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SEC T I O N 1| Preventive Care Dimension

STD/ST I TEST ING

Few Women Checked for Diseases With
Serious Consequences
Reported testing rates for STDs/STIs varyacross countries. Lesotho, a small sub-SaharanAfrican country, leads other countries in testing;nearly half of women in Lesotho (48%) say
they were tested for an STD/STI.

In 2020, WHO estimated 374 million new infections
with one of four curable STIs: chlamydia, gonorrhea,
syphilis and trichomoniasis.31 As the COVID-19 pandemic
persisted, many countries reported disruptions in
STD/STI-related testing and care activities, which helped
lead to a resurgence of STDs/STIs. Even countries withstrong STI surveillance, such as the U.S. and Canada,
have documented increases in syphilis, gonorrhea
and chlamydia.32,33

On the other end of the spectrum, no women in
Kuwait, where it is taboo to talk publicly about
sex-related topics, report being tested for an
STD/STI in the past 12 months.34

In Year 3, just 10% of women were tested for
an STD/STI — leaving nearly 2 billion womenof reproductive age at risk of infertility,
increased maternal and fetal mortality, anddeadly diseases.

In a host of other countries, including Vietnam,
Indonesia, Lithuania, Morocco, Sri Lanka and
Bangladesh, as few as 2% of women reportbeing tested. In most of these countries,
reported testing has been low and stable in all
three years of the survey.

Countries/Territories With the Highest and Lowest Rates of STD/STI Testing
Percentage of women tested for STDs/STIs in past 12 months

Lowest-Ranking Countries/Territories

Highest-Ranking Countries/Territories

Lesotho48

Bangladesh

2

Uganda44

Sri Lanka

2South Africa

34

Morocco2

Zambia34

Lithuania

2

Eswatini

33

Indonesia

2

Vietnam2

Kuwait0

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SEC T I O N 1| Preventive Care Dimension

INSIGHT INTO PREVENTIVE CAREAt the regional level, it is notable that the STD/STI testing rate among women in sub-SaharanAfrica declined from 26% in Year 1 to between 19% and 20% in Years 2 and 3.
This dip is concerning, especially because STDs/STIs can increase the risk of HIV transmission.
If overall STD/STI testing rates do not improve in the region, gains in HIV prevention could
be at risk.35

Percentage of Women Worldwide Tested for STDs/STIs in Past 12 Months by Region
Year 1

Year 2

Year 3

26
22

20

24
19

20

16

21
18

18
14

12

Caribbean

10

12 12

Eastern Asia

Sub-Saharan Africa

13
10

12

5

Central Asia

South-eastern Asia

5

12
9

11
5

U.S. and Canada

10Central America

11

12

12 12
9

EuropeSouth America

9Australia and
New Zealand974Western Asia

4

3

Northern Africa

5

4

4

Southern Asia

Values are missing for the question regarding testing for STDs/STIs in the following countries: Iran and Pakistan in Southern Asia, and Jordan, Saudi Arabia,
and Yemen in Western Asia.

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SEC T I O N 1| Preventive Care Dimension

INSIGHT INTO PREVENTIVE CARE

Globally, it is also of concern that young women aged 15 to 24 are no more likely to havebeen tested for STDs/STIs than women in most other age groups, even though young
women are at greater risk.36

40 Percentage of Women Worldwide Tested for STDs/STIs in Past 12 Months by Age
Year 1

Year 2

Year 3

30
20
10
0

14
9

9

15-24

13

10

25-30

11

12 12

31-40

The Hologic Global Women’s Health Index | Year 3 Global Report

11

13
10 10

41-50

41

9

9

51-60

9

10
7

9
5

61-70

6

6

71+

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SEC TI O N 2

Emotional Health
Negative Emotions Rising, With Notable
Gaps Between Women and Men
About four in 10 women experienced worry andstress during a lot of the previous day; three
in 10 experienced sadness and one in four
experienced anger.

Stress, worry, sadness, anger and other emotions
are all a normal part of life. When these feelings run
high for extended periods, however, they can be
overwhelming and interfere with a person’s ability tocarry out everyday tasks.

These emotions were rising before the pandemic,
but COVID-19 exacerbated them — exacting aneven bigger toll on women’s health. Only stress isunchanged from Year 1.

Negative emotions can become unhealthy andsignal more serious conditions, such as anxiety anddepressive disorders or other mental health diagnoses.
There is also consistent evidence that one’s emotional
state can affect cardiovascular health and risk factors
for other noncommunicable diseases with whichmental disorders can co-occur, such as diabetes andcancer.37,38

INSIGHT INTO EMOTIONAL HEALTH

More women are sad, angry and worried now than they were three years ago. They arealso much more likely than men to feel these emotions.

Negative Emotions Among Women Continue to Run HighDid you experience the following feelings during a lot of the day yesterday?
% Yes
Year 1

Year 2

Year 3

40

43 42

38

41

39
32

23

26 25

Anger

The Hologic Global Women’s Health Index | Year 3 Global Report

26

Worry

Stress4330

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SEC T I O N 2| Emotional Health Dimension

INSIGHT INTO EMOTIONAL HEALTH

Women are more likely than men to report feeling negative emotions. For example,
women are 20% more likely than men to say they experience sadness daily.

Negative Emotions in Year 3 by Gender
Did you experience the following feelings during a lot of the day yesterday?
% Yes
Women

Men

25

Anger

21
42

Worry

39
39

Stress38
30

SadnessThe Hologic Global Women’s Health Index | Year 3 Global Report25

44© 2024 Hologic, Inc. All rights expressly reserved.

SEC T I O N 2| Emotional Health Dimension

Measuring Emotional Health
Feelings and emotions are life’s intangibles that “hard data” like GDP or mortality rates were not designed to capture.
The Emotional Health dimension of the Hologic Global Women’s Health Index gauges women’s daily experiences ofnegative feelings with four questions that have been asked as part of Gallup’s World Poll for more than a decade:• Did you experience the following feelings during a lot of the day yesterday? How about worry?
• Did you experience the following feelings during a lot of the day yesterday? How about sadness?
• Did you experience the following feelings during a lot of the day yesterday? How about stress?
• Did you experience the following feelings during a lot of the day yesterday? How about anger?
Scores on this component are calculated at the individual level. To get a score, individuals need to answer at least
three of the four questions. The resulting score is a simple mean of the positive answers. Higher scores on the
Emotional Health dimension mean fewer women are experiencing negative feelings on a given day.

Emotional Health Dimension: Scores and Rankings
Higher scores on the Emotional Health dimension of the Index mean fewer women are experiencing negative feelings
on a given day. Although higher scores on the individual questions within the Emotional Health dimension mean more
women are experiencing these negative emotions, the dimension score is based on the women who do not say “yes”— the positive response to this question.
The Year 3 global score for Emotional Health is 66 out of 100— up from 64 in Year 2, but below the 68 in Year 1.

A woman in Vietnam talks about her views during asurvey with a Gallup World Poll interviewer.

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SEC T I O N 2| Emotional Health Dimension

Country Data Within the Emotional Health Dimension
Highest-Ranking Countries/Territories

Emotional
Health Rank

Overall
Index
Rank

Emotional
Health Score

Overall
Index
Score

Emotional Health
Score Change
Y3-Y1

Emotional Health
Score Change
Y3-Y2

GLOBAL AVER AGE

66

54

-2

2

Country/Territory

115

Vietnam

89

64

21

20

2

31

Kazakhstan

86

61

0

-2

3

1

Taiwan, Province of China

86

72

-3

-2

4

2

Kuwait*

84

68

N/A

N/A

5

9

Poland

84

64

22

14

Average of Highest Ranked

86

66

10

8

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

Lowest-Ranking Countries/Territories

Emotional
Health Rank

Overall
Index
Rank

Emotional
Health Score

Overall
Index
Score

Emotional Health
Score Change
Y3-Y1

Emotional
Health Score
Change Y3-Y2

GLOBAL AVER AGE

66

54

-2

2

Country/Territory

139

115

Armenia

47

44

N/A

-9

140

141

Sierra Leone

46

34

N/A

-3

141

122

Northern Cyprus*

43

42

N/A

N/A

142

130

Iraq

43

40

4

-7

143

142

Afghanistan

38

26

N/A

16

Average of Lowest Ranked

43

37

4

-1

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

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SEC T I O N 2| Emotional Health Dimension

Countries/Territories With Largest Increases and Declines From Year 2 to Year 3
Apart from Afghanistan, all countries and territories that saw meaningful gains on the Emotional Healthdimension between Years 2 and 3 score above the global average of 66. Although Afghan women’s scores
have improved year over year, they still rank last in the world on this dimension. Majorities of Afghan women still
experience daily stress, sadness and worry, but they are smaller majorities than in years past, and their experiencesof anger dropped below the majority level to 43% in Year 3.

+

Largest Increases

Emotional
Health Rank

Overall
Index
Rank

1

15

143

Emotional Health
Score

Emotional Health
Score Change Y3-Y2

Vietnam

89

20

142

Afghanistan

38

16

40

28

Greece

73

15

5

9

Poland

84

14

24

32

Thailand76

11

Country/Territory

All countries and territories that saw meaningful losses on the Emotional Health dimension between Years 2 and3 experienced economic, political or even armed conflict in Year 3. The country with the largest decrease on thisdimension, Ukraine, which fell 22 points, was invaded by Russia in early 2022.39 All negative emotions soared among
Ukrainian women as the conflict continued, but worry and anger more than doubled.

–

Largest Declines

Emotional
Health Rank

Overall
Index
Rank

118

91

Nicaragua

56

-9

93

117

Myanmar

63

-9

139

115

Armenia

47

-9

135

134

Morocco

51

-12

123

N/A

Ukraine54-22

Emotional Health
Score

Country/Territory

Emotional Health
Score Change Y3-Y2

N/A: Due to the ongoing conflict in Ukraine, several questions could not be asked in that country.
Because of these missing questions, Gallup could not calculate an overall Index score for Ukraine.

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SEC T I O N 2| Emotional Health Dimension

Demographic Data Within the Emotional Health Dimension% Yes
Emotional
Health Score

Y3-Y1
ChangeY3-Y2
ChangeExperienced
anger

Experienced
stressExperienced
sadness

Experienced
worry

15-24

69

-1

2

26

35

25

36

25-30

65

-1

3

28

38

31

42

31-40

63

-3

1

30

43

30

44

41-50

65

-2

1

25

42

30

43

51-60

64

-3

2

22

38

35

48

61-70

66

-5

-2

19

34

35

45

71+

73

-5

1

14

28

29

37

Urban

68

-1

1

23

41

25

38

Rural

64

-3

2

27

37

34

45

Age

Area

Per Capita Income Quintiles

Poorest 20%

59

-2

2

31

45

39

50

Second 20%

64

-1

3

26

40

32

45

Middle 20%

67

-2

1

25

37

28

42

Fourth 20%

71

-1

1

21

34

25

36

Richest 20%

70

-2

-1

23

36

24

36

At the global level, changes must be at least two points higher or lower to be considered significant.
Quintiles based on respondent-reported income.

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A woman in Kazakhstan talks about her views during asurvey with a Gallup World Poll interviewer.

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SEC T I O N 2| Emotional Health Dimension

Gender Gaps in Emotional Health Widest inSouth and Central America and the Caribbean
All people feel negative emotions. Globally,
however, women continue to be more likely thanmen to experience negative emotions daily.

Given the lack of gender-disaggregated mental
and emotional health data in these regions, theannual availability of women’s health data likethese may be a particularly valuable resource.40

Regionally, the gender gap in emotional health— with more women than men feeling thesenegative emotions — is most pronounced inSouth and Central America and the Caribbean,
where double-digit gaps separate women andmen on most of the negative emotions.

Percentage Point Differences Between Women and Men on Negative Emotions in Year 3
Gender gap (women-men) in daily experiences ofAnger

StressSadnessWorry

G LO B AL PO PU LATION

4

1

5

3

South America

10

16

12

10

Caribbean

4

16

13

12

Central America

4

9

11

5

Central Asia

4

8

7

10

Southern Asia

8

0

8

6

Western Asia

2

3

5

5

Europe0266Australia and New Zealand

-2

5

10

4

Northern Africa

1

2

6

4

South-eastern Asia

6

4

3

0

U.S. and Canada

0

5

6

3

Sub-Saharan Africa

1

-1

3

2

Eastern Asia

4

-7

-2

-5

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SEC T I O N 2| Emotional Health Dimension

While the Index measures emotional health, which
is separate from a clinical mental health diagnosis,
there are relationships between chronic negative
emotions and mental health conditions.

There are underlying contributing factors that help
explain why so many women in these regions areexperiencing these emotions. Globally, women’s
experiences with health problems and pain (asmeasured on the Individual Health dimension) andtheir ability to afford food (as measured on the Basic
Needs dimension) are related to a higher incidenceof feeling negative emotions. These relationships
are evident in South America, where women in are
more likely than men to experience physical pain
(43% vs. 35%), have health problems (25% vs. 22%)and struggle to afford food (45% vs. 36%).

Studies have found depression is twice as
frequent among women in Latin America andthe Caribbean as it is among men.41
Further, for some mental and substance use
conditions, nearly 90% of people in these regions
will not receive the treatment they require.42

Percentage Point Differences Between Women and Men on Ability to Afford Food, Health Problems
and Physical Pain in Year 3
Gender gap (women-men)
Could not afford
food at times

Have health problems thatprevent them from doing thingsothers their age normally can doExperienced physical pain in
the previous day

G LO BA L PO PULATION

2

2

4

South America

9

3

8

Caribbean

-2

0

11

Central America

7

-2

2

Central Asia

4

4

8

Southern Asia

5

7

10

Western Asia

4

4

8

Europe343Australia and New Zealand

5

9

8

Northern Africa

1

6

9

South-eastern Asia

2

1

1

U.S. and Canada

3

5

4

Sub-Saharan Africa

-1

3

3

Eastern Asia

-5

-4

0

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SECT I O N 3

Opinions of Health and Safety
Women Feel No Safer, No More Satisfied
With Healthcare
Many women — including more than four in 10
young women between the ages of 15 and 24— do not feel safe walking alone at night. And
many women are dissatisfied with the availabilityof quality healthcare where they live.

Women’s satisfaction with the availability of quality
healthcare where they live and their perceptions of
the quality of prenatal care in their communities arelargely missing from standard global health statistics.
WHO estimates that worldwide, one woman diesevery two minutes from preventable causes related
to pregnancy and childbirth.43 In environments where
women feel personally safe, adolescent pregnancy
rates and maternal mortality rates are lower andhealth expenditures per capita are higher.44

INSIGHT INTO OPINIONS OF HEALTH AND SAFETY

More than one in three women do not feel safe walking alone at night in their own
community — meaning that nearly 1 billion women feel unsafe. However, while theproportion of women who feel unsafe is down slightly from Year 2, it is the same as thepercentage in Year 1.

Percentage of Women Who Feel Safe Walking Alone at Night Where They Live by Age

90Year 1

Year 2

60

65

65

61

Year 3

64
52 50

56

59

63

70

71

65 67

68

71

71

66

71

64

59

63

66
52

59

30
0

Global

15-24

25-30

The Hologic Global Women’s Health Index | Year 3 Global Report

31-40

41-50

53

51-60

61-70

71+

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SEC T I O N 3| Opinions of Health and Safety Dimension

INSIGHT INTO OPINIONS OF HEALTH AND SAFETY

Nearly seven in 10 women are satisfied with the availability of quality healthcare where
they live and believe most pregnant women in their communities receive high-quality
prenatal care. Slightly more women feel this way in Year 3 than did in Year 2, but theirattitudes are largely the same as in Year 1.

Women’s Perceptions of Quality Healthcare Availability and Prenatal Care
Year 1

Year 2

Year 369

68 65 68

69

% Think most pregnant women in theirarea receive high-quality care

% Satisfied with availabilityof quality healthcare

The Hologic Global Women’s Health Index | Year 3 Global Report

65

54

©
© 20242024 Hologic,
Hologic, Inc.
Inc. AllAll rights
rights expressly
expressly reserved.
reserved.
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SEC T I O N 3| Opinions of Health and Safety Dimension

Measuring Opinions of Health and Safety
The Opinions of Health and Safety dimension of the Hologic Global Women’s Health Index gauges women’s satisfaction
with access to quality healthcare in general, whether they think pregnant women receive high-quality care and whether
they feel safe walking alone at night. Three questions make up this dimension:• Do you think most pregnant women in the city or area where you live receive high-quality healthcare during theirpregnancies, or not?
• In the city or area where you live, are you satisfied or dissatisfied with the availability of quality healthcare?
• Do you feel safe walking alone at night in the city or area where you live?
Scores on this dimension are calculated at the individual level. To get a score, individuals need to answer at least two of thethree questions. The resulting score is a simple mean of the positive answers. Higher scores on the Opinions of Health and
Safety dimension mean more women feel safe and satisfied with the quality and availability of healthcare where they live.

Opinions of Health and Safety Dimension: Scores and Rankings
Higher scores on the Opinions of Health and Safety dimension mean more women feel safe and are satisfied
with the quality and availability of healthcare where they live.
The global score for Opinions of Health and Safety in Year 3 is 70 out of 100,up from 66 in Year 2 but unchanged from Year 1.

A woman in Nepal talks about her views during a survey
with a Gallup World Poll interviewer.

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SEC T I O N 3| Opinions of Health and Safety Dimension

Country Data Within the Opinions of Health and Safety Dimension
Highest-Ranking Countries/Territories

Opinions of
Health and
Safety Rank

Overall
Index
Rank

Opinions of
Health and
Safety Score

Overall
Index
Score

Opinions of Healthand Safety Score
Change Y3-Y1

Opinions of Healthand Safety Score
Change Y3-Y2

GLOBAL AVERAGE

70

54

0

4

Country/Territory

1

2

Kuwait*

97

68

N/A

N/A

2

18

United Arab Emirates

95

63

0

4

3

17

Singapore

93

64

N/A

-4

4

55

Tajikistan

90

57

4

1

5

1

Taiwan, Province of China

89

72

4

1

Average of Highest Ranked

93

65

3

1

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

Lowest-Ranking Countries/Territories

Opinions of
Health and
Safety Rank

Overall
Index
Rank

Country/Territory

Opinions of
Health and
Safety Score

Overall
Index
Score

Opinions of Healthand Safety Score
Change Y3-Y1

Opinions of Healthand Safety Score
Change Y3-Y2

70

54

0

4

GLOBAL AVERAGE

138

124

Peru

37

41

5

1

139

126

Ecuador

35

41

-8

-1

140

135

Gabon  

33

39

0

0

141

120

Venezuela

32

42

5

13

142

142

Afghanistan

22

26

N/A

11

Average of Lowest Ranked

32

38

1

5

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

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SEC T I O N 3| Opinions of Health and Safety Dimension

Countries/Territories With Largest Increases and Declines From Year 2 to Year 3
Except for Mali and Lebanon, all countries and territories that saw meaningful gains on the Opinions of Healthand Safety dimension between Years 2 and 3 score at or above the global average of 70. Mali’s 17-point
increase improved its score to 68, while the 14-point increase in Lebanon improved its score to 42. Even with thisimprovement, Lebanon still ranks among the lowest-scoring countries on this dimension, reflecting the ongoing
political and economic turmoil gripping the country.

+

Largest Increases

Opinions of
Health and
Safety Rank

Overall
Index
Rank

46

56

15

Opinions of Healthand Safety Score

Opinions of Health and
Safety Score Change Y3-Y2

Jamaica

70

22

15

Vietnam

85

18

50

106

Mali

68

17

43

73

El Salvador

71

15

131

110

Lebanon42

14Country/Territory

All countries and territories that saw meaningful losses on this dimension between Years 2 and 3 score well below
the global average of 70. Scores in Sierra Leone dropped 11 points — ranking it among the lowest-scoring countries in
the world in Year 3 — as the country was roiled by protests as well as a strike by the country’s healthcare providers.45–

Largest Declines

Opinions of
Health and
Safety Rank

Overall
Index
Rank

Country/Territory

Opinions of Healthand Safety Score

Opinions of Health and
Safety Score Change Y3-Y2

69

101

Nepal

64

-6

123

82

Tunisia

44

-6

137

63

Chile

38

-6

77

46

Croatia

61

-10

136

141

Sierra Leone

39

-11

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SEC T I O N 3| Opinions of Health and Safety Dimension

Demographic Data Within the Opinions of Health and Safety Dimension% Yes
Opinions of
Health and
Safety Score

Y3-Y1
ChangeY3-Y2
ChangeThink pregnant women
receive high-quality
healthcare

Satisfied withavailability of quality
healthcare

Feel safe
walking alone
at night

15-24

65

0

4

66

68

56

25-30

68

0

3

69

68

63

31-40

70

-2

3

72

68

67

41-50

73

-1

3

72

69

71

51-60

73

0

5

70

68

71

61-70

69

-3

3

67

65

63

71+

73

-5

5

67

72

59

Urban

72

0

2

70

72

65

Rural

68

-1

4

69

66

64

Age

Area

Per Capita Income Quintiles

Poorest 20%

66

-1

5

65

64

61

Second 20%

69

-2

5

70

66

63

Middle 20%

70

-1

3

69

69

66

Fourth 20%

72

1

3

72

72

66

Richest 20%

73

-1

2

71

73

67

At the global level, changes must be at least two points higher or lower to be considered significant.
Quintiles based on respondent-reported income.

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A woman in Niger talks about her views during a survey
with a Gallup World Poll interviewer.

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SP OT LIG H T O N

Domestic Violence
In Year 3, two in three women worldwide(64%) say domestic violence is a widespread
problem in their country. Nearly six in 10 men(56%) agree.

While not part of the calculation of the Index, theissue of domestic violence is important to women’squality of life and longevity on its own. This is why
Hologic and Gallup continue to ask women and men
every year about the scope of domestic violence intheir countries. According to the UN’s most recent
estimates, worldwide, more than five women were
killed every hour in 2021 by a family member or
intimate partner.46
Due to the sensitivity of the topic, which is often
taboo or could pose a risk to the respondent to speak
openly about in many settings, the survey question
frames the issue indirectly, allowing women and men
to safely express their views on domestic violence intheir country broadly without having to report on theirown victimization or that of loved ones:

Globally, majorities of both women and men agree
on the pervasiveness of the problem, but the gap
between men and women’s perceptions of domestic
violence remains just as wide today as it was the firstyear that Hologic and Gallup asked the question.
These gender gaps are important markers of leaders’willingness and interest in developing and enforcing
laws to prevent and respond to domestic violence,as well as to invest in evidence-based prevention
programs and response services for survivors.

“Domestic violence can be physical, psychological,
or involve sexual acts done to someone against
their will by a person they live with. In your opinion,
is domestic violence a widespread problem in[country name], or not?”It’s important to note that this question measurespeople’s perceptions of domestic violence as awidespread problem. Rather than reflecting theincidence of domestic violence, respondents’ answers
may be a better indicator of their awareness of theseriousness of the challenge facing their countries.

The gender divides are more than twice thesize of the global gap in a host of countries
that illustrate how the issue of domestic
violence transcends income, educationand culture.

While the pandemic seemed to create a new senseof urgency around making violence against womena global public health and policy priority, the findings
show domestic violence is perceived as just as bigof a problem in Year 3 as it was in Year 1, by both
women and men.

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When looking at the 10 countries with the biggest gaps in men’s and women’s perceptions, four — Canada,
Norway, Sweden and South Korea — rank in the top 20 countries with the highest scores on the UN
Human Development Index.47% Women who
say domestic
violence iswidespread% Men who
say domestic
violence iswidespread

Percentage
point gender gap(women-men)% Women who haveexperienced physicaland/or sexual violence48

UN HumanDevelopment
Index49

Pakistan

84

52

32

29

.544

Latvia

73

44

29

25

.863

Lithuania

61

35

26

22

.875

Canada

81

57

24

44

.936

Norway

52

30

22

20

.961

RussianFederation


57

36

21

*

.822

Slovenia

79

61

18

18

.918

Armenia

65

47

18

10

.759

Sweden

71

53

18

21

.947

South Korea

62

45

17

*

.925

Country/Territory*Data unavailable.

Prevention of domestic violence requires engagementof all stakeholders, including men and boys. In
addition to prevention, countries must continue toinvest in survivor-centered and trauma-informed
services. This requires capacity strengthening acrossmultiple sectors, including justice, law enforcement,
healthcare and housing in partnership with women-led
organizations and other advocacy groups.

In these 10 countries, which all have at least a 17-point
gap between men’s and women’s perceptions ofdomestic violence as a problem, incidence rates
remain relatively high. At least one in 10 women inthese countries will experience domestic or intimate
partner violence in their lifetime. Together, these data
illustrate how difficult it will be to achieve SDG target
5.2.1, which calls for the elimination of violence against
women and girls.50

Although evidence is lacking, meta-analyses suggestthat engaging men and boys as primary prevention
advocates is still in its infancy and mostly focusedon individual, rather than systemic, change.51
Much work remains to gain universal recognitionof domestic violence as an urgent, widespreadsocietal challenge.52

To help change these gender dynamics, countries
must prioritize evidence-based prevention andresponse programs and policies that transform social
norms and behaviors that sustain domestic violenceand other forms of violence against women.

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SECT I O N 4

Basic Needs
Nearly 1 Billion Women Still Struggling
to Afford Food
Having enough safe and nutritious food to eat
and safe, affordable housing are two basic
needs for healthy living. Adults who lack regularaccess to enough safe and nutritious food are
disproportionately at risk for obesity and chronic
diseases. Hunger or undernourishment is also a
leading risk factor for death and other negative
health outcomes — leading to 9 million deaths ayear, more than the death toll from AIDS, malaria
and tuberculosis combined.53

In the Year 3 survey, 36% of women couldn’t afford
the food their families needed. While this is slightly
higher than the 34% in Year 1, it is largely attributable
to the addition of 22 countries in Year 3, the majorityof which are lower- and middle-income countries.
Without these countries included, the percentage ofwomen struggling to afford food in Year 3 is 34% —the same percentage as in Year 1. The Year 3 figure
is one percentage point lower than the 37% who
reported struggling in Year 2.

Three in 10 women worldwide — whichtranslates into nearly 1 billion women — saythey cannot afford the food or shelter thatthey or their families need.

INSIGHT INTO BASIC NEEDS

Three in 10 women say there have been times in the past year when they were unable
to afford adequate shelter or housing for themselves or their families. While the percentages haveremained unchanged for the past three years of the Index, in Gallup’s historical trends on this question,
the percentage of women struggling to afford shelter has almost doubled in the past decade.

Women Struggling to Afford Basic Needs
Year 1

Year 2

Year 334

37 36
29 30 30

% Could not afford shelter at times% Could not afford food at times

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SEC T I O N 4| Basic Needs Dimension

Measuring Basic Needs
The Basic Needs dimension of the Hologic Global Women’s Health Index gauges women’s ability to meet their basic
needs with two questions that Gallup’s World Poll has asked for more than a decade:• Have there been times in the past 12 months when you did not have enough money to buy food that you or yourfamily needed?
• Have there been times in the past 12 months when you did not have enough money to provide adequate shelteror housing for you and your family?
Scores on this dimension are calculated at the individual level. To get a score, individuals need to answer both questions.
The resulting score is a simple mean of the positive answers. Higher scores on the Basic Needs dimension mean fewer
women are struggling to afford the food and shelter they need.

Basic Needs Dimension: Scores and Rankings
Higher scores on the Basic Needs dimension mean fewer women in a country are struggling to afford thefood and shelter they need.
The global score for Basic Needs in Year 3 is 67 out of 100,
which is statistically unchanged from Years 1 and 2.

A woman in Benin talks about her views during a survey
with a Gallup World Poll interviewer.

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SEC T I O N 4| Basic Needs Dimension

Country Data Within the Basic Needs Dimension
Highest-Ranking Countries/Territories

Basic Needs
Rank

Overall
Index
Rank

Basic Needs
Score

Overall
Index
Score

Basic Needs
Score Change
Y3-Y1

Basic Needs
Score Change
Y3-Y2

GLOBAL AVERAGE

67

54

-1

1

Country/Territory1

21

Sweden

97

63

4

0

2

6

Israel

96

66

7

1

3

12

Netherlands

95

64

-1

3

4

1

Taiwan, Province of China

94

72

1

0

5

9

Poland

94

64

4

5

Average of Highest Ranked

95

66

3

2

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

Lowest-Ranking Countries/Territories

Basic Needs
Rank

Overall
Index
Rank

Basic Needs
Score

Overall
Index
Score

Basic Needs
Score Change
Y3-Y1

Basic Needs
Score Change
Y3-Y2

GLOBAL AVERAGE

67

54

-1

1

Country/Territory

139

96

Kenya   

31

47

-2

-8

140

139

T
 he Democratic
Republic of the Congo*

30

36

N/A

N/A

141

125

Niger*

28

41

N/A

N/A

142

138

Benin

27

37

-11

-13

143

142

Afghanistan

19

26

N/A

-6

Average of Lowest Ranked

27

37

-7

-9

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

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SEC T I O N 4| Basic Needs Dimension

Countries/Territories With Largest Increases and Declines From Year 2 to Year 3
Even with higher scores on this dimension in Year 3, three countries, Türkiye, Zambia and Cambodia, post scoreson the Basic Needs dimension that are lower than the global average of 67. In Cambodia, the majority of women
struggle to afford both food (61%) and shelter (53%).

+

Largest Increases

Basic Needs
Rank

Overall
Index
Rank

72

103

59

Basic Needs Score

Basic Needs Score
Change Y3-Y2

Türkiye

62

17

59

Russian Federation

69

14

48

15

Vietnam

82

13

112

87

Cambodia

43

11

101

75

Zambia46

11Country/Territory

Apart from Malaysia, the countries with the biggest meaningful declines all score below the global average on the
Basic Needs dimension in Year 3. In Benin, which posted the lowest score on this dimension of the group, 79% of
women struggled to afford food and 65% could not afford shelter at times.

–

Largest Declines

Basic Needs
Rank

Overall
Index
Rank

121

88

Panama

40

-13

142

138

Benin

27

-13

63

41

Malaysia

68

-14

84

32

Thailand

56

-14

76

74

Republic of Moldova

59

-14

81

98

Pakistan

56-15Country/Territory

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Basic Needs Score

66

Basic Needs Score
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SEC T I O N 4| Basic Needs Dimension

Demographic Data Within the Basic Needs Dimension% Yes
Basic Needs
Score

Y3-Y1
ChangeY3-Y2
ChangeCould not afford
food at times

Could not afford
shelter at times

15-24

63

-5

-2

39

33

25-30

64

0

1

39

33

31-40

64

-2

0

40

32

41-50

68

2

0

34

30

51-60

68

-1

3

36

28

61-70

71

-6

-1

31

26

71+

81

-6

1

21

17

Urban

73

1

-1

29

25

Rural

62

-3

2

42

34

Age

Area

Per Capita Income Quintiles

Poorest 20%

57

-1

0

49

37

Second 20%

63

0

3

41

33

Middle 20%

68

-3

2

35

29

Fourth 20%

72

-3

-2

29

27

Richest 20%

75

-1

-3

26

24

At the global level, changes must be at least two points higher or lower to be considered significant.
Quintiles based on respondent-reported income.

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SEC T I O N 4| Basic Needs Dimension

C OUN TRY SPOT L IG HT ON B ASIC N E E D S

Bangladesh
Dramatic Increase in Women’s
Inability to Meet Basic Needs

Year 3 saw a continuing decline in Bangladeshi
women’s ability to meet their basic needs — asboth food and shelter insecurity continue to rise.
The proportion of women who struggled
to afford food increased by 30 points
over two years, and the proportion
struggling to afford shelter more thandoubled, increasing 34 points.

More than five in 10 households

reported borrowing money, going into
debt or selling assets to buy food.54,55

Global economic conditions and inflation
have contributed to the worsening situation in
Bangladesh, where inflation hit a 10-year highat the time of the survey. In May 2023, inflation
surpassed the 9.52% record set last August(during the Year 3 survey data collection),soaring to 9.94%.

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SEC T I O N 4| Basic Needs Dimension

C OUN TRY SPOT L IG HT ON B ASIC N E E D S

In addition, climate change is affecting the agricultural system in Bangladesh.56
Catastrophic flooding, droughts and rising seawater levels are forcing systemic changes to farming,
water collection, sanitation and other basic functions to support day-to-day life. The effects of thesechanges are not gender neutral, with women bearing the brunt. Data from the Index can inform efforts todevelop more gender-responsive monitoring and evaluation of the consequences of climate change in
Bangladesh, as called for by the UN.57

More Bangladeshi Women Struggling to Afford the Basics% Struggled to afford food

% Struggled to afford shelter

61

67

55
37

47

21

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Year 2

69

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SECT I O N 5

Individual Health
Physical Pain Is a Significant Problem
Nearly a billion women — one in three —say they spent a lot of the previous day inphysical pain. And one in four women — whichtranslates into nearly 700 million — have
health problems that keep them from doing
normal activities.

Health-related statistics such as disease rates, life
expectancy and maternal mortality are standard metrics
that can provide a great deal of insight into a country’s
overall health. However, these standard measures arelimited, utilitarian and often not available annually. They
also shed little light on how health problems affectwomen’s daily lives.
The Individual Health dimension looks at two critical,
but often overlooked, measures: women’s experiencesof physical pain and health problems.

INSIGHT INTO INDIVIDUAL HEALTH

Thirty-four percent of women report experiencing physical pain during a lot of theprevious day — which is the same as the 34% who reported this in Year 2, but up from 30% inYear 1. In all three years, more women than men have reported experiencing physical pain.

Women in Physical Pain Daily
Did you experience the following feelings during a lot of the day yesterday? How about physical pain?
% Yes

34

34

Year 1

Year 2

Year 3

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SEC T I O N 5| Individual Health Dimension

INSIGHT INTO INDIVIDUAL HEALTH

Twenty-four percent of women say they have health problems that prevent them fromdoing things people their age normally can do — statistically the same as the 25% in Year 2
who said this, but up from 20% in Year 1.

Women’s Experience of Health Problems
Do you have any health problems that prevent you from doing any of the things people your age normally can do?
% Yes

25

24

20

Year 1

Year 2

Year 3

INSIGHT INTO INDIVIDUAL HEALTH

Women with an elementary education or less are disproportionately affected by daily
pain and health problems. This coincides with a declining belief among less educatedwomen that checkups with a health professional improve health.

Women’s Individual Health Varies With Education
Completedelementary
education or lessCompletedsecondaryeducation

Completed four years of education
beyond high school or received
four-year college degree% Experienced physical pain

44

28

20

% Have health problems

33

19

12

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SEC T I O N 5| Individual Health Dimension

Measuring Individual Health
The Individual Health dimension of the Hologic Global Women’s Health Index gauges women’s dailyexperiences of pain and health problems with two questions that have been asked as part of Gallup’s
World Poll for more than a decade:• Did you experience the following feelings during a lot of the day yesterday? How about physical pain?
• Do you have any health problems that prevent you from doing any of the things people your age normally can do?
Scores on this dimension are calculated at the individual level. To get a score, individuals need to answer bothquestions. The resulting score is a simple mean of the positive answers. Higher scores on the Individual Healthdimension mean fewer women are experiencing health problems and pain on a given day.

Individual Health Dimension: Scores and Rankings
Higher scores on the Individual Health dimension mean fewer women are experiencing health problems
and pain on a given day.
The global score for Individual Health in Year 3 is 71 out of 100,
which is unchanged from Year 2 but down from 75 in Year 1.

A woman in Chad talks about her views during a survey
with a Gallup World Poll interviewer.

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SEC T I O N 5| Individual Health Dimension

Country Data Within the Individual Health Dimension
Highest-Ranking Countries/Territories

Individual
Health Rank

Overall
Index
Rank

Individual
Health Score

Overall
Index
Score

Individual Health
Score Change
Y3-Y1

Individual Health
Score Change
Y3-Y2

GLOBAL AVERAGE

71

54

-4

0

Country/Territory

115

Vietnam

89

64

6

4

2

9

Poland

87

64

14

10

3

6

Israel

87

66

5

3

4

2

Kuwait*

86

68

N/A

N/A

5

1

Taiwan, Province of China

85

72

0

-3

Average of Highest Ranked

87

67

6

4

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

Lowest-Ranking Countries/Territories

Individual
Health Rank

Overall
Index
Rank

Country/Territory

Individual
Health Score

Overall
Index
Score

Individual Health
Score Change
Y3-Y1

Individual Health
Score Change
Y3-Y2

71

54

-4

0

GLOBAL AVERAGE

139

138

Benin

48

37

-21

-7

140

128

Mauritania*

47

41

N/A

N/A

141

130

Iraq

45

40

-8   

-5

142

141

Sierra Leone

41

34

N/A

-18

143

137

Chad*

39

37

N/A

N/A

Average of Lowest Ranked

44

38

-15

-10

N/A = Not asked in the comparison year.
*First appearance in the Index.
At the global level, changes must be at least two points higher or lower to be considered significant.
At the country level, changes must be at least five points higher or lower to be considered meaningful.

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SEC T I O N 5| Individual Health Dimension

Countries/Territories With Largest Increases and Declines From Year 2 to Year 3
Except for Lebanon, all countries and territories that saw meaningful increases between Year 2 and Year 3 on the
Individual Health dimension post scores above the global average of 71. Higher scores in Mexico, Poland and Türkiye
vaulted these countries to the top of the rankings on this dimension in Year 3, with Poland ranking second in the world.

+

Largest Increases

Individual
Health Rank

Overall
Index
Rank

12

103

2

Individual Health Score

Individual Health Score
Change Y3-Y2

Türkiye79119Poland

87

10

63

110

Lebanon

69

8

34

46

Croatia

73

8

10

69

Mexico80

8Country/Territory

All countries and territories that saw meaningful losses between Year 2 and Year 3 on the Individual Healthdimension post scores well below the global average. Sierra Leone saw the biggest decline in the group year overyear and ranks almost last in the world on this dimension.

–

Largest Declines

Individual
Health Rank

Overall
Index
Rank

108

135

132

Individual Health Score

Individual Health Score
Change Y3-Y2

Gabon  

60

-10

74

Republic of Moldova

52

-10

113

117

Myanmar

59

-11

133

134

Morocco

52

-12

142

141

Sierra Leone

41

-18

Country/Territory

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SEC T I O N 5| Individual Health Dimension

Demographic Data Within the Individual Health Dimension% Yes
Individual
Health Score

Y3-Y1
ChangeY3-Y2
ChangeHave health problems

Experienced physical pain

15-24

81

-3

1

13

25

25-30

77

-4

1

16

31

31-40

75

-3

0

18

33

41-50

69

-3

1

26

36

51-60

59

-3

-2

38

44

61-70

53

-6

-4

47

47

71+

56

-6

0

43

45

Urban

76

0

-1

19

29

Rural

67

-7

1

28

38

Poorest 20%

64

-3

0

28

43

Second 20%

68

-4

1

27

36

Middle 20%

70

-7

-1

25

34

Fourth 20%

75

-4

-2

19

30

Richest 20%

77

-3

0

19

27

Age

Area

Per Capita Income Quintiles

At the global level, changes must be at least two points higher or lower to be considered significant.
Quintiles based on respondent-reported income.

The Individual Health experiences of rural women are also getting worse. Rural women were nearparity with urban women on this dimension in Year 1, but a gap opened in Year 2 that has not closed.
A nine-point gap separates them on both physical pain and health problems in Year 3.

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SEC T I O N 5| Individual Health Dimension

COUN TRY SPOT L IG HT ON IN D IVID UAL HE ALT H

FinlandChronic Pain, Health
Conditions Mean Fewer
Quality Years for Women

While the Index is focused on the globallyconsistent factors associated with longer lives
for women, it is also important to understand thequality of the additional years. The European
Union conducted a study to determine thenumber of healthy life years expected for
citizens within each of its member states. Healthy
life years, also known as disability-free life
expectancy (DFLE), are defined as the numberof years that a person is expected to continue tolive in a healthy condition.58,59

Overlaying life expectancy at birth, healthy life
years, and women’s self-reported experiencesof pain and health problems illustrates the toll
additional years can take on women. While Finnish
women are expected to live six years beyond theaverage life of a Finnish man, they can expect tolive two fewer healthy life years. This net of eight
more non-healthy years among women versus
men is among the highest in the EU.60

Life Expectancy at Birth and Healthy Life
Years for Finnish Women and Men

Experience of Pain in Previous Day
Among Finnish Women and Men

Life expectancy at birth

Healthy life years

Female
50

100

85

79
57

0

Male

33

59

22 21
0

FemaleMale% in Pain 202019
% in Pain 2022

Within the context of the Index data, the picture of these additional years becomes even more clear, with
33% of women reporting they were in pain the day before, compared with 19% of men. This disparity
is 13 points larger today than in Year 1. The contributing factors to these large gaps are complex, but
undoubtedly they serve as a call to address the unique needs of Finnish women as they age.

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Conclusion
This year’s Index should serve as a global wake-up call.
The data in this report lead to an inescapable conclusion: Across most dimensions, women’s health is seriously at
risk. And even where we’re seeing improvements, the pace of progress is far too slow.

If we don’t do more, and quickly, billions of women will suffer. The next generation of girls and young
women will be at even greater risk. And any hope of achieving the SDGs by 2030 will be lost.
To reignite progress in women’s health, urgent action is required from partners worldwide.

1 

Global leaders — including governments, funders, UN agencies and other international institutions — must
make good on their commitments, including pledges to include women and girls in decision-making that
affects their health and lives.

2 
3 

Countries must prioritize and commit funding to advance women’s health and safety.
Women’s health advocates must engage broader coalitions of partners to ensure that women’s healthand safety are prioritized across movements — from disaster relief to economic empowerment toenvironmental protection.

Hologic hopes that the Index will continue to inspire and guide these efforts. It will also be an important accountability
tool, tracking indicators aligning with or complementing global commitments, including the SDGs.
We can meaningfully improve the health and well-being of all women for generations to come if we follow theroadmap set out in this Index. The data are clear. Now, let’s seize the opportunity.

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The Hologic Global Women’s Health Index | Year 3 Global Report79© 2024 Hologic, Inc. All rights expressly reserved.
Hologic_Y3GlobalReport_MainReferences for Year 3 Global Report
1

The Lancet. (2023). A broader vision for women’s health. The Lancet, 402(10399), 347. https://doi.org/10.1016/
s0140-6736(23)01570-2

2 Because data were not collected in China in 2022, the data collected in 2021 are used in all calculations andestimates in this report.
3 The Year 3 survey includes 143 countries. Several questions could not be asked in Ukraine due to the ongoing
conflict. Because of these missing questions, Gallup could not calculate Ukraine’s overall Index score and certain
dimension scores. Some rankings in this report only include 142 countries.
4 World Health Organization. (2022, October 18). Staggering backsliding across women’s, children’s andadolescents’ health revealed in new UN analysis. World Health Organization. https://www.who.int/news/item/18-102022-staggering-backsliding-across-women-s--children-s-and-adolescents--health-revealed-in-new-un-analysis
5 Significant and meaningful differences: At the global and regional levels, where sample sizes are large, differencesmust be at least two points to be considered statistically significant. Gallup also considers whether differences are likely
meaningful in the real world. At the country level, sample sizes are smaller, and differences must be at least five points
to be considered meaningful.
6 The survey questionnaire asked people whether they had been “tested” for these four conditions rather than“screened,” the clinical term typically used to refer to scheduled preventive tests. This wording choice was madeto help ensure the questions were easily comprehensible to all respondents.
7 Vogel, B., Acevedo, M., Appelman, Y., Merz, C. N. B., Chieffo, A., Figtree, G. A., Guerrero, M., Kunadian, V., Lam, C.
S., Maas, A. H., Mihailidou, A. S., Olszanecka, A., Poole, J. E., Saldarriaga, C., Saw, J., Zühlke, L., & Mehran, R. (2021).
The Lancet women and cardiovascular disease commission: Reducing the global burden by 2030. The Lancet,
397(10292), 2385–2438. https://doi.org/10.1016/s0140-6736(21)00684-x
8 Wenger, N. K., Arnold, A., Merz, C. N. B., Cooper-DeHoff, R. M., Ferdinand, K. C., Fleg, J. L., Gulati, M., Isiadinso, I.,
Itchhaporia, D., Light-McGroary, K. A., Lindley, K. J., Mieres, J. H., Rosser, M., Saade, G. R., Walsh, M. N., & Pepine, C.
J. (2018). Hypertension across a woman’s life cycle. Journal of the American College of Cardiology, 71(16), 1797–
1813. https://doi.org/10.1016/j.jacc.2018.02.033
9 World Health Organization. (2021, August 25). More than 700 million people with untreated hypertension. World
Health Organization. https://www.who.int/news/item/25-08-2021-more-than-700-million-people-with-untreatedhypertension
10 Office of Disease Prevention and Health Promotion. (2023, May 22). Get your blood pressure checked. U.S.
Department of Health And Human Services. https://health.gov/myhealthfinder/doctor-visits/screening-tests/getyour-blood-pressure-checked
11 WHO Regional Office for Africa. (2022, May 19). Supporting Togo’s health care improvement drive. World HealthOrganization. https://www.afro.who.int/countries/togo/news/supporting-togos-health-care-improvement-drive
12 Bala, A. (2022, March 9). Costa Rica prioritizes public health. International Monetary Fund. https://www.imf.org/en/
News/Articles/2022/03/09/cf-costa-rica-prioritizes-public-health

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13 Ibid.
14 Gawande, A. (2021, August 23). Costa Ricans live longer than we do. What’s the secret? The New Yorker. https://www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret
15 World Health Organization. (2021, August 25). More than 700 million people with untreated hypertension. World
Health Organization. https://www.who.int/news/item/25-08-2021-more-than-700-million-people-with-untreatedhypertension
16 Rosero-Bixby, L., & Dow, W. H. (2016). Exploring why Costa Rica outperforms the United States in life expectancy: A
tale of two inequality gradients. Proceedings of the National Academy of Sciences of the United States of America,
113(5), 1130–1137. https://doi.org/10.1073/pnas.1521917112
17 The Global Health Observatory. (2023, January 12). Medical doctors by sex (%). World Health Organization.
https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-by-sex
18 Farber, O. N. (2018, August 6). Women survive a heart attack more often when their doctor is female, study finds.
STAT. https://www.statnews.com/2018/08/06/heart-attacks-women-female-doctors/
19 Union for International Cancer Control. (2020, December 17). GLOBOCAN 2020: New global cancer data. UICC.
https://www.uicc.org/news/globocan-2020-new-global-cancer-data
20 International Agency for Research on Cancer. (2023). Cancer today. World Health Organization. https://gco.
iarc.fr/today/online-analysis-pie?v=2020&mode=population&mode_population=income&population=900&po
pulations=900&key=total&sex=0&cancer=39&type=1&statistic=5&prevalence=0&population_group=0&ages_
group%5B%5D=0&ages_group%5B%5D=17&nb_items=7&group_cancer=1&include_nmsc=1&include_nmsc_
other=1&half_pie=0&donut=0
21 World Health Organization. (2022, February 3). Cancer. World Health Organization. https://www.who.int/newsroom/fact-sheets/detail/cancer
22 World Health Organization. (n.d.) Promoting cancer early diagnosis. https://www.who.int/activities/promotingcancer-early-diagnosis
23 Saeed, S., Asim, M., & Sohail, M. M. (2021). Fears and barriers: Problems in breast cancer diagnosis and treatment
in Pakistan. BMC Women’s Health, 21(1), 151. https://doi.org/10.1186/s12905-021-01293-6
24 National Cancer Institute. (2022, November 10). Screening tests. https://www.cancer.gov/about-cancer/screening/
screening-tests#recommended-cancer-screening-tests
25 World Cancer Research Fund International. (n.d.). Worldwide cancer data. WCRF International. https://www.wcrf.
org/cancer-trends/worldwide-cancer-data/
26 Economist Impact. (2023). Enhancing patient-centred approaches to optimise early-breast cancer care: A review
of current practice in South Korea. Economist. https://impact.economist.com/perspectives/sites/default/files/msd_
south_korea_early_breast_cancer_report_v3_1.pdf

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27 Jung, K., Kang, M. J., Park, E. H., Yun, E. H., Kim, H., Kong, H., Im, J., & Seo, H. G. (2023). Prediction of cancer
incidence and mortality in Korea, 2023. Cancer Research and Treatment, 55(2), 400–407. https://doi.org/10.4143/
crt.2023.448
28 International Diabetes Federation. (n.d.). Diabetes Facts and Figures. https://idf.org/about-diabetes/diabetesfacts-figures/
29 Centers for Disease Control and Prevention. (2023, September 5). What is diabetes? https://www.cdc.gov/
diabetes/basics/diabetes.html
30 Khan, M. A., Hashim, M., King, J., Govender, R. D., Mustafa, H., & Kaabi, J. A. (2020). Epidemiology of Type 2
diabetes – Global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1),107–111. https://doi.org/10.2991/jegh.k.191028.001
31 World Health Organization. (2023, July 10). Sexually transmitted infections (STIs). https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)
32 World Health Organization. (2022, September 2). STIs in 2022: Emerging and re-emerging outbreaks.
World Health Organization. https://www.who.int/news/item/02-09-2022-stis-in-2022-emerging-and-reemerging-outbreaks
33 Centers for Disease Control and Prevention. (2023, April 11). Impact of COVID-19 on STDs. https://www.cdc.gov/
std/statistics/2021/impact.htm
34 Alhasawi, A., Grover, S., Sadek, A., Ashoor, I., Alkhabbaz, I., & Almasri, S. (2019). Assessing HIV/AIDS knowledge,
awareness, and attitudes among senior high school students in Kuwait. Medical Principles and Practice, 28(1),470–476. https://karger.com/mpp/article-pdf/28/5/470/3127663/000500307.pdf
35 Joshi, K., Lessler, J., Olawore, O., Loevinsohn, G., Bushey, S., Tobian, A. A., & Grabowski, M. K. (2021). Declining
HIV incidence in sub-Saharan Africa: A systematic review and meta-analysis of empiric data. Journal of theInternational AIDS Society, 24(10). https://doi.org/10.1002/jia2.25818
36 Centers for Disease Control and Prevention. (2022, April 12). CDC fact sheet: Information for teens and young
adults: Staying healthy and preventing STDs. https://www.cdc.gov/std/life-stages-populations/stdfact-teens.htm
37 Levine, G. N., Cohen, B. E., Commodore-Mensah, Y., Fleury, J., Huffman, J. C., Khalid, U., Labarthe, D. R., Lavretsky,
H., Michos, E. D., Spatz, E. S., & Kubzansky, L. D. (2021). Psychological health, well-being, and the mind-heart-bodyconnection: A scientific statement from the American Heart Association. Circulation, 143(10). https://doi.org/10.1161/
cir.0000000000000947
38 Stein, D. J., Benjet, C., Gureje, O., Lund, C., Scott, K. M., Poznyak, V., & Van Ommeren, M. (2019). Integrating mental
health with other non-communicable diseases. BMJ, 364, l295. https://doi.org/10.1136/bmj.l295
39 Center for Preventive Action. (2023, October 17). War in Ukraine. Global Conflict Tracker. https://www.cfr.org/
global-conflict-tracker/conflict/conflict-ukraine
40 Gaviria, S. L., & Rondón, M. B. (2010). Some considerations on women’s mental health in Latin America and the
Caribbean. International Review of Psychiatry, 22(4), 363–369. https://doi.org/10.3109/09540261.2010.500868

The Hologic Global Women’s Health Index | Year 3 Global Report82© 2024 Hologic, Inc. All rights expressly reserved.
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41 World Health Organization. (n.d.). Mental health. Pan American Health Organization. https://www.paho.org/en/
topics/mental-health
42 Pan American Health Organization. (2023). Policy for improving mental health. https://iris.paho.org/bitstream/
handle/10665.2/57237/OPASNMHMH230002_eng.pdf?sequence=1&isAllowed=y43 Suzuki, E., Kouame, C., & Mills, S. (2023, February 22). Progress in reducing maternal mortality has stagnated and
we are not on track to achieve the SDG target: New UN report. World Bank Blogs. https://blogs.worldbank.org/
opendata/progress-reducing-maternal-mortality-has-stagnated-and-we-are-not-track-achieve-sdg-target
44 Gallup. (2022). Worldwide research methodology and codebook. Gallup, Inc.
45 Fofana, U. (2022, August 2). Sierra Leone doctors strike over pay, fuel allowances. Reuters. https://www.reuters.
com/world/africa/sierra-leone-doctors-strike-over-pay-fuel-allowances-2022-08-01/
46 UN News. (2022, November 22). Home is a deadly place for many women and girls, UN report reveals. United
Nations. https://news.un.org/en/story/2022/11/1130962
47 United Nations Development Programme. (n.d.). Human development insights. Human Development Reports.
https://hdr.undp.org/data-center/country-insights#/ranks
48 OECD. (n.d.). Violence against women. OECD Data. https://data.oecd.org/inequality/violence-against-women.htm
49 United Nations Development Programme. (n.d.). Human development insights. Human Development Reports.
https://hdr.undp.org/data-center/country-insights#/ranks
50 The Global Health Observatory. (n.d.). SDG target 5.2.1 | Eliminate violence against women and girls: Eliminate allforms of violence against all women and girls in the public and private spheres, including trafficking and sexualand other types of exploitation. World Health Organization. https://www.who.int/data/gho/data/themes/topics/
indicator-groups/indicator-group-details/GHO/sdg-target-5.2.1-eliminate-violence-against-women-and-girls
51 Wells, L., & Fotheringham, S. (2021). A global review of violence prevention plans: Where are the men and boys?
International Social Work, 65(6), 1232–1248. https://doi.org/10.1177/0020872820963430
52 Hologic. (2022). The Hologic Global Women’s Health Index: Pathways to a healthy future for women.
https://hologic.womenshealthindex.com/en
53 United Nations. (n.d.). COVID-related hunger could kill more people than the virus. United Nations Global
Compact. https://unglobalcompact.org/take-action/20th-anniversary-campaign/covid-related%20hunger-could-killmore-people-than-the-virus
54 Trading Economics. (n.d.). Bangladesh inflation rate. https://tradingeconomics.com/bangladesh/inflation-cpi
55 OCHA. (2022, December 19). Bangladesh: Food security monitoring November 2022 - Remote household foodsecurity survey brief - Bangladesh. ReliefWeb. https://reliefweb.int/report/bangladesh/bangladesh-food-securitymonitoring-november-2022-remote-household-food-security-survey-brief

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56 Sengupta, S. (2023, June 25). Bangladesh offers a glimpse of the water crises of tomorrow. The New York Times.
https://www.nytimes.com/2023/06/25/climate/bangladesh-water-floods.html
57 UN Women and IUCN. (2022). State of gender equality and climate change in Bangladesh. UN Women. https://
asiapacific.unwomen.org/sites/default/files/2022-08/FINAL-Bangladesh-State-of-Gender-Equality-and-ClimateChange-Report_10-08-22.pdf
58 Eurostat Statistics Explained. (n.d.). Glossary: Healthy life years (HLY). https://ec.europa.eu/eurostat/statisticsexplained/index.php?title=Glossary:Healthy_life_years_(HLY)
59 Eurostat. (2019, February 4). Number of healthy years of life: Countries compared. Eurostat. https://ec.europa.eu/
eurostat/web/products-eurostat-news/-/DDN-20190204-1
60 Eurostat Statistics Explained. (2023, March 14). File: Table01 life expectancy at birth 2021.png. https://ec.europa.eu/
eurostat/statistics-explained/index.php?title=File:Table01_Life_expectancy_at_birth_2021.png

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AP P E N DI X 1Developing the Hologic Global
Women’s Health Index

The goal of the Hologic Global Women’s Health Index is to contribute to extending the life expectancy of womenaround the world and improving their quality of life. The ultimate outcome of the partnership with Gallup is to create
a global measure to track progress in key aspects of women’s health and well-being that informs change to improve
women’s health in the future.
The Gallup World Poll has collected data since 2005 in more than 160 countries and territories and over 140 languages.
To consistently and accurately collect data on the same indicators from a wide range of respondents in different countries
and territories, questions are rigorously tested to ensure clarity and precision so that they are easily translated, wellunderstood and interpreted across cultures.

Why an Index?
An Index provides the opportunity to summarize the multidimensional construct we are measuring —factors contributing to women’s health — in an easy-to-interpret way. This produces a tool to assess
progress over time and captures the interest of both the public and policymakers. This means that it will beeasier to communicate complex ideas and promote accountability.
It is important to clearly communicate what the Index captures to not oversimplify complex issues andtopics and to avoid overstating policy conclusions. We are transparent with our methodology and what theIndex does and does not measure, including the weighting process used to combine the variables.

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Development of the Hologic Global Women’s Health Index
1

Theoretical framework development

In consultation with a wide and growing list of experts,
Hologic and Gallup set out to understand which key
metrics would be most salient to a women-reported
Index of health at the national level.

While not all of these issues can accurately be measured
in a non-epidemiological social science survey, they
convey that women’s health is a combination of physical,
social, economic and political factors (culture, poverty,
discrimination, violence, system of provision of healthservices, geographical location, etc.).

The World Health Organization (WHO) listed the top
10 issues for women’s health 20 years after countries
signed pledges in the 1995 Beijing Declaration andPlatform for Action, adding that women still face many
health problems, which we must recommit to address(Bustreo, 2015).

This process of working with experts and existingknowledge sources identified three key objectives ofthe survey:
1) Capture knowledge, attitudes and behaviors

These included:(KAB model) related to health, which is a common
framework for health surveys across many culturesand languages (Bhattacharya et al., 2018; Fan etal., 2018; Mustafa et al., 2008; Okobia et al., 2006;
Zhang et al., 2020).

• cancer• reproductive health• maternal health• HIV2) Focus on female-specific health issues:• sexually transmitted diseases (STDs) and sexuallytransmitted infections (STIs)

a. prenatal health, pregnancy and deliveryb. health consequences of gender-based violence:
sexual and physical violence• violence against women• mental healthc. increasingly common causes of death:heart and lung disease, cervical, lung andbreast cancer, and obesity• noncommunicable diseases• age-related issues (teenage pregnancies; older
women may have fewer pensions and benefits,less access to healthcare and social services,and greater risk of poverty, compounded by themore widespread health challenges associatedwith old age)d. aging-related and noncommunicablediseases, which are increasing while infectious
diseases are decreasing — making preventive
care essential
3) Bring attention to actionable areas to increase

female longevity:

An additional list put forth by the WHO in 2020 indicates
top health checks for women, which include: bloodpressure, blood glucose tests, body mass index, bonedensity screening, breast cancer detection, colon cancer
detection, dental checkups, lipid profile checks andscreening for cervical cancer (Pap smears and HPV
testing) (WHO, 2020b).

a. increasing years of education to improve thelife expectancy, independence and earning
power of womenb. reducing domestic violence, sexual assault
and femicidec. diagnosing conditions early so they are
effectively treated and having services toprovide care on an ongoing basisd. decreasing neonatal and infant mortality, as wellas maternal mortality

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2

Indicator and data selection

The Gallup World Poll already includes items that cover general health and quality of life, opinions of general health,safety and victimization, food and shelter insecurity, and emotional health and well-being. Because the Gallup World
Poll creates nationally representative samples in each country, the survey is intended for both male and female
respondents. Accordingly, the survey questions should be as broadly applicable as possible.
Building on these existing items, Gallup and Hologic developed the following module to field starting in 2020.
These items were cognitively tested in seven countries: Nigeria (Yoruba and English), Kyrgyzstan (Russian), Vietnam(Vietnamese), United States (English), United Kingdom (English), Peru (Spanish) and Tunisia (Arabic). This process
helped refine the final survey questionnaire and ensured that questions are well interpreted and understood acrossdifferent countries, cultures and languages.
These questions are also discussed in greater detail in the subsequent section.

Hologic Survey Module Included in the Gallup World Poll
Topic

Question

Why It Matters

Value ofpreventive care

• Do you think going to a healthcare
professional, such as a medical
doctor or a nurse, at least once
every 12 months for a checkup,
can help people improve theirhealth, or not?

Knowledge and attitudes toward preventive healthcare
are the first two dimensions of “knowledge, attitudes andbehaviors theory” (KAB). KAB is a health behavior theory ofchange wherein the change in human behavior is divided into
three successive processes, namely, acquisition of the rightknowledge, generation of attitudes and adoption of behaviors(or practices) (Bhattacharya et al., 2018; Fan et al., 2018; Mustafa
et al., 2008; Okobia et al., 2006; Zhang et al., 2020).

Experience ofpreventive care

• In the past 12 months, haveyou talked to a healthcare
professional, such as a medical
doctor or nurse, about yourown health?

Knowledge and attitudes need to lead to concrete behaviors,
which are shaped by individual and social barriers.

• To the best of your knowledge,
were you tested for any of thefollowing in the past 12 months?
[High blood pressure, cancer,
diabetes, STDs/STIs]?

• Heart disease is the leading cause of death in both men andwomen (CDC, 2020b).
• Men and women are susceptible to different types of cancer,
and testing is crucial to early diagnosis and increasing theodds of successful treatment (CDC, 2020a).
• Obesity and diabetes-related diseases are a growing concern
around the world and are associated with heart disease, as
well as increased incidence of certain cancers (CDC, 2021b).
• STDs/STIs have an outsized impact on women’s reproductive
health and fertility (compared to men) (CDC, 2021a).

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TopicQuestion

Why It Matters

Prenatal care

• Do you think most pregnant
women in the city or area where
you live receive high-quality
healthcare during theirpregnancies, or not?

Perceptions of the quality of prenatal care are lacking in
global statistics — a critical dimension of women’s healthcare
experiences throughout their lives.

Pregnancy• How many children do you,personally, have?

A woman’s age of first pregnancy and number of children havea strong relationship with years of education, employability,
household income, time available to manage personal health,mental health, etc. (PRB, 2011; UNFPA, 2021a; UNICEF, 2021;
World Bank, 2021).

• How old were you the first time
you were pregnant?

Domestic violence

Now I would like to ask you aquestion regarding domestic
violence. Domestic violence can bephysical, psychological, or involve
sexual acts done to someone
against their will by a person they
live with. In your opinion, is domestic
violence a widespread problem in[country name], or not?

Perceptions of widespread domestic violence can vary
for different groups (e.g., men vs. women). In addition, thepsychological burden of believing domestic violence iswidespread could be tied to negative well-being outcomes.

Value of Preventive Care
Do you think going to a healthcare professional, such as a medical doctor or a nurse, at least once every
12 months for a checkup, can help people improve their health, or not?
Rationale
Preventive health screenings and yearly primary care consultations have been found to significantly increase life
expectancy, particularly among the 30- to 75-year-old age group, but recommendations vary greatly depending on
the disease, level of resources in the community and gender.
The framing of this item specifically addresses people’s knowledge and attitudes (“do you think”) toward preventive
care and provides a specific time frame (“at least once every 12 months”) to aid with recall.
The question is also framed neutrally and the final clause “or not” allows respondents to answer based on personal
opinions, reducing the chance of social desirability bias as much as possible. This framing may appear odd in English,
but Gallup has found it to be highly successful in reducing acquiescence bias, especially in other languages.

Implications• Inform where preventive care is not occurring systematically.
• Earlier detection of chronic illnesses and deadly diseases helps decrease mortality rates. Many of the top risk
factors leading to illness and premature death can be prevented.
• Reduce medical expense through early detection.

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Experience of Preventive CareIn the past 12 months, have you talked to a healthcare professional, such as a medical doctor or nurse,
about your own health?
Rationale
This item is a follow-up to the previous question about knowledge and attitudes and seeks to uncover whether
respondents have taken action to seek annual preventive care (behavior or practice).
The concept of a visit to a healthcare professional is described in simple and broad terms (“have you talked toa healthcare professional […] about your own health”) to capture unscheduled, informal consultations as well as
annual health examinations. The question echoes the specific time frame used in the previous question (“the past 12
months”) to aid with recall and yield more precise responses.
The question also defines who is considered a medical professional. In some countries, a nurse may be considered“less than” a doctor and therefore their checkup and medical advice could be given less credence. Specifying who
is considered a medical professional also helps eliminate any informal sources of health advice, such as local healers
or family members credited with health knowledge, especially in countries with less access to medical infrastructure.

Implications• Highlight potential differences and service inequities between populations.
• Educate the public regarding personal care behaviors.

To the best of your knowledge, were you tested for any of the following in the past 12 months?
[High blood pressure, cancer, diabetes, STDs/STIs]?
Rationale
The framing of this question lets us survey participants on four different issues using a common stem, which makes
the overall time involved in asking the questions shorter and allows respondents to move through the battery quickly,
reducing the overall cognitive burden of the survey.
The item is being framed as a yes/no question to simplify the process of answering.
In addition, the inclusion of STDs/STIs — a highly sensitive topic — occurs at the end of the list to allow respondents
to gain confidence in answering questions about less sensitive diseases before disclosing their answer.
The question provides a specific time frame to aid with recall and precision in the responses.
The diseases themselves are described in the simplest terms possible and translated into local languages using thecommonly used terminology.

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Following the question about discussing health with a healthcare professional, the four types of specific screenings
were chosen because they include the most frequent, fastest growing and/or most damaging diseases for women:• Heart disease is the leading cause of death in both men and women (CDC, 2020b).
• Cancer is the second-leading cause of death globally and was responsible for an estimated 10 million deaths in
2020. Globally, about one in six deaths is due to cancer (CDC, 2020a; WHO, 2021c).
• Obesity and diabetes-related diseases are a growing concern around the world and are associated with heartdisease, as well as increased incidence of certain cancers (CDC, 2021b; WHO, 2021b, 2021g).
• STDs/STIs have an outsized, potentially devastating impact on women’s reproductive health and fertility(compared with men) (CDC, 2021a).

Implications• Earlier detection of chronic illnesses and deadly diseases helps decrease mortality rates.
• Underscores the importance of understanding the role of annual screenings in improving health andcurtailing expenses.
• The COVID-19 pandemic may have an amplifier effect on already worrying trends:- Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes (WHO, 2021g).
- Diabetes is one of the fastest-growing health challenges of the 21st century, with the number of adults livingwith diabetes having more than tripled over the past 20 years (IDF, 2019).

Maternal Care
Do you think most pregnant women in the city or area where you live receive high-quality healthcare
during their pregnancies, or not?
Rationale
Perceptions of the quality of maternal care are lacking in global statistics. This item is inviting an opinion of prenatal
care based on personal experience and knowledge of local institutions.
The geographical delimitation to the local vicinity (“city or area where you live”) helps respondents express
an opinion more confidently since they are more likely to know about the situation locally rather than in theirregion or country.
By asking about “most pregnant women,” respondents are encouraged to consider a broad majority of women,
regardless of their socioeconomic status and beyond their own social circle.

Implications• Most maternal deaths are preventable with timely management by a skilled healthcare professional working in a
supportive environment (WHO, 2021a).
• Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth.
Ninety-four percent of all maternal deaths occur in low- and lower-middle income countries (WHO, 2019).
• Maternal conditions are the top cause of mortality among girls aged 15 to 19 globally (UNICEF, 2021). Adolescentpregnancy is common and high risk for the neonate and mother.

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Pregnancy
How many children do you, personally, have?
How old were you the first time you were pregnant? [Question only asked of female respondents who
said they had children in the previous question.]
Rationale
A lot can be learned about a woman and her socioeconomic status through her age at her first pregnancy and her
number of children. A woman’s age at first pregnancy and number of children can impact her overall health, numberof years of education, employability, household income, time available to manage personal health and mental health(PRB, 2011; UNFPA, 2021a; UNICEF, 2021; WHO, 2020a; World Bank, 2021).
Notably, the question about the age at first pregnancy is the only question asked only of women in the survey as partof the Hologic survey module.
The questions are extremely simple, allowing respondents to answer accurately and easily.

Implications• Adolescent mothers (aged 10 to 19 years) face higher risks of eclampsia, puerperal endometritis and systemic
infections than women aged 20 to 24 years, and babies of adolescent mothers face higher risks of low birthweight, preterm delivery and severe neonatal conditions (UNFPA, 2021a; WHO, 2020a).
• Adolescent pregnancy takes an enormous toll on a girl’s education and income-earning potential and longevity.
Many girls who become pregnant are pressured or forced to drop out of school. Leaving school jeopardizes agirl’s future economic prospects and excludes her from other opportunities in life (UNFPA, 2021a).

Domestic Violence
Now I would like to ask you a question regarding domestic violence. Domestic violence can be physical,
psychological, or involve sexual acts done to someone against their will by a person they live with.
In your opinion, is domestic violence a widespread problem in [Country], or not?
Rationale
Domestic violence has dramatic health and safety consequences for women of all socioeconomic backgrounds
around the world. The belief that domestic violence is widespread and thus negatively affects health and safety could
potentially lead to the deconstruction of harmful norms, such as victim-blaming, and could optimistically lead to acultural awakening, as seen during the #MeToo movement. Cultural movements and grassroots initiatives focusing on
domestic violence can be strong forces in calling for social and legislative change, putting pressure on leaders to act.
This question allows respondents to express their view on the incidence of domestic violence without having todiscuss their own victimization or that of loved ones.
The item intentionally asks how “widespread” the problem is, rather than how “serious” or “important,” given that thequestion of gravity elicited high levels of agreement due to desirability bias during cognitive testing.
Answers to this question framed at the national level may be based on personal contact with domestic abusers andsurvivors, but also on awareness of the national debate on the issue.

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Implications• Domestic violence against women is a major public health and education problem globally and can damage
physical, mental and financial well-being (UNFPA, 2021b; UNHCR, 2021; WHO, 2021e; World Bank, 2019).
• Across their lifetime, one in three women — around 736 million — are subjected to physical or sexual violence byan intimate partner or sexual violence from a non-partner, a number that has remained largely unchanged overthe past decade (WHO, 2021d, 2021f).
• The WHO lists a series of commitments countries can honor to reduce violence against women and girls:- sound gender transformative policies, from policies on childcare to equal pay, and laws that support
gender equality- a strengthened health system response that ensures access to survivor-centered care and referral to otherservices as needed- school and educational interventions to challenge discriminatory attitudes and beliefs, including
comprehensive sexuality education- a targeted investment in sustainable and effective evidence-based prevention strategies at local, national,
regional and global levels- strengthening data collection and investing in high-quality surveys on violence against women andimproving measurement of the different forms of violence experienced by women, including those who aremost marginalized (WHO, 2021e)• The provision of assistance, including in humanitarian settings and to mitigate secondary impacts of the COVID-19
pandemic, such as food insecurity and gender-based violence (National Security Directive (sec 2. (b)(iii)(B))).

Determining the Dimensions of Health and Calculating theHologic Global Women’s Health Index
Approaching analysis in Year 3 of the Index
In the third year of fielding the Index, researchers replicated the process to test for robustness in the Year 1 andYear 2 analysis and to confirm that the assumptions from Year 1 and Year 2 remained true. We found that assumptions
remained valid, and the process of calculating the Index is described in more detail in the following sections.
The Year 3 analysis result shows that:• All the selected variables used for Index creation cluster in the same way as in Year 1 and Year 2. That is, theYear 3 Index is made up of the same five sub-indexes and each sub-index includes the same elements as inYear 1 and Year 2.
• The weights associated with each dimension calculated based on Year 3 data are within 2% of theircorresponding values in Year 1 and Year 2. The changes are minor, allowing one to directly compare the Indexscore across years.

Factor analysis
The Gallup and Hologic research team initially hypothesized that 18 items would be usable for the Index.

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Items considered for inclusion in the Hologic Global Women’s Health Index
Note: Items marked in blue are from the Hologic World Poll module. All other items are Gallup historical items
collected since 2005.
Topic

Question

Attitudes andbehaviors regarding
preventive care

• Do you think going to a healthcare professional, such as a medical doctor or a nurse, at least once
every 12 months for a checkup, can help people improve their health, or not?
• In the past 12 months, have you talked to a healthcare professional, such as a medical doctor or
nurse, about your own health?
• To the best of your knowledge, were you tested for any of the following in the past 12 months?
[High blood pressure, cancer, diabetes, STDs/STIs]?

Domestic violence• Now I would like to ask you a question regarding domestic violence. Domestic violence can bephysical, psychological, or involve sexual acts done to someone against their will by a person they
live with. In your opinion, is domestic violence a widespread problem in [country name], or not?
• Do you feel safe walking alone at night in the city or area where you live?

Access to quality
maternal care andpersonal experienceof childbirth• Do you think most pregnant women in the city or area where you live receive high-quality healthcare
during their pregnancies, or not?

General quality
healthcare access• In the city or area where you live, are you satisfied or dissatisfied with the availability of quality
healthcare?

Food and shelter
accessibility• Have there been times in the past 12 months when you did not have enough money to buy food thatyou or your family needed?

• How many children do you, personally, have?
• How old were you the first time you were pregnant?

• Have there been times in the past 12 months when you did not have enough money to provide
adequate shelter or housing for you and your family?
Overall health(quality of life,
daily pain levels)• Do you have any health problems that prevent you from doing any of the things people your age
normally can do?

Emotional
well-being issues• Did you experience the following feelings during a lot of the day yesterday? How about worry?

• Did you experience the following feelings during a lot of the day yesterday? How about
physical pain?

• Did you experience the following feelings during a lot of the day yesterday? How about sadness?
• Did you experience the following feelings during a lot of the day yesterday? How about stress?
• Did you experience the following feelings during a lot of the day yesterday? How about anger?
• Life Evaluation Index (Thriving, Struggling, Suffering)

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In preparation for running a factor analysis of the listed items, the following two tests were used to check correlationand sampling adequacy:• Bartlett Test: If the p-value is less than 0.05, this shows the significance of the test and indicates a factor analysis
may be useful for our dataset.
• Kaiser-Meyer-Olkin Test: If the test score is above 0.8, it indicates the sample is adequate for factor analysis.
Tetrachoric correlation (instead of Pearson’s correlation) was used to measure the association between variables
since all variables are binary.
• After testing, the following variables were dropped:- Two items — the questions about the number of children and age of first pregnancy — were excluded due toscaling and issues with directionality.
- The question regarding whether going to a healthcare professional improves health was excluded due tolow variance.
Researchers then used factor analysis to determine which factors emerged and which items were mosthighly loaded.
• Factor analysis is limited to female respondents only since we are trying to predict the health and safety statusof women, rather than the general population. Female cases without missing values in the selected items were
included in the analysis.
• Before running factor analysis, many of the variables were recoded.
• The question regarding domestic violence and the Life Evaluation Index were dropped due to not being highly
loaded (with factor loadings above 0.4) on any factor.
A statistically good factor analysis solution was achieved by setting the number of factors to five and using “Varimax”
rotation (orthogonal). The eigenvalues of all five factors are greater than one. The eigenvalue is used to measure
the amount of variance of variables that a factor explains. The logic is that only factors that explain at least the sameamount of variance as a single variable are worth keeping.
• Factor 1 is about preventive care, including having been tested for high blood pressure, cancer, diabetes
and STDs/STIs.
• Factor 2 is about emotional issues, including experiencing worry, sadness, stress and anger for a lot of the dayprior (all items reverse scored).
• Factor 3 is about health and safety, including receiving high-quality care during pregnancy, satisfaction withquality healthcare in general and feeling safe walking alone at night.
• Factor 4 is about basic needs, including having trouble affording food and shelter in the past 12 months (all items
reverse scored).
• Factor 5 is about individual health, including having health problems and experiencing pain for a lot of the dayprior (all items reverse scored).
The extracted five factors explain 61.9% of the total variance of the selected items for Year 3.
To achieve a valid score, a respondent needs to answer “Yes” or “No” to at least three of the four items for factor 1,
three of the four items for factor 2, two of the three items for factor 3, two of the three items for factor 4 and two of
the two items for factor 5.

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3

Missing data

Given the global nature of the Gallup World Poll, all national surveys are subject to the relevant government
approvals and restrictions.
The following exclusions apply:• Yemen: Values are missing for the questions regarding domestic violence and testing for STDs/STIs.
• Iran: Values are missing for the question regarding testing for STDs/STIs.
• Jordan: Values are missing for the question regarding testing for STDs/STIs.
• Pakistan: Values are missing for the question regarding testing for STDs/STIs.
• Saudi Arabia: Values are missing for the question regarding testing for STDs/STIs.
• Tanzania: Values are missing for the question regarding having experienced stress yesterday.
• Ukraine: Values are missing for the questions regarding quality healthcare and feeling safe walking alone.

4

Rounding

The numbers in the Hologic Global Women’s Health Index use many observations and are calculated first to theinfinite decimal place. Then, to display the scores, they are rounded to the nearest whole number.
• To calculate a country’s rank, Hologic and Gallup researchers use the full score with multiple digits to avoid ties.
- If two countries have a score of 56 but one is 56.1 and one is 56.4, the country with 56.4 has a higher rank.
• However, to calculate change the standard way, scores are rounded first, then subtracted.
- If a country has a rounded final score of 54 in Year 2 and a score of 52 in Year 3, the change will be 54-52, ora decrease of 2.

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Differences in Countries Surveyed in Year 3
In Year 3, 22 countries and territories were surveyed that were not surveyed in all three years. For a comparison to
the baseline countries surveyed in Year 1, please see the Year 2 report.
Year Wave
Year 2

Year 3GlobalCoverage

Number ofCountries

94%

122

97%*

143

New Countries and Territories

Azerbaijan

Libya

Botswana

Luxembourg

ChadMadagascar

Comoros

Mauritania

Democratic Republic of the Congo

Montenegro

Eswatini

Niger

Ethiopia

Northern Cyprus

Guatemala

Palestinian Territories

KuwaitPuerto Rico

Lesotho

The Gambia

Liberia

Yemen*Includes data collected in China in Year 2.

Countries included in the Year 3 Hologic Global Women’s Health Index

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5

Weighting and aggregation approach

Each sub-index score is calculated for each factor by taking the simple average of its corresponding recoded
items. The Hologic Global Women’s Health Index score is calculated by taking a weighted sum of the five sub-index
scores, with weights proportional to each factor’s eigenvalue (amount of variance of variables that a factor explains).
The weights are shown in Figure 1.
FIGURE 1

Index Weights Based on Eigenvalues

1.0

0.11

0.9

0.15
0.8

0.17

0.7

0.6

0.28

0.5

0.4

0.3

0.29
0.2

0.1

0.0
Preventive Care

Emotional Health

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Opinions of
Health and Safety97

Basic Needs

Individual Health© 2024 Hologic, Inc. All rights expressly reserved.
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6

Data normalization

Variables were recoded for inclusion in the Hologic Global Women’s Health Index as follows:
For a list of variable codes, please see Section 9: Survey module.
• TEST_FOR_HBP: Set to 1 if H4A. = 1, 0 if H4A. = 2 OR H3. = 2, NA for any other value.
• TEST_FOR_CANCER: Set to 1 if H4B. = 1, 0 if H4B. = 2 OR H3. = 2, NA for any other value.
• TEST_FOR_DIABETES: Set to 1 if H4C. = 1, 0 if H4C. = 2 OR H3. = 2, NA for any other value.
• TEST_FOR_STD: Set to 1 if H4D. = 1, 0 if H4D. = 2 OR H3. = 2, NA for any other value.
• WORRY_REVERSE: Set to 1 if WP69 = 2, 0 if WP69 = 1, NA for any other value.
• SADNESS_REVERSE: Set to 1 if WP70 = 2, 0 if WP70 = 1, NA for any other value.
• STRESS_REVERSE: Set to 1 if WP71 = 2, 0 if WP71 = 1, NA for any other value.
• ANGER_REVERSE: Set to 1 if WP74 = 2, 0 if WP74 = 1, NA for any other value.
• PREGNANT_HEALTHCARE: Set to 1 if H2. = 1, 0 if H2. = 2, NA for any other value.
• QUALITY_HEALTHCARE: Set to 1 if WP97 = 1, 0 if WP97 = 2, NA for any other value.
• SAFE_NIGHT_WALKING: Set to 1 if WP113 = 1, 0 if WP113 = 2, NA for any other value.
• NO_FOOD_REVERSE: Set to 1 if WP40 = 2, 0 if WP40 = 1, NA for any other value.
• NO_SHELTER_REVERSE: Set to 1 if WP43 = 2, 0 if WP43 = 1, NA for any other value.
• HEALTH_PROBLEM_REVERSE: Set to 1 if WP23 = 2, 0 if WP23 = 1, NA for any other value.
• PHYSICAL_PAIN_REVERSE: Set to 1 if WP68 = 2, 0 if WP68 = 1, NA for any other value.
• DOMESTIC_VIOLENCE: Set to 1 if H7. = 1, 0 if H7. = 2, NA for any other value.

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7

Multivariate analysis

To understand the interactions of the individual dimensions and their relationship to health outcomes, the Gallup andHologic research team ran correlations among the variables and regression analysis using life expectancy as thedependent variable.
Correlations reveal low collinearity between the individual dimensions. In addition, all the dimensions and GDP 2019are relatively highly correlated with the life expectancy of women.
The regression analysis reveals that the five factors of the Hologic Global Women’s Health Index explain
approximately 70% of the female life expectancy at birth at the country level. Note: Gallup identified an error in the
regression analysis in Year 1 and Year 2. Previously, Gallup found that these factors accounted for more than 80% of
the variance in why some women live longer than others. After further testing and rigorous analysis, Gallup still foundextremely strong relationships in all three years of data collection, including the present study.
FIGURE 2

Female Life Expectancy at Birth

GDP per Capita

Hologic Global Women's
Health Index Year 3

Individual Health

Basic Needs

Opinions of Health and Safety

Emotional HealthPreventive Care

Correlation Table

1.0

Preventive Care

0.8
Emotional Health

0.6
0.4

Opinions of Health and Safety

0.2

Basic Needs

0.0
Individual Health-0.2

Hologic Global Women's
Health Index Year 3
GDP per Capita

-0.4
-0.6
-0.8

Female Life Expectancy at Birth

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99

-1.0

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HGWHI_Y3GlobalReport_Appendix1

Regression analysis
Call: lm(formula = Life_expectancy_at_birth_years_Female ~ Preventive Care + Emotional Health + Opinions on
Health and Safety + Basic Needs + Individual Health, data = df_sub, weights = df_sub$weight)
Dependent variable: Female life expectancy at birth
Regression Output for Female Life Expectancy at Birth
Variable

Std. Error

Coefficient

Preventive Care

(4.385)14.695**

Emotional Health(5.159)-14.997**

Opinions of Health and Safety(2.493)-1.555

Basic Needs(2.349)23.790***Individual Health(4.444)12.108**Constant(2.251)60.225***Observations = 136
R2 = 0.6983 Adjusted R2 = 0.6867
Residual Std. Error = 14670 (df = 130) F Statistic = 60.17*** (df = 5; 130)
Note: *p<0.1; **p<0.05; ***p<0.01

8Relationship with other measures

Adding to the relationships that the Hologic Global Women’s Health Index has with a woman’s life expectancy atbirth, as well as a country’s GDP per capita, researchers tested the following Sustainable Development Goals (SDGs):• SDG 1.1
- population pushed below a relative poverty line by household health expenditures(60% of median daily per capita consumption or income) (%)• SDG 2.2.3- prevalence of anemia in pregnant women (aged 15 to 49) (%)• SDG 3.1.1- maternal mortality ratio (MMR) (per 100,000 live births)• SDG 3.1.2- births attended by skilled health personnel (%)• SDG 3.8.1- universal health service coverage (UHC)• SDG 5.2.1- proportion of ever-partnered women and girls aged 15 to 49 years subjected to physical and/or sexual
violence by a current or former intimate partner in the previous 12 months• 10.4.1- labor share of GDP

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FIGURE 3

Pearson Correlation Coefficients
Dark Magenta = Strong Negative Relationship (-.7 to -1)
Light Magenta = Negative Relationship (-.3 to -.7)
Light Teal = Positive Relationship (.3 to .7)

Healthcare Professional(12 month)

Domestic Violence

Access to High-Quality
Pregnancy Healthcare

High = Bad

Individual Health_

Basic Needs

High = Good

Opinions of Healthand Safety

SDG 1.1(poverty from health)+Emotional HealthFemale Life
Expectancy at Birth

Preventive Care

Predicted
RelationshipWith Women’s
HealthHGWHI Year 3

Dark Teal = Strong Positive Relationship (.7 to 1)

0.72

0.32

0.36

0.53

0.81

0.59

0.59

0.05

0.33

-0.19

-0.21

-0.22

-0.12

-0.03

-0.18

-0.20

0.02

-0.24

SDG 2.2.3(anemia in pregnancy)

_

-0.68

-0.50

-0.35

-0.39

-0.71

-0.57

-0.62

-0.22

-0.23

SDG 3.1.1
(MMR)

_

-0.62

-0.33

-0.38

-0.42

-0.61

-0.52

-0.45

-0.09

-0.25

SDG 3.1.2(skilled health at birth)

+

0.55

0.39

0.29

0.31

0.59

0.41

0.46

0.15

0.15

SDG 3.8.1
(UHC)

+

0.78

0.49

0.43

0.50

0.79

0.63

0.68

0.13

0.33

SDG 5.2.1(domestic violence
past 12 months)

_

-0.67

-0.27

-0.43

-0.52

-0.70

-0.44

-0.49

-0.08

-0.32

SDG 10.4.1(labor share of GDP)

+

0.42

0.41

0.16

0.19

0.47

0.25

0.50

0.32

0.16

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9

Survey module

H1	Do you think going to a healthcare professional, such as a medical doctor or a nurse, atleast once every 12 months for a checkup, can help people improve their health, or not?
Yes

No

(DK)

(Refused)

1

2

8

9

H2	Do you think most pregnant women in the city or area where you live receive high-quality
healthcare during their pregnancies, or not?
Yes

No

(DK)

(Refused)

1

2

8

9

H3	In the past 12 months, have you talked to a healthcare professional, such as a medical
doctor or nurse, about your own health?
Yes

No

(DK)

(Refused)

1

2

8

9

(If code 1 in H3., Continue;
Otherwise, Skip to H5.)

H4	To the best of your knowledge, were you tested for any of the following in the past 12
months? (Read items)

Yes

No

(DK)

(Refused)

H4A. High blood pressure

1

2

8

9

H4B. Cancer

1

2

8

9

H4C. Diabetes

1

2

8

9

H4D. Sexually transmitted diseases or infections

1

2

8

9

H5	How many children do you, personally, have? (Interviewer: Respondent should include all
children even if they are now adults or have died.)

Circle One Response
Write in:___________________________

None

00

97+

97

(DK)

98

(Refused)99

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(If [respondent is a woman and has children], Continue;
Otherwise, Skip to Read before H7.)

H6	How old were you the first time you were pregnant? (Open-ended and code actual age)
Circle One Response
Write in:___________________________

96+

96

(Never pregnant/has only adopted children or stepchildren)

97

(DK)

98

(Refused)99

Now I would like to ask you a question regarding domestic violence. Domestic violence can be physical,
psychological, or involve sexual acts done to someone against their will by a person they live with.

H7	In your opinion, is domestic violence a widespread problem in [Country], or not?
Yes

No

(DK)

(Refused)

1

2

8

9

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References for Appendix 1
Bhattacharya, S., Thakur, J. S., & Singh, A. (2018). Knowledge attitude, and practice regarding dietary salt intake
among urban slum population of North India. Journal of Family Medicine and Primary Care, 7(3), 526–530.
https://doi.org/10.4103/jfmpc.jfmpc_60_17
Bustreo, F. (2015, February 20). Ten top issues for women’s health. World Health Organization.
https://www.who.int/news-room/commentaries/detail/ten-top-issues-for-women’s-healthCDC. (2020a, July 29). How to prevent cancer or find it early. Centers for Disease Control and Prevention.
https://www.cdc.gov/cancer/dcpc/prevention/index.htm
CDC. (2020b, September 8). Heart disease facts. Centers for Disease Control and Prevention.
https://www.cdc.gov/heartdisease/facts.htm
CDC. (2021a). How STDs impact women differently from men. Centers for Disease Control and Prevention.
https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/stds-women.pdf
CDC. (2021b, March 22). Adult obesity facts. Centers for Disease Control and Prevention.
https://www.cdc.gov/obesity/data/adult.html
Dang, B.N., Westbrook, R.A., Njue, S.M. et al. (2017). Building trust and rapport early in the new doctor-patient
relationship: A longitudinal qualitative study. BMC Medical Education, 17, 32. https://doi.org/10.1186/s12909-017-0868-5
Fan, Y., Zhang, S., Li, Y., Li, Y., Zhang, T., Liu, W., & Jiang, H. (2018). Development and psychometric testing of theKnowledge, Attitudes and Practices (KAP) questionnaire among student Tuberculosis (TB) Patients (STBP-KAPQ) in
China. BMC Infectious Diseases, 18(1), 213. https://doi.org/10.1186/s12879-018-3122-9
Gee, R. E. (2012). Preventive services for women under the Affordable Care Act. Obstetrics & Gynecology, 120(1).
https://doi.org/10.1097/aog.0b013e31825bd604
IDF. (2019). Worldwide toll of diabetes. International Diabetes Federation. https://diabetesatlas.org/#:~:text=537%20
million%20adults%20(20%2D79,2021%20%2D%201%20every%205%20seconds.
Jin, J. (2022). Routine checkups for adults. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2790936
Liss, D. T., Uchida, T., Wilkes, C. L., Radakrishnan, A., & Linder, J. A. (2021). General health checks in primary adult care.
JAMA. https://jamanetwork.com/journals/jama/article-abstract/2780614
Mustafa, R., Afreen, U., & Hashmi, H. A. (2008). Contraceptive knowledge, attitude and practice among rural
women. Journal of College of Physicians and Surgeons Pakistan, 18(9), 542–545.
Neumann, P. J., & Cohen, J. T. (2009). Cost savings and cost-effectiveness of clinical preventive care. The Synthesis
project. Research synthesis report, (18), 48508.

The Hologic Global Women’s Health Index | Year 3 Global Report104© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix1

Office of Disease Prevention and Health Promotion. (2021). Get your well-woman visit every year. Health.gov/
MyHealthfinder. https://health.gov/myhealthfinder/healthy-living/sexual-health/get-your-well-woman-visit-every-year
Okobia, M. N., Bunker, C. H., Okonofua, F. E., & Osime, U. (2006). Knowledge, attitude and practice of Nigerian
women toward breast cancer: A cross-sectional study. World Journal of Surgical Oncology, 4(1), 1–9.
PRB. (2011, August 15). The effect of girls’ education on health outcomes: Fact sheet. PRB.
https://www.prb.org/resources/the-effect-of-girls-education-on-health-outcomes-fact-sheet/
UNFPA. (2021a). Adolescent pregnancy. United Nations Population Fund. https://www.unfpa.org/adolescent-pregnancy
UNFPA. (2021b). Gender-based violence. United Nations Population Fund. https://www.unfpa.org/gender-based-violence
UNHCR. (2021). Gender-based violence. The UN Refugee Agency. https://www.unhcr.org/gender-based-violence.html
UNICEF. (2021). Early childbearing. UNICEF. https://data.unicef.org/topic/child-health/adolescent-health/WHO. (2019, September 19). Maternal mortality. World Health Organization.
https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
WHO. (2020a, January 31). Adolescent pregnancy. World Health Organization.
https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy
WHO. (2020b, March 12). Top health checks for women. World Health Organization.
https://www.who.int/news-room/photo-story/photo-story-detail/top-health-checks-for-women
WHO. (2021a). Maternal health. World Health Organization.
https://www.who.int/health-topics/maternal-health#tab=tab_1
WHO. (2021b). Obesity. World Health Organization. https://www.who.int/westernpacific/health-topics/obesity
WHO. (2021c, March 3). Cancer. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cancer
WHO. (2021d, March 9). Devastatingly pervasive: 1 in 3 women
globally experience violence. World Health Organization.
https://www.who.int/news/item/09-03-2021-devastatingly-pervasive-1-in-3-women-globally-experience-violence
WHO. (2021e, March 9). Violence against women. World Health Organization.
https://www.who.int/news-room/fact-sheets/detail/violence-against-women
WHO. (2021f). Violence against women prevalence estimates, 2018. World Health Organization.
https://www.who.int/publications-detail-redirect/9789240022256
WHO. (2021g, April 13). Diabetes. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/diabetes

The Hologic Global Women’s Health Index | Year 3 Global Report105© 2024 Hologic, Inc. All rights expressly reserved.
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Women’s Health Alliance (WHA). (2022, March 7). How often should I schedule a well woman exam? Women’s HealthAlliance. https://womenshealthalliance.com/how-often-should-i-get-a-well-woman-exam/
World Bank. (2019, September 25). Gender-based violence (Violence against women and girls). World Bank.
https://www.worldbank.org/en/topic/socialsustainability/brief/violence-against-women-and-girls
World Bank. (2021). Adolescent fertility rate (births per 1,000 women ages 15-19). World Bank.
https://data.worldbank.org/indicator/SP.ADO.TFRT
Zhang, M., Zhou, M., Tang, F., Wang, Y., Nie, H., Zhang, L., & You, G. (2020). Knowledge, attitude, and practice
regarding COVID-19 among healthcare workers in Henan, China. Journal of Hospital Infection, 105(2), 183–187.

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AP P E N DI X 2

Hologic Global Women’s Health Index:
Methodology and Data Analysis
Introduction
The Hologic Global Women’s Health Index is the world’s most comprehensive, globally comparative survey about
women’s health. This appendix provides key methodological details related to the Year 1-Year 3 surveys and further
information about the data analysis presented in this report.
ReportData Collection Year

Year 1

2020

Year 2

2021

Year 3

2022

Methodology
The Hologic Global Women’s Health Index was included as a module within the Gallup World Poll beginning in 2020.
Since 2005, the World Poll has regularly surveyed people in more than 160 countries using mixed methods oftelephone and face-to-face interviewing. In a typical year, the poll results represent more than 95% of the world’s
population aged 15 and older, using randomly selected, nationally representative samples.

Data collection in 2020
2020 was far from a typical year. The unprecedented challenges presented by the COVID-19 pandemic forced
Gallup to pause its global data collection in March 2020 to thoroughly assess risk and prepare contingency plans forcollecting data. By May, the continued prevalence of COVID-19 made it clear there was too much risk of community
transmission to conduct face-to-face data collection in 2020.
Nonetheless, Gallup recognized the importance of finding a way to collect representative, high-quality data during
this critical period and prepared a contingency methodology. This new methodological approach was driven by
several key considerations, including the safety of Gallup World Poll interviewers and respondents and retaining highlevels of representativity.

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Ultimately, the Year 1 Hologic Global Women’s Health Index survey was conducted primarily by phone (via computerassisted telephone interviewing, or CATI) in nearly all of the 116 countries and territories — representing more than 93% of
the global aged 15 and older population — with the exception of the Republic of the Congo, Mali, Pakistan and Senegal.
As a standard practice, Gallup and its partners complied with all government-issued guidance from local authorities andtook this guidance into account throughout the interviewing process, including following social distancing measures fortelephone interviews conducted in a call center (however, most CATI data collection was done remotely).

Changing modes in 2021
The Gallup World Poll returned to face-to-face interviewing in many countries in 2021 (see dataset details).
The change in mode is reflected in the design effect — thus, larger percentage differences are required forsignificant change.

Data collection in 2022
The Gallup World Poll returned to face-to-face interviewing in most countries where respondents had beeninterviewed this way prior to 2020 (see dataset details). The exceptions were a handful of Eastern European
countries, where respondents continued to be interviewed by telephone.
Because the Hologic Global Women’s Health Index was not fielded in China in 2022, the Year 3 report uses the mostrecent data from 2021. The data for China are weighted to 2022 population estimates.

Questionnaire Translation
The questionnaire was translated into the major conversational languages of each country and area (autonomous orsemi-autonomous regions or territories that are not recognized as sovereign states). The Hologic Global Women’s
Health Index was originally developed in English. From this starting point, Gallup translators produced several
major-language questionnaires in French, Spanish, Portuguese, Russian and Arabic (using one of the two translation
methods described below, as deemed appropriate by the Gallup World Poll Regional Directors).
Then, local language translations were performed from the major-language versions. For example, the Russian majorlanguage questionnaire was created first (translation from English to Russian), then translated from Russian into otherlanguages, such as Ukrainian, Kyrgyz and Uzbek. As a key component of quality assurance, one of the following two
methods was used in each country as an independent check of every questionnaire translation:
Method 1: Two independent translations are completed. An independent third party with some knowledge ofsurvey research methods adjudicates the differences. A professional translator translates the final version backinto the source language.
Method 2: A translator translates into the target language, and an independent translator back-translates into
the source language. An independent third party with knowledge of survey methods reviews and revises thetranslation as necessary.
Professional translators — experienced in translating survey questionnaires and who have typically worked for years
with Gallup’s local data collection network (local translators) — were selected. All translators received the same setof notes and guidance regarding the meaning of specific items. Interviewers were instructed to follow the interview
script and not to deviate from the translated language.

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HGWHI_Y3GlobalReport_Appendix2

Interviewer Training and Quality Control
As a standard practice, Gallup and its data collection partners were mindful of complying with all government-issued
guidance from local authorities and took this guidance into account throughout the interviewing process, including
following social distancing measures for telephone interviews. Gallup selects and retains in-country partners basedon their experience in nationwide survey research studies in the mode that is typically appropriate for that country,
and Gallup continued to use data collection partners when fielding the Hologic Global Women’s Health Index.
Gallup conducted all training remotely using available technologies such as e-learning and video conferencing.
The changes were largely necessary to address the lack of telephone data collection experience, technical andinfrastructural limitations, and compressed timelines.

Gallup provided a standardized training manual to assist the fieldwork
team with training and ensure consistency and structure.
Topics covered in training included:1Standards for conducting a quality interview• how to ask closed-ended questions• how to ask open-ended questions• rotation of survey questions or response options• how to follow or implement skip patterns• probing2

Respondent selection and disposition coding (i.e., recording the results ofeach contact)• within-household selection for those reached on landline and mobile in countries
where telephone coverage is low• coding practices for each telephone attempt• sample release and management

3

Recruitment and retention of interviewers and field quality control• characteristics of a successful interviewer/motivation for retention• requirements for setting up remote data collection• monitoring sample performance and interviewer productivity

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HGWHI_Y3GlobalReport_Appendix2

Sampling and Data Collection Methodology
All samples were probability-based — meaning respondents were selected randomly — and nationally representativeof the aged 15 and older population. As all eligible landline exchanges and valid mobile service providers were
included, coverage area is an entire country, including rural areas. The sampling frame represents adults aged 15
and older with access to a phone (either landline or mobile). Gallup used random digit dialing (RDD) or a nationally
representative list of phone numbers.

How the sample generation and selection process works
Gallup uses telephone surveys in countries where telephone coverage represents at least 80% of the
population or is the customary survey methodology. In countries where telephone interviewing is employed,
Gallup uses RDD or a nationally representative list of phone numbers. Telephone methodology is typical insuch areas as the U.S., Canada, Western Europe, Japan and Australia. Gallup purchases telephone samples
from various sample providers located in each region, including Sample Answers and Sample Solutions.
In the developing world, including much of Latin America, the former Soviet Union countries, nearly all ofAsia, the Middle East and Africa, Gallup uses an area frame design for face-to-face interviewing in randomly
selected households.
Face-to-face interviews are approximately one hour, while telephone interviews are about 30 minutes.
With some exceptions, all samples are probability based and nationally representative of the resident
population aged 15 and older. The coverage area is the entire country including rural areas, and thesampling frame represents the entire civilian, noninstitutionalized adult population of the country. Exceptions
include areas where the safety of the interviewing staff is threatened and scarcely populated islands in somecountries. Sampling procedures include the following stages:• 1) Selecting primary sampling units (PSUs): In countries where Gallup conducts face-to-face surveys,
the first stage of sampling is the identification of PSUs, consisting of clusters of households. PSUs are
stratified by population size and/or geography and clustering is achieved through one or more stagesof sampling. Where population information is available, sample selection is based on probabilities
proportional to population size; otherwise, Gallup uses simple random sampling. In countries where
telephone interviewing is employed, Gallup uses RDD or a nationally representative list of phone
numbers. In select countries where cellphone penetration is high, Gallup uses a dual sampling frame.
Gallup makes at least three attempts to reach a person in each household.
• 2) Selecting households: Gallup uses random-route procedures to select sampled households. Unlessan outright refusal occurs, interviewers make up to three attempts to survey the sampled household.
To increase the probability of contact and completion, interviewers make attempts at different times ofthe day and, when possible, on different days. If the interviewer cannot obtain an interview at the initialsampled household, they use a simple substitution method.
• 3) Selecting respondents: In face-to-face and telephone methodologies, random respondent selectionis achieved by using either the latest birthday or the Kish grid method. In a few Middle Eastern andAsian countries, gender-matched interviewing is required, and probability sampling with quotas
is implemented during the final stage of selection. Gallup implements quality control proceduresto validate the selection of correct samples and that the interviewer selects the correct person ineach household.

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HGWHI_Y3GlobalReport_Appendix2

Response Rates
As is the case with Gallup World Poll surveys more generally, response rates for the Hologic Global Women’s HealthIndex vary considerably across countries. In general, response rates are lower in countries where interviewing is
conducted by telephone than in countries where interviewing is conducted in person. However, in many countries
and territories where telephone interviewing is used, response rates are comparable to those of other polling firms.
The Gallup World Poll does not publish individual country response rates.

Data Weighting
Data weighting is used to minimize bias in survey estimates and is intended for use in generating nationally
representative estimates within a country. The weighting procedure was formulated based on the sample design andperformed in multiple stages. Gallup constructed a probability weight factor (base weight) to account for selectionof telephone numbers from the respective frames and correct for unequal selection probabilities that result fromselecting one adult in landline households and for dual users coming from both the landline and mobile frame. For
instance, an individual in a five-person household will have a lower probability selection than someone who lives
alone, holding everything else equal. The data weighting process seeks to address this type of imbalance.
Next, the base weights were post-stratified to adjust for nonresponse (where selected respondents are neverreached or refuse to participate) and to match the weighted sample totals to known target population totals obtained
from country-level census data. Gallup made calibration adjustments for gender, age and, where reliable data wereavailable, education. In many nontraditional telephone countries, weights were also adjusted on an additional setof demographic factors, including employment status (whether employed for an employer/self or not employed),urbanicity, region or some combination of these factors. In general, countries with lower coverage of the target
population required a larger set of weighting variables than countries with a minimum amount of coverage error.
Where necessary, Gallup implemented procedures to limit or reduce the number and size of extreme samplingweights. This process was done in both stages of the data weighting process. In any given country, the unweighted
demographic profile (including but not limited to characteristics such as gender, age group, educational attainment
level, employment status and region) was compared against reliable statistics (typically census data from the national
government); Gallup also compared the final weighted sample to these statistics.
Finally, approximate study design effect and margin of error were calculated (calculations are presented in Table 1).
The design effect calculation reflects the influence of weighting on sampling variance compared to a simple random
sample of the same size.

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HGWHI_Y3GlobalReport_Appendix2

Sampling Error and Precision of Estimates
When interpreting survey results, all sample surveys are subject to various types of potential errors. For example,
errors may occur due to nonresponse (where selected respondents are never reached or refuse to participate),interviewer administration error (where a response can be mistyped or misinterpreted by the interviewer), or
incomplete or inaccurate answers from the respondent.
The sampling design employed in this study was used to produce unbiased estimates of the stated target population.
An unbiased sample will have the same characteristics and behaviors as those of the total population from which
it was drawn. In other words, with a properly drawn sample, we can make statements about the target population
within a specific range of certainty. Sampling errors can be estimated, and their measures can help interpret the final
data results. The size of such sampling errors depends largely on the number of interviews and the complexity of thesampling design.
The margin of error (MOE), or the level of precision used in estimating the unknown population proportion ‘P,’ can bederived based on the following formula:

MOE = 1.96 * √(P*(1-P)/n)where ‘n’ is the sample size (i.e., the number of completed surveys). Under the most conservative assumption (P =0.5), the MOE for a sample size of 1,000 will be 1.96 * √(0.25/1000) = 3.1 percentage points under the assumption of
simple random sampling.
Table 1 shows the size of the MOE associated with the 95% confidence interval for various sample sizes under theassumption of simple random sampling. They may be interpreted as indicating the approximate range (plus or minus
the figure shown) around the point estimate within which the results of repeated sampling in the same time period
could be expected to fall 95% of the time, assuming the same sampling procedures, interviewing process andquestionnaire.
For any given sample size, the estimated precision is lowest when P = 0.5 (or 50%). For example, the sample size
needed to ensure a sampling error (or half-width of confidence interval) of 0.05 at 95% confidence level is around400 cases when P = 0.5 (or 50%). A sample size of 300 will produce a sampling error close to 0.057 at 95% level ofsignificance when P = 0.5 (or 50%). With P = 0.4 (or 40%), a sample size of 300 will produce a sampling error of 0.056.
Table 1 shows estimated precision levels for different values of P and sample sizes under the assumption of simple
random sampling.

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HGWHI_Y3GlobalReport_Appendix2

TA B L E 1

Margin of Error Associated With 95% Confidence Interval for Percentages for Entire Sample or
Subgroups, in Percentage Points

For Percentages Near
SampleSizes Near

5/95%
±

10/90%±

20/80%±

30/70%±

40/60%±

50/50%
±

400

2.1

2.9

3.9

4.5

4.8

4.9

500

1.9

2.6

3.5

4.0

4.3

4.4

600

1.7

2.4

3.2

3.7

3.9

4.0

800

1.5

2.1

2.8

3.2

3.4

3.5

1,000

1.4

1.9

2.5

2.8

3.0

3.1

1,500

1.1

1.5

2.0

2.3

2.5

2.5

2,000

.96

1.3

1.8

2.0

2.1

2.2

2,500

.85

1.2

1.6

1.8

2.0

2.0

3,000

.78

1.1

1.4

1.6

1.8

1.8

4,000

.68

.93

1.2

1.4

1.5

1.5

5,000

.60

.88

1.2

1.3

1.3

1.4

While the above table reflects precision assuming simple random sampling (i.e., respondents within a target
population have an equal probability of being selected for the survey), World Poll surveys rely on more complex
designs, even for telephone samples (which was the sole mode of data collection in 2020). In addition to design
complexities, data are weighted to correct for unequal probabilities of household selection and post-stratification
adjustments. This weighting process introduces a design effect that needs to be considered while computing thesampling error (or precision) of the estimates.
The design effect is defined as the ratio of the complex, design-based sample variance to the sample varianceobtained from a simple random sample of the same size. To calculate the precision of an estimate using the complex
sampling design with a design effect, one must multiply the precision under the assumption of simple random
sampling by the square root of the design effect associated with this estimate.

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HGWHI_Y3GlobalReport_Appendix2

In other words, the precision of an estimate (p) of an unknown population proportion ‘P’ may be approximated as:

Precision (p) = {SQRT (Deff)} × SE(p)where ‘Deff’ is the design effect associated with the estimate (p)SE(p) = SQRT{p*(1-p)/(n – 1)}
n = the unweighted sample size
For purposes of simplicity, an estimate of ‘Deff_wt’ is provided for each country, taking into consideration only thevariability of weights. A design effect of 1 means the effective sample size is the same as the nominal sample size,
which is 1,000 for most countries in the World Poll. For proportions close to 50%, a design effect of 2 reduces theeffective sample size by 50% or increases margin of error by 41% compared to a simple random sample size of 1,000.

Meaningful change
Researchers developed a standardized definition of meaningful change in a country’s score from one year to thenext — a threshold of +/- 5 points. This definition allows researchers to establish best practice when comparing
country scores from year to year, while considering a country’s sample size and margin of error estimates (definedin Table 1).
A 5-point change is the smallest standard number where researchers can be certain that change cannot be
explained by sampling random fluctuations or by measurement error, no matter the percentage or the country’s
particular design effect. This number is defined as a meaningful change because, while complex survey sampling
methods to test for significant change were not individually applied (Cohen, 1988), this is the upper limit of change
where researchers can be certain there is a statistically significant difference between the two groups.
Researchers seek to avoid confusion by setting this threshold, so in all instances, a change of +/- 5 or more points ishighlighted throughout the report.

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HGWHI_Y3GlobalReport_Appendix2

Hologic Global Women’s Health Index Country Dataset Details
TA B L E 2Country Dataset Details
Gallup Worldwide Research Data Collected From 2022aThe design effect calculation reflects the weights and does not incorporate the intraclass correlation coefficients. Design effect calculation:n*(sum of squared weights)/[(sum of weights)*(sum of weights)]b

Margin of error is calculated around a proportion at the 95% confidence level. The maximum margin of error was calculated assuming a reported
percentage of 50% and takes into account the design effect. Margin of error calculation: √(0.25/N)*1.96*√(DE)

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages*Handheld data collection.

Exclusions(Samples are nationally
representative unless
noted otherwise)2022

Afghanistan

17.1

Jul 20 –Aug 27, 2022

1,000

1.33

3.6

Face-to-Face(HH)*

Dari, Pashto

Gender-matched sampling
was used during the final
stage of selection.

2022

2022

2022

Albania

Algeria

Argentina

17.1

Sep 1 –
Oct 13, 2022

17.1

Sep 18 –Oct 5, 2022

17.1

Jul 18 –Sep 9, 2022

1,000

821

1,005

1.65

1.44

1.42

4.0

Face-to-Face
(HH)*

4.1

Face-to-Face
(HH)*

3.7

Face-to-Face(HH)*

Albanian

People living in remoteor difficult-to-access rural
areas were excluded. The
excluded areas represent
approximately 2% of the
population.

ArabicSparsely populated areasin the far South were
excluded, representing
approximately 10% of the
population.

SpanishThose living in dispersed
rural population areas were
excluded. This represents
about 4% of the population.
Settlements near territories
disputed with Azerbaijan
were not included for
insecurity reasons. The
excluded areas represent
approximately 3% of the
population.

2022

Armenia17.1

Sep 8 –
Oct 19, 2022

1,003

1.71

4.1

Face-to-Face(HH)*

Armenian

2022

Australia

17.2

Sep 12 –Oct 30, 2022

1,000

1.70

4.0

Landlineand Mobile
Telephone

English2022

Austria17.2

Sep 12 –Oct 10, 2022

1,000

1.56

3.9

Landlineand Mobile
Telephone

German2022

Azerbaijan

17.1

Oct 15, 2022 –Feb 26, 2023

The Hologic Global Women’s Health Index | Year 3 Global Report

1,028

1.48

3.7

115

Face-to-Face
(HH)*

Azeri

Kelbadjaro-Lacha,
Nakhichevan, East Zangezur
and Nagorno-Karabakh
territories not included.
These areas represent
approximately 18% of thetotal population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2022

Bangladesh

17.1

Jun 29 –Sep 29, 2022

1,000

1.37

3.6

Face-to-Face(HH)*

Bengali

2022

Belgium

17.2

Aug 30 –Sep 30, 2022

1,001

1.30

3.5

Landlineand Mobile
TelephoneFrench,
Dutch

2022

Benin

17.1

Sep 26 –Oct 9, 2022

1,000

1.89

4.3

Face-to-Face(HH)*

Bariba, Fon,
FrenchExclusions(Samples are nationally
representative unless
noted otherwise)2022

Bolivia17.1

Jun 25 –Aug 10, 2022

1,000

1.40

3.7

Face-to-Face(HH)*

Spanish2022

Bosnia andHerzegovina

17.1

Sep 9 –
Dec 21, 2022

1,000

1.44

3.7

Face-to-Face(HH)*

Bosnian2022

Botswana

17.1

Sep 25 –Oct 21, 2022

1,003

1.95

4.3

Face-to-Face(HH)*

English,Setswana

2022

Brazil17.1

Jul 1 –
Aug 8, 2022

1,000

1.30

3.5

Face-to-Face(HH)*

Portuguese

2022

Bulgaria

17.1

Jun 29 –Sep 8, 2022

1,000

1.42

3.7

Face-to-Face(HH)*

Bulgarian2022

Cambodia

17.1

Sep 14 –Oct 15, 2022

1,000

1.50

3.8

Face-to-Face(HH)*

Some distant, small
locations were excluded
due to accessibility and/or security issues. The
exclusions represent
approximately 7% of the
population.

Sampling units of population
size less than 50 were
excluded from the samplingframe. This exclusion isapproximately 4% of the
population of Botswana.

Khmer

Koh Kong, Stueng Treng,
Otdor Meanchey and Kep
provinces were excluded.
These excluded areas
represent approximately
3% of the population of
Cambodia.

2022

Cameroon

17.1

Jun 14 –Jul 7, 2022

1,000

1.40

3.7

Face-to-Face(HH)*

French,English,Fulfulde

Some arrondissementsin the East region,
the North region, theExtreme North region, theNorthwest region and theSouthwest region were
excluded due to insecurity.
Neighborhoods with lessthan 50 households werealso excluded from thesampling. The exclusions
represent 32% of the total
population.

2022

Canada17.2

Aug 4 –
Sep 21, 2022

1,004

1.28

3.5

Landlineand Mobile
Telephone

English,FrenchYukon, Northwest Territories
and Nunavut were excluded
from the sample.

The Hologic Global Women’s Health Index | Year 3 Global Report

116© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Languages

Mode ofInterviewing

Marginof Errorb

DesignEffecta

Number ofInterviews

Data Collection
Date

Wave

Country

Data Collection
Year

Exclusions(Samples are nationally
representative unless
noted otherwise)

2022

Chad

17.1

Oct 9 –
Nov 12, 2022

1,000

1.75

4.1

Face-to-Face(HH)*

French,ChadianArabic,Ngambaye

2022

Chile

17.1

Jul 13 –Sep 20, 2022

1,000

1.50

3.8

Face-to-Face(HH)*

Spanish2022

Colombia

17.1

Jul 14 –Aug 3, 2022

1,000

1.26

3.5

Face-to-Face(HH)*

Spanish2022

Comoros

17.1

Aug 3 –
Sep 22, 2022

1,000

1.54

3.8

Face-to-Face(HH)*

French,Comorian

2022

Congo

17.1

Jul 2 –
Jul 23, 2022

1,000

1.88

4.2

Face-to-Face(HH)*

French,Kituba,Lingala2022

Congo,
Democratic
Republic of
the

17.1

Aug 16 –Sep 17, 2022

1,000

2.03

4.4

Face-to-Face(HH)*

French,Lingala,Swahili

2022

Costa Rica

17.1

Jun 25 –Aug 17, 2022

1,000

1.32

3.6

Face-to-Face(HH)*

Spanish2022

Croatia17.1

Sep 7 –
Nov 15, 2022

1,002

1.77

4.1

Face-to-Face(HH)*

Croatian

2022

Cyprus

17.2

Aug 19 –Oct 4, 2022

1,010

1.98

4.3

Landlineand Mobile
Telephone

Greek,English

2022

Czech
Republic

17.2

Sep 22 –Nov 9, 2022

1,007

1.45

3.7

Landlineand Mobile
Telephone

Czech

2022

Denmark

17.2

Oct 19 –Nov 21, 2022

1,004

1.86

4.2

MobileTelephone

Danish2022

Dominican
Republic

17.1

Jun 22 –Jul 5, 2022

1,000

1.49

3.8

Face-to-Face(HH)*

Spanish2022

Ecuador17.1

Jul 11 –Aug 22, 2022

1,000

1.46

3.8

Face-to-Face(HH)*

SpanishThe Hologic Global Women’s Health Index | Year 3 Global Report

117

Because of security issues
and difficult terrain, sevenregions were excluded fromthe sampling: Lac, Ouaddaï,Wadi Fira, Bourkou, Ennedi,
Tibesti and Salamat. In
addition, the North Kanemand Bahr El Gazal North
districts were excluded
due to accessibility issues.
Quartiers/villages withless than 50 inhabitants
were also excluded fromsampling. The excluded
areas represent 23% of the
population.

Ten departments and an
additional 19 municipalities
were excluded since they
are located in areas of low
population or with extreme
insecurity issues. The
excluded areas represent
approximately 5% of the
population.

Parts of Province Orientale,
Nord Kivu, Sud Kivu andKatanga were excluded due
to insecurity. Geographic
exclusions represent 19% of
the population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

1,001

1.40

3.7

Face-to-Face(HH)*

Arabic2022

El Salvador

17.1

Aug 15 –Sep 24, 2022

1,000

1.81

4.2

Face-to-Face(HH)*

Spanish2022

Estonia17.2

Jul 22 –Sep 21, 2022

1,002

1.57

3.9

MobileTelephone

Estonian,
Russian2022

Eswatini

17.1

Nov 1 –
Nov 29, 2022

1,000

1.58

3.9

Face-to-Face(HH)*

Siswati,EnglishMarginof Errorb

Aug 26 –Sep 8, 2022

DesignEffecta

17.1

Number ofInterviews

Egypt

Wave

2022

Frontier governorates(Matruh, Red Sea, New
Valley, North Sinai andSouth Sinai) were excluded,
as they are remote andrepresent a small proportionof the population of thecountry. The excluded areas
represent less than 2% of
the total population.

Country

Languages

Mode ofInterviewing

Data Collection
Date

Data Collection
Year

Exclusions(Samples are nationally
representative unless
noted otherwise)2022

Ethiopia

17.1

Sep 22 –Nov 16, 2022

1,000

1.64

4.0

Face-to-Face(HH)*

Amharic,
English,
Oromo

2022

Finland17.2

Aug 9 –
Oct 13, 2022

1,000

1.51

3.8

MobileTelephone

Finnish2022

France17.2

Oct 17 –Nov 17, 2022

1,000

1.62

3.9

Landlineand Mobile
TelephoneFrench

2022

Gabon

17.1

Aug 12 – Aug
30, 2022

1,000

1.71

4.1

Face-to-Face(HH)*

French, Fang

2022

Georgia17.1

Aug 8 – Oct31, 2022

1,000

1.36

3.6

Face-to-Face(HH)*

Georgian,
Russian2022

Germany

17.2

May 30 – Jun
28, 2022

1,000

2.36

4.8

Landlineand Mobile
Telephone

German

2022

Ghana

17.1

Aug 5 – Aug25, 2022

1,000

1.38

3.6

Face-to-Face(HH)*

English, Ewe,Twi, Dagbani,
Hausa

2022

Greece17.1

Jun 24 – Sep
17, 2022

1,000

1.38

3.6

Face-to-Face
(HH)*

Greek

2022

Guatemala17.1

Jun 29 – Oct17, 2022

1,000

1.47

3.8

Face-to-Face(HH)*

SpanishThe Hologic Global Women’s Health Index | Year 3 Global Report118

Due to ongoing conflictand security issues, theTigray, Gambella and Harari
regions were excluded. The
excluded areas represent
approximately 7% of thetotal population of Ethiopia.

South Ossetia and Abkhazia
were not included for thesafety of the interviewers.
In addition, very remotemountainous villages
or those with less than
100 inhabitants werealso excluded. The
excluded areas represent
approximately 8% of the
population.

Localities with less than 100
inhabitants were excluded
from the sample. The
excluded areas represent
approximately 4% of the
population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2022

Guinea17.1

Sep 11 – Oct3, 2022

1,000

1.58

3.9

Face-to-Face(HH)*

French,Malinke,
Pular,
Soussou

2022

Honduras

17.1

Aug 20 – Oct3, 2022

1,000

1.51

3.8

Face-to-Face(HH)*

Spanish2022

Hong Kong,
S.A.R. of
China

17.2

Aug 25 – Oct30, 2022

1,005

1.18

3.4

Landlineand Mobile
Telephone

Chinese2022

Hungary17.2

Oct 4 – Nov 7,
2022

1,000

2.00

4.4

Landlineand Mobile
Telephone

Hungarian

2022

Iceland17.2

Aug 17 – Sep
27, 2022

503

1.29

5.0

Landlineand Mobile
Telephone

Icelandic

Exclusions(Samples are nationally
representative unless
noted otherwise)

2022

India

17.1

Jul 25 –Oct 18, 2022

3,000

1.35

2.1

Face-to-Face(HH)*

Assamese,
Bengali,English,Gujarati,
Hindi,
Kannada,Malayalam,
Marathi,Odia, Punjabi,
Tamil, Telugu

2022

Indonesia

17.1

Jul 27 –Aug 28, 2022

1,002

1.24

3.4

Face-to-Face(HH)*

BahasaIndonesia

2022

Iran

17.2

Oct 12 –Oct 21, 2022

1,007

1.39

3.6

Landlineand Mobile
Telephone

Farsi

2022

Iraq

17.1

Sep 27 –Dec 2, 2022

1,046

1.42

3.6

Face-to-Face andFace-to-Face(HH)*

Arabic,Kurdish2022

Ireland17.2

Sep 12 –Oct 12, 2022

1,000

2.00

4.4

Landlineand Mobile
Telephone

English2022

Israel

17.1

Aug 22 –Oct 2, 2022

1,000

1.14

3.3

Face-to-Face(HH)*

Hebrew,Arabic

2022

Italy

17.2

Sep 12 –Oct 7, 2022

1,000

2.49

4.9

Landlineand Mobile
Telephone

Italian

2022

Ivory Coast

17.1

Jul 12 –Jul 29, 2022

1,000

1.82

4.2

Face-to-Face(HH)*

French,Dioula2022

Jamaica

17.1

Aug 30 –Oct 27, 2022

500

1.35

5.1

Face-to-Face(HH)*

EnglishThe Hologic Global Women’s Health Index | Year 3 Global Report

119

Excluded population living
in Northeast states andremote islands, and Jammu
and Kashmir. The excluded
areas represent less than
10% of the population.

The sample does notinclude the area of East
Jerusalem. This area wasincluded in the sample ofPalestinian Territories.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

1,005

1.33

3.6

Landlineand Mobile
TelephoneJapanese

2022

Jordan17.1

Aug 28 –Sep 17, 2022

1,000

1.29

3.5

Face-to-Face(HH)*

Arabic2022

Kazakhstan

17.1

Oct 1 –
Oct 27, 2022

1,000

1.56

3.9

Face-to-Face(HH)*

Russian,
Kazakh

2022

Kenya

17.1

Jun 27 –Jul 12, 2022

1,000

1.33

3.6

Face-to-Face(HH)*

English,Swahili/
Kishwahili

2022

Kosovo17.1

Jul 21 –Oct 18, 2022

1,000

1.58

3.9

Face-to-Face(HH)*

Albanian,
SerbianMarginof Errorb

Aug 27 –Nov 4, 2022

DesignEffecta

17.2

Number ofInterviews

Japan

Wave

2022

Landline RDD excluded
12 municipalities near the
nuclear power plant inFukushima. These areas
were designated as notto-call districts due to thedevastation from the 2011
disasters. The exclusion
represents less than 1% of
the population of Japan.

Country

Languages

Mode ofInterviewing

Data Collection
Date

Data Collection
Year

Exclusions(Samples are nationally
representative unless
noted otherwise)

2022

Kuwait17.2

Oct 13 –Oct 30, 2022

1,003

1.77

4.1

MobileTelephoneArabic,Bengali,English, Hindi

2022

Kyrgyzstan

17.1

Oct 5 –
Oct 28, 2022

1,000

1.62

3.9

Face-to-Face(HH)*

Kyrgyz,Russian,
Uzbek
Excluded Xaisomboun
Province, Xayaboury
Province and somecommunes that are
unreachable and/or havesecurity considerations. The
excluded areas represent
approximately 7% of the
population.

2022

Lao People's
Democratic
Republic

17.1

Sep 19 –Oct 16, 2022

1,000

1.55

3.9

Face-to-Face
(HH)*

Lao

2022

Latvia17.2

Aug 9 –
Oct 25, 2022

1,000

1.48

3.8

MobileTelephone

Latvian,Russian2022

Lebanon17.1

Jul 14 –Aug 18, 2022

1,000

1.28

3.5

Face-to-Face(HH)*

Arabic2022

Lesotho

17.1

Sep 10 –Dec 25, 2022

1,010

1.89

4.2

Face-to-Face(HH)*

English,Sesotho2022

Liberia17.1

Aug 9 –
Sep 12, 2022

1,001

1.32

3.6

Face-to-Face(HH)*

English,PidginEnglish

2022

Libya

17.2

Dec 5, 2022
– Jan 16, 2023

1,000

1.37

3.6

MobileTelephoneArabicThe Hologic Global Women’s Health Index | Year 3 Global Report

120

Includes only Kuwaitis, Arab
expatriates and non-Arabs
who were able to complete
the interview in Arabic,
English, Bengali or Hindi.

Hermel, Baalbak andBint Jbeil under the strict
control of Hezbollah
were excluded. The
excluded areas represent
approximately 10% of the
population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

1,0001.24

3.4

Face-to-Face(HH)*

Lithuanian

2022

Luxembourg

17.2

Sep 12 –Oct 18, 2022

1,000

1.83

4.2

Landlineand Mobile
TelephoneFrench,GermanMarginof Errorb

Aug 3 –
Oct 16, 2022

DesignEffecta

17.1

Number ofInterviews

Lithuania

Wave

2022

Very small settlements (withless than 100 inhabitants)
were excluded. The
excluded areas represent
approximately 9% of thetotal population.

Country

Languages

Mode ofInterviewing

Data Collection
Date

Data Collection
Year

Exclusions(Samples are nationally
representative unless
noted otherwise)

2022

Madagascar

17.1

Jun 16 –Jul 24, 2022

1,000

1.42

3.7

Face-to-Face(HH)*

French,Malagasy

2022

Malawi17.1

Aug 26 –Sep 6, 2022

1,000

1.26

3.5

Face-to-Face(HH)*

Chichewa,
English,Tumbuka

17.1

Jul 21 –Sep 17, 2022

3.7

Face-to-Face(HH)*

BahasaMalay,
Chinese,English2022

Malaysia

1,000

1.45

2022

Mali

17.1

Sep 8 –
Oct 4, 2022

1,000

1.30

3.5

Face-to-Face(HH)*

French,Bambara

2022

Malta

17.2

Jul 26 –Sep 6, 2022

1,005

1.31

3.5

Landlineand Mobile
Telephone

Maltese,English2022

Mauritania

17.1

Aug 19 –Oct 21, 2022

1,000

1.66

4.0

Face-to-Face(HH)*

French,Poulaar,
Hassanya2022

Mauritius

17.2

Aug 5 –
Sep 19, 2022

1,000

1.61

3.9

Landlineand Mobile
Telephone

Creole,English,French2022

Mexico17.1

Jul 8 –
Aug 22, 2022

1,000

1.40

3.7

Face-to-Face(HH)*

SpanishFace-to-Face(HH)*

Romanian/
Moldavian,Russian2022

Moldova,
Republic of

17.1

Aug 2 –
Oct 13, 2022

The Hologic Global Women’s Health Index | Year 3 Global Report

1,000

1.63

4.0

121

Regions that were unsafe or
unreachable were excluded
from the sample. The
excluded areas represent
approximately 17% of thetotal population.

The regions of Gao, Kidal,
Mopti and Tombouctou
were excluded because
of insecurity. Quartiersand villages with lessthan 50 inhabitants werealso excluded from thesample. The excluded areas
represent 23% of the total
population.

Some communes in Hodh
Ech Chargui and Hodh El
Gharbi were excluded due
to increasing insecurity. The
excluded areas represent
approximately 4% of the
population.

Transnistria (Prednestrovie)
excluded for safety
of interviewers. The
excluded area represents
approximately 13% of the
population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2022

Mongolia

17.1

Jun 30 –Aug 8, 2022

1,000

1.26

3.5

Face-to-Face(HH)*

Mongolian2022

Montenegro

17.1

Sep 28 –Dec 11, 2022

1,000

1.43

3.7

Face-to-Face(HH)*

Montenegrin

2022

Morocco17.1

Jul 26 –Aug 21, 2022

1,015

1.29

3.5

Face-to-Face(HH)*

Exclusions(Samples are nationally
representative unless
noted otherwise)

MoroccanArabicExcludes the Southern
provinces. The excluded
area represents
approximately 3% of the
population.
Cabo Delgado Province anda small number of districts
in other provinces were
excluded due to insecurity.
The excluded areas
represent 8% of population.

2022

Mozambique

17.1

Sep 27 –Nov 25, 2022

1,000

1.90

4.3

Face-to-Face(HH)*

Portuguese,
Xichangana,Emakhuwa

2022

Myanmar17.2

Oct 7 –
Nov 4, 2022

1,000

2.56

5.0

MobileTelephone

Myanmar,Burmese2022

Namibia17.1

Sep 22 –Oct 18, 2022

1,003

1.83

4.2

Face-to-Face(HH)*

English,Oshivambo,
Afrikaans

2022

Nepal

17.1

Jul 2 –
Aug 2, 2022

1,000

1.66

4.0

Face-to-Face(HH)*

Nepali

2022

Netherlands

17.2

May 23 – Aug27, 2022

1,009

1.42

3.7

Landlineand Mobile
Telephone

Dutch

2022

New
Zealand17.2

Aug 22 –Oct 2, 2022

1,000

1.56

3.9

Landlineand Mobile
Telephone

English2022

Nicaragua

17.1

Jul 30 –Sep 15, 2022

1,000

1.66

4.0

Face-to-Face(HH)*

Spanish

2022

Niger

17.1

Sep 22 –Oct 18, 2022

1,000

1.48

3.8

Face-to-Face(HH)*

French,Hausa,
Zarma

Some communes in the
Agadez region and Diffa
region were excluded
because of insecurity.
In addition, PSUs withfewer than 25 households
were also excluded. The
excluded areas represent
approximately 8% of the
population.
The three Northeasternstates of Adamawa, Borno
and Yobe were excluded
due to insecurity andBoko Haram insurgency.
In addition, disputed areasof Taraba state were also
excluded. Together, theseexclusions account forroughly 8% of the total
population.

2022

Nigeria17.1

Sep 21 –Oct 16, 2022

1,000

2.50

4.9

Face-to-Face(HH)*

English,Hausa,
Igbo, Pidgin
English,Yoruba2022

Northern
Cyprus

17.2

Aug 12 –Sep 12, 2022

1,000

1.67

4.0

Landlineand Mobile
Telephone

TurkishThe Hologic Global Women’s Health Index | Year 3 Global Report122© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2022

North
Macedonia

17.1

Jul 30 –Oct 30, 2022

1,000

1.37

3.6

Face-to-Face(HH)*

Macedonian,
Albanian

2022

Norway17.2

Aug 4 –
Oct 4, 2022

1,002

1.85

4.2

MobileTelephone

Norwegian2022

Pakistan

17.1

Sep 30 –Nov 14, 2022

1,012

1.76

4.1

Face-to-Face(HH)*

Exclusions(Samples are nationally
representative unless
noted otherwise)

Urdu

Did not include AJKor Gilgit-Baltistan. The
excluded areas represent
approximately 5% of
the population. Gendermatched sampling was usedduring the final stage of
selection.
Areas with security
concerns close to theIsraeli borders, areasthat are accessible only
to special Israeli permit
holders and areas withpopulation concentrations
less than 1,000 people were
excluded. The excluded
areas represent less than
2% of the population.

2022

Palestinian
Territories

17.1

Sep 8 –
Sep 28, 2022

1,000

1.22

3.4

Face-to-Face(HH)*

Arabic2022

Panama17.1

Jul 13 –Sep 1, 2022

1,000

1.58

3.9

Face-to-Face(HH)*

Spanish2022

Paraguay

17.1

Aug 31 –Sep 27, 2022

1,000

1.34

3.6

Face-to-Face(HH)*

Spanish,Jopara

2022

Peru

17.1

Aug 19 –Sep 18, 2022

1,000

1.29

3.5

Face-to-Face(HH)*

Spanish2022

Philippines

17.1

Dec 14, 2022
– Feb 7, 2023

1,000

1.41

3.7

Face-to-Face(HH)*

Filipino, Iluko,
Cebuano,Hiligaynon,
Waray, Bicol

2022

Poland17.1

Jun 27 –Sep 21, 2022

1,000

1.26

3.5

Face-to-Face(HH)*

Polish2022

Portugal

17.2

Jul 12 –Aug 13, 2022

1,001

1.78

4.1

Landlineand Mobile
Telephone

Portuguese

2022

Puerto Rico

17.1

Aug 21 –Dec 5, 2022

500

1.61

5.6

Face-to-Face(HH)*

Spanish2022

Romania17.1

Jun 16 –Aug 8, 2022

1,000

1.43

3.7

Face-to-Face(HH)*

Romanian

2022

RussianFederation

17.1

Aug 13 –Nov 2, 2022

The Hologic Global Women’s Health Index | Year 3 Global Report

2,006

1.44

2.6

123

Face-to-Face(HH)*

Russian

Low population areas
were excluded. The
excluded areas represent
approximately 5% of the
population.

People living in very
remote or difficult-to-accessareas were excluded. The
excluded areas represent
approximately 5% of the
population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Languages

1.88

Mode ofInterviewing

DesignEffecta

Number ofInterviews
1,021

Marginof Errorb

Saudi Arabia 17.2

Data Collection
Date

Wave

Country

Data Collection
Year
2022

Jul 18 –Aug 3, 2022

Exclusions(Samples are nationally
representative unless
noted otherwise)

5.1

Landlineand Mobile
TelephoneArabic,English,Hindi, Urdu

Includes Saudis, Arab
expatriates and non-Arabs
who were able to complete
the interview in Arabic,
English, Urdu or Hindi.

2022

Senegal17.1

Oct 1 –
Oct 29, 2022

1,000

1.52

3.8

Face-to-Face(HH)*

French,
Wolof

2022

Serbia17.1

Aug 27 –Dec 21, 2022

1,001

1.51

3.8

Face-to-Face(HH)*

Serbian2022

Sierra Leone

17.1

Aug 18 –Sep 13, 2022

1,028

1,000

3.4

Face-to-Face(HH)*

English, Krio,
Mende

1.68

4.0

MobileTelephone

English,Chinese,Bahasa
Malay

1.18

2022

Singapore

17.1

Dec 10 –Dec 28, 2022

2022

Slovakia

17.1

Jul 22 –Oct 23, 2022

1,001

1.38

3.6

Face-to-Face(HH)*

Hungarian,
Slovak

2022

Slovenia

17.2

Aug 16 –Oct 1, 2022

1,000

2.08

4.5

Landlineand Mobile
Telephone

Slovene2022

South Africa

17.1

Oct 12, 2022
– Jan 31, 2023

1,007

1.75

4.1

Face-to-Face(HH)*

Afrikaans,
English,Sotho,
Xhosa, Zulu

2022

South Korea

17.1

Aug 8 –
Sep 28, 2022

1,010

1.44

3.7

Landlineand Mobile
Telephone

Korean

2022

Spain

17.2

Oct 3 –
Oct 28, 2022

1,000

1.77

4.1

Landlineand Mobile
Telephone

Spanish2022

Sri Lanka

17.1

Aug 24 –Nov 26, 2022

1,000

1.51

3.8

Face-to-Face(HH)*

Sinhala, Tamil

2022

Sweden17.2

Aug 11 –Oct 5, 2022

1,000

1.56

3.9

MobileTelephone

Swedish2022

Switzerland

17.2

Sep 12 –Oct 15, 2022

1,000

1.64

4.0

Landlineand Mobile
Telephone

German,French,Italian

2022

Taiwan,Province of
China

17.2

Aug 8 –
Sep 8, 2022

1,000

1.62

3.9

Landlineand Mobile
Telephone

Chinese2022

Tajikistan

17.1

Nov 22 –Dec 21, 2022

1,000

1.49

3.8

Face-to-Face
(HH)*

Tajik

The Hologic Global Women’s Health Index | Year 3 Global Report

124

The Sindian commune
in Zinguichor region was
excluded due to insecurity.
PSUs (quartiers and villages)
with household sizes lessthan 50 were excluded due
to small population size. The
excluded areas represent
18% of the population.

Sampling units with lessthan 50 households were
excluded from sampling.
The excluded areas
represent less than 3% of
the population.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2022

Tanzania

17.1

Aug 4 –
Aug 28, 2022

1,001

1.48

3.8

Face-to-Face(HH)*

English,Swahili,
Kishwahili

Exclusions(Samples are nationally
representative unless
noted otherwise)

Three provinces in theSouth region (Pattani,
Narathiwat and Yala) were
excluded for security
reasons; in addition, a few
districts in other provinces
were excluded. The
excluded areas in total
represent less than 4% of
the population.

2022

Thailand17.1

Aug 10 –Oct 27, 2022

1,000

1.72

4.1

Face-to-Face
(HH)*

Thai

2022

The Gambia

17.1

Sep 10 – Oct23, 2022

1,000

1.35

3.6

Face-to-Face(HH)*

English,Pulaar, Wolof,
Malinke

2022

Togo

17.1

Oct 11 –Oct 27, 2022

1,000

2.12

4.5

Face-to-Face(HH)*

French, Ewe

2022

Tunisia17.1

Aug 13 –Aug 28, 2022

1,000

1.28

3.5

Face-to-Face(HH)*

Arabic2022

Türkiye17.1

Oct 13 –Dec 4, 2022

1,000

1.40

3.7

Face-to-Face(HH)*

TurkishThree districts in the Northregion were excluded for
security reasons — Kotido,
Moroto and Nakapiripirit.
The excluded areas
represent 2% or less of the
population.

2022

Uganda17.1

Oct 19 –Oct 29, 2022

1,000

1.48

3.8

Face-to-Face(HH)*

Ateso,English,Luganda,Runyankole

2022

Ukraine17.2

Oct 3 –
Oct 12, 2022

1,000

1.86

4.2

MobileTelephone

Russian,
Ukrainian

3.3

MobileTelephoneArabic,English,Hindi, Urdu

Includes only Emiratis, Arab
expatriates and non-Arabs
who were able to complete
the interview in Arabic,
English, Hindi or Urdu.

EnglishRegions outside of England,
Scotland, Wales andNorthern Ireland were
excluded.

2022

United ArabEmirates

17.2

Aug 23 –Sep 13, 2022

2022

UnitedKingdom ofGreat Britain 17.2
and Northern
IrelandSep 12 –Oct 10, 2022

1,000

1.85

4.2

Landlineand Mobile
Telephone

1,000

1.13

2022

UnitedStates ofAmerica

17.2

Oct 18 –Dec 20, 2022

1,006

1.46

3.7

Landlineand Mobile
Telephone

English,Spanish2022

Uruguay

17.1

Aug 5 –
Oct 14, 2022

1,000

1.28

3.5

Face-to-Face(HH)*

Spanish17.1

Jul 6 –
Sep 8, 2022

3.7

Face-to-Face(HH)*

Uzbek,
Russian2022

Uzbekistan

The Hologic Global Women’s Health Index | Year 3 Global Report

1,000

1.46

125

The entire Karakalpak
region was excluded,
which corresponds to 6%of the total population in
Uzbekistan.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

1,0001.46

3.7

Face-to-Face(HH)*

Spanish2022

Vietnam

17.1

Jun 22 –Aug 13, 2022

1,000

1.30

3.5

Face-to-Face(HH)*

Vietnamese

2022

Yemen

17.1

Nov 7, 2022
– Jan 9, 2023

1,000

1,000

2022

Zambia17.1

Sep 28 –Oct 17, 2022

2022

Zimbabwe17.1

Aug 20 –Sep 25, 2022

The Hologic Global Women’s Health Index | Year 3 Global Report

1,000

Marginof Errorb

Aug 26 –Sep 15, 2022

DesignEffecta

17.1

Number ofInterviews

Venezuela

Wave

2022

The federal dependencies
were excluded due toremoteness and difficultyof access. Exclusions
represent less than 1% of
the population.

Country

Languages

Mode ofInterviewing

Data Collection
Date

Data Collection
Year

Exclusions(Samples are nationally
representative unless
noted otherwise)

4.2

Face-to-Face andFace-to-Face(HH)*

Arabic1.68

4.0

Face-to-Face(HH)*

Bemba,English,Lozi, Nyanja,
Tonga

1.61

3.9

Face-to-Face(HH)*

English,Shona,
Ndebele1.81

126

Al Baydaa, Al Jawf, Mareb,
Sadah, the Island of Socotra
and several districts inother governorates were
excluded due to their small
size, remoteness or security
issues. The excluded areas
represent approximately
23% of the population. In
addition, due to the ongoingsecurity situation during
fielding, over one-fourth of
the PSUs were replacedwith a similar PSU in thesame province.

© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Data Analysis Methodology
The analysis in this report sought to answer the critical research questions that motivated this study. In someinstances, this entailed reporting on the topline results for each country and area in the study; however, more
complex data analysis techniques often were required to better understand why and how attitudes toward scienceand health differed across the world or parts of the world, or within a certain population. This section explores theanalytical tools and techniques employed in this analysis.

Country groupings
The Index was fielded in 116 countries and territories in Year 1, 122 countries and territories in Year 2, and 143
countries and territories in Year 3. The survey findings are often reported in various cross-national groupings to help
illustrate the global variation of results without overburdening the reader by presenting data points from more than
140 different countries and territories. The major types of country groupings used in this report are by country income
breakdowns described below.

Presentation of cross-country results
All results presented at a combined-country level — such as by region, country income level or at the overall (i.e.,‘global’) level — were weighted by the aged 15 and older population size of the countries included in the analysis.
This process gives more populated countries more weight than less populated countries.
For example, in Year 1, China had the largest population of the 116 countries included in the Hologic Global Women’s
Health Index. China’s aged 15 and older population represented about 22% of the total 15 and older population
across the countries and areas surveyed, according to the national census figures Gallup used in its sampling andweighting processes. Thus, when presenting global estimates in the report, respondents from China were given agreater weight — corresponding to their share of the population — in determining the final calculation.
Because data for the Hologic Global Women’s Health Index were not collected in China in 2022, data collected
in 2021 were used in Year 3 report calculations. The 2021 data were weighted to the 2022 population estimatesfor China.

Standardization of income, education and employment groups
Personal information such as income, education and employment can be defined or measured differently acrosscountries, which can create challenges when attempting to compare cross-country results.
For this reason, the Hologic Global Women’s Health Index examined these characteristics using standardized
definitions of income that have been developed by the Gallup World Poll. Additionally, employment status was
defined in a manner consistent with the Bureau of Labor Statistics in the United States.

The Hologic Global Women’s Health Index | Year 3 Global Report127© 2024 Hologic, Inc. All rights expressly reserved.
HGWHI_Y3GlobalReport_Appendix2

Country income level
Countries were divided into four income groupings, as defined by the World Bank:
The World Bank updates its classifications annually on July 1 based on the GNI per capita in current USD of theprevious year.
In 2020 these categories were:• Low income: Gross national income (GNI) per capita of $1,035 or less (in 2019)• Lower-middle income: GNI per capita of $1,036 to $4,045• Upper-middle income: GNI per capita of $4,046 to $12,535• High income: GNI per capita above $12,535
In 2021 these categories were:• Low income: GNI per capita of $1,035 or less (in 2019)• Lower-middle income: GNI per capita of $1,046 to $4,095• Upper-middle income: GNI per capita of $4,096 to $12,695• High income: GNI per capita above $12,695
In 2022 these categories were:• Low income: GNI per capita of $1,085 or less (in 2021)• Lower-middle income: GNI per capita of $1,086 to $4,255• Upper-middle income: GNI per capita of $4,256 to $13,205• High income: GNI per capita above $13,205
Note: The World Bank does not classify Venezuela in any of the categories. When the country averages are presented at their country income level breaks,
Venezuela is not included.

References in Appendix 2
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). L. Erlbaum Associates.

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HGWHI_Y3GlobalReport_Appendix2

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