2020 GLOBAL REPORTThe Hologic
Global Women’s
Health Index
Pathways to a Healthy
Future for WomenTable of Contents

1

3

A Letter From Hologic’s CEO

5

Introduction

6

Key Findings

9

The Hologic Global Women’s Health Index

14

Global Results

19

Regional Rankings

26

The Building Blocks for Improving Women’s Health28

Relatively Few Women Tested for Serious Diseases

40

Stress, Worry Are Major Challenges for Women46

Healthcare, Safety Contribute to Longer Lives for Women

56

Food, Shelter Are Necessities Many Women Cannot Afford

60

The World Needs to Help Women Manage Pain

64

Conclusion

65

Index Scores by Country and Territory

70

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

89

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

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“Critical data for global, regional andnational development policymaking is stilllacking. Many governments still do nothave access to adequate data on their
entire populations. This is particularly true
for the poorest and most marginalized.
U N I T E D N AT I O N S

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FO R E WO R D:

A Letter From Hologic’s CEO
Healthy women are the cornerstones of healthy economies and societies. But women’s health rarely gets theattention that it deserves.
By focusing on women’s health and working together to address key issues, we can not only improve women’s lives,
we can also realize social and economic progress globally.
To accomplish this, we need robust data on women’s health, and the ability to benchmark and track it over time ona global level. As a science-based company, Hologic knows that having quality data is important to making gooddecisions. The challenge is that in most of the world, these data are at best lacking, or at worst, nonexistent.
This is why we are partnering with Gallup to create a data roadmap that helps leaders and policymakers give
women’s health the priority that it deserves.
The Hologic Global Women’s Health Index, which we launched amid the COVID-19 pandemic, is a multiyear,
comprehensive global survey about women’s health. Through it, we can listen to women and men in their own words,
and track progress on key women’s health issues globally and by country.
As part of its World Poll, Gallup interviewed more than 120,000 women and men in 116 countries and territories inmore than 140 languages. The aggregate results of those discussions are shared in this report, which is also being
distributed to global leaders and policymakers around the world.
Our goal is to call to action world leaders — in and out of government — to improve women’s health. This, in turn, willchange lives, support greater development and address longstanding inequalities.
Hologic’s passion is to be a global champion for women’s health. Through our Index, our ambition is to work withworld leaders to improve women’s quality of life, and ultimately life expectancy. Women’s health is tied to economic
performance, productivity and overall well-being; improving it will benefit all of us, as well as future generations.
We look forward to sharing information with national, corporate and non-profit leaders, working with them to develop
tailored solutions that address women’s health, and providing them with more data in the future.
Through this report, women are telling us what they need. We all need to listen. Then act, together.

Stephen P. MacMillan
Chairman, President and Chief Executive Officer of Hologic

3

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Introduction
Women’s health and health equity are arguably
in a better place today than they were more than
25 years ago when 189 countries adopted the 1995
Beijing Declaration and Platform of Action, the firstglobal policy framework for achieving gender equality
in critical areas including women’s health.
However, progress on many of the objectives set
for women’s health in Beijing has been uneven. For
example, while the global maternal mortality rate
dropped by 38% between 2000 and 2017, the use ofcontraceptives has increased slowly and unevenly
over that same period, and as recently as 2019, as
many as 270 million women of reproductive age had
an unmet need for modern contraception.1
Today, many women still face these and otherfundamental health challenges, including cancer,
reproductive health issues, sexually transmitted
diseases and violence against them.2,3 To keep
moving forward, and save more women’s lives,
leaders and policymakers need to understand therealities of these women’s healthcare experiences.
And to do that, they need access to robust, quality
data that disaggregates this information by genderand exposes the inequities and what’s driving them.

5

The Hologic Global Women’s Health Index — amultiyear, globally comparative survey of women’s
health — strives to fill the critical gap in what theworld knows about the health and well-being of theworld’s women and girls. But more than that, it aims
to identify the keys to help them live longer, safer andhealthier lives.
The findings in this report offer a glimpse into what
Hologic learned about women’s health from the firstyear of this survey, which is based on interviews
Gallup conducted throughout 2020 with just over
120,000 women and men aged 15 and older in
116 countries and territories.
The results in this report focus primarily on women’sanswers, and serve as a baseline of their knowledge,
attitudes and behaviors regarding their health,specifically in vital areas such as prenatal care andpreventive testing. Future administrations of the study
will track changes in women’s health and safety andmonitor whether women’s health is improving at thecountry, regional and global levels.

1

Kantorová, V., Wheldon, M. C., Ueffing, P., & Dasgupta, A. N. Z. (2020). Estimating progress towards meeting women’s contraceptive needs in 185 countries: A
Bayesian hierarchical modelling study. PLOS Medicine, 17(2), e1003026. https://doi.org/10.1371/journal.pmed.1003026

2

Ten top issues for women’s health. (2015, February 20). World Health Organization. https://www.who.int/news-room/commentaries/detail/ten-top-issues-forwomen%27s-health3

Women’s Issues in Pandemic Times: How COVID-19 Has Exacerbated Gender Inequities for Women in Canada and around the World. (2020, December 1).
PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528830/

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Key Findings
Every country or territory has
work to do.
• Higher scores on the Hologic Global Women’s

Health Index mean potentially healthier, safer andlonger lives for women, but with a global score ofjust 54 out of 100, world leaders need to do betteron women’s health.

• Every country or territory has room to improve. Not
one country or territory scores higher than a 69 on
the Index.

And there is also extreme inequity inwomen’s health.

• Only a fraction of the world’s women have the

The world is weak on
preventive care.
Sixty-one percent — or more than 1.5 billion
women — did not get tested for any of themost damaging diseases for women in thepast 12 months.

• On average, one in three women worldwide had

their blood pressure tested in the previous 12
months — despite heart disease being the leading
cause of death globally for women and men.

• Worldwide, just 12% of women said in 2020 thatthey have been tested for any type of cancer in thepast 12 months.

highest Index scores. Women in high-income
economies — which make up just 17% of womensurveyed — score a 61 on the Index.

• Worldwide, about one in five (19%) women reported• Scores on the Index drop with each subsequent• Fewer than one in nine women had been tested forcountry-income group level after that, eventuallywidening to a 12-point gap between women living
in high-income economies (61) and low-income
economies (49).

Five dimensions of women’s healthcan change — and lengthen —their lives.
• Together, the five dimensions of the Hologic

Global Women’s Health Index — Preventive Care,
Opinions of Health and Safety, Emotional Health,Individual Health and Basic Needs — explain morethan 80% of women’s average life expectancy
at birth.

being tested in the previous 12 months for diabetes,
the sixth leading cause of death for women globally.
sexually transmitted diseases or infections — all ofwhich are risk factors for HIV, cancer and infertility— in the previous 12 months.

Most women (88%) believe checkups help
improve people’s health, but many (40%)
haven’t seen a healthcare professional in thepast 12 months.

• Majorities of women in all the countries andterritories surveyed believe regular medical
checkups help improve people’s health. Worldwide,
the percentages of women who believe this range
from a low of 72% in Hungary to a high of 100%in Tanzania.

• However, in the majority of countries, there weresignificant gaps between women’s perceptions
and actions.

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Women are generally satisfied withhealthcare quality.

• Women — along with the world in 2020 — werefeeling the worst they had in 15 years. Global
experiences of worry, stress, sadness and anger
continued to rise in 2020 and set new records.

In their communities, most women aresatisfied with the quality of their healthcare
and prenatal care.

Women are living with pain.

• Most women are satisfied with the availability of• Three in 10 (30%) women in 2020 — or more thanquality healthcare where they live (68%) and thinkmost pregnant women in their communities receivehigh-quality prenatal care (69%).

A women’s age at her first pregnancy sharply
differentiates her health outcomes.

• In almost every part of the world, women who report
first becoming pregnant at an age younger than 19score worse in every area of their health than those
who first became pregnant at a later age.

But well over half a billion women do
not feel safe walking alone at night.
• More than 800 million women do not feel safe

walking alone. Women are also less likely than men
to feel safe.

Most women and men identify domestic
violence as a widespread problem where
they live.

• Two in three women worldwide — or about 1.7 billion
women — say domestic violence is a widespread
problem in their country. And nearly six in 10
men agree.

Women’s emotional health suffered.

750 million worldwide — report experiencing
physical pain during a lot of the previous day.

• One in five (20%) women in 2020 — or morethan 500 million women — say they have healthproblems that prevent them from doing things
people their age normally do.

Millions struggling with basic needs.
Hundreds of millions of women worldwide
cannot afford the food and shelter that they ortheir families need.

• In 2020, 34% of women — or nearly 900 million

women — struggled to afford food in the past year.

• Nearly three in 10 (29%) women — or nearly 700

million — say there had been times in the past year
when they were unable to afford adequate shelter.

Money is just part of the solution.
• Countries and territories that spend more per capita
on healthcare tend to earn higher scores on theoverall Index.

• This is true everywhere except the U.S., which

spends the most of any country — $10,623 perperson in 2018 — and scores a 61.

Women in 2020 were more worried andstressed, sad and angry, along with the rest of
the world.

• About four in 10 women in 2020 say theyexperienced worry (40%) and stress (38%) during
a lot of the day before the survey, while about one
in four say they experienced sadness (26%) andanger (23%).

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The Hologic Global Women’s Health Index
What is the Hologic Global Women’s Health Index?
Harnessing the statistical power and global reachof Gallup’s World Poll, the Hologic Global Women’s
Health Index is a multiyear, globally comparative
survey that tracks multiple health issues essential to
improving the health, quality of life and life expectancyof the world’s women and girls.
Based on women’s responses in the first year of thissurvey, Hologic and Gallup developed the Hologic
Global Women’s Health Index, an indicator of women’s
health that country leaders and policymakers can use
to help build a healthy and safe future for women.
The Hologic Global Women’s Health Index is asingle number based only on women’s answers thatsummarizes a host of complex factors that contributeto women’s health. A higher score on the overall Indexmeans more women are having positive experiencesin five dimensions that explain more than 80% of
women’s average life expectancy at birth: Preventive
Care, Basic Needs, Emotional Health, Opinions of
Health and Safety, and Individual Health. Higherscores in these individual dimensions mean more
women are having positive experiences in each ofthese respective areas.
Global, regional and country-level results on theoverall Index, as well as the five individual dimensions,are presented and discussed in further detailthroughout this report. More technical details about
the construction and scoring of the Index and thedimensions are available in the Appendix.

Preventive CareHigh blood pressure*
Cancer*Diabetes*
STDs/STIs*

Emotional Health
Anger
StressSadness
Worry

Opinions of Health and Safety
High-quality pregnancy care*
High-quality healthcare
Safe walking alone at night

Basic Needs
Food
Shelter

Individual Health
Health problems
Pain a lot of the day

About Gallup’s World Poll:
Since 2005, Gallup has been interviewing nationally
representative samples of women and men in morethan 160 countries and territories annually on core
topics that are important to women’s lives, and to therest of the world. All of Gallup’s core question items
are disaggregated by gender.

9

The Hologic Global Women’s Health Index | Global Report*Indicates Hologic additions to the World Poll

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How was the Hologic Global Women’s Health Index developed?
Starting in 2019, in consultation with international public health and medical experts4 and the Gallup World Poll
research team, Hologic developed a set of questions designed to consistently measure women’s experiences withhealth issues and healthcare. The goal is to track changes on each of these measures over multiple years:
Health/Healthcare Issue

Hologic Question

Value of preventive care

• Do you think going to a healthcare professional, such as a medical doctor or a nurse, atExperience ofpreventive care

• In the past 12 months, have you talked to a healthcare professional, such as a medical

least once every 12 months for a checkup, can help people improve their health, or not?

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]?

Prenatal care

• Do you think most pregnant women in the city or area where you live receive high-quality

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

Domestic violence• Now I would like to ask you a question regarding domestic violence. Domestic violence

healthcare during their pregnancies, or not?

can be physical, psychological, or involve sexual acts done to someone against their willby a person they live with. In your opinion, is domestic violence a widespread problem in[country name], or not?

More information about the design and formulation of the Index is in the Appendix.

Throughout 2020, Gallup asked just over 120,000 women and men in 116 countries and territories these questions,along with questions that the World Poll has been asking for almost two decades about general health, opinions ofavailable quality healthcare, safety, food and shelter, and emotional health.

What does the Index measure?
Using a factor analysis of the responses to these questions from nearly 60,000 women aged 15 and older, the Gallupand Hologic research team identified questions that related to five dimensions of women’s health that together
explain more than 80% of women’s average life expectancy at birth: Preventive Care, Emotional Health, Opinions of
Health and Safety, Basic Needs, and Individual Health.5
While Gallup and Hologic originally hypothesized that 18 of the Hologic or World Poll questions would be factored
into the Index, after testing, several were dropped for various reasons (please see the Appendix for more details).
For example, while a question about domestic violence asks about an important safety and health issue for women,
it was not included in the Index because it was not highly related to any of the five dimensions.

10

4Annastasiah Mhaka, Ph.D., Caroline Popper, M.D., Claire Wagner, M.D, MBA, Karen Drenkard, Ph.D., RN, Mary Catherine Beach, M.D., Robert Bollinger, M.D.,
Alexandra von Plato, Daniel J. Mollura, M.D., Sezin Palmer

5

For details on this factor analysis and why Gallup and Hologic included certain questions and not others, please see the Appendix.

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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/infections
Emotional Health

Did you experience the following feelings during a lot of the day yesterday?

Opinions of Health and Safety• In the city or area where you live, are you satisfied or dissatisfied with the• How about worry?
• How about sadness?
• How about stress?
• How about anger?
availability of 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
to buy food that you or your family needed?

• 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?

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 calculated individual Index scores, first creating a simple average of the responses to the questions includedin each dimension and then a weighted average of all dimension scores.6
This provides the foundation for the calculation of country averages and allows for a granular understanding of how
different groups of women score differently based on health determinants — such as age, education, income, urban
or rural status and women’s age of first pregnancy.

6

11

For more information on the scoring of the Index, please see the Appendix.

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Why is the Index important?
Hologic and Gallup discovered that theHologic Global Women’s Health Index isstrongly related to women’s average life
expectancy at birth — one of the mostfrequently used health status indicators.7

The current data suggest positive improvements
on any one of the five dimensions could potentiallyhelp women live healthier, longer lives. As it stands,
these dimensions account for more than 80% of
why some women live longer than others do — andprovide insights with the power to change countries
and territories.8

CHART 1:

Women’s Health Index and Life Expectancy
100

90

80

70

LatviaSaudi
Arabia60

South
AfricaIndia

Zambia50

Uzbekistan

Pakistan
Guinea40

Bolivia
Republic of
the Congo

30

UnitedStatesNew
ZealandGermany
Australia
Japan

UkraineBrazilDominican
Republic

Gabon

Colombia

Peru

20

10

0

12

60

62

64

66

68

70

72

74

76

78

80

82

84

86

88

7

Health status - Life expectancy at birth - OECD Data. (n.d.). The OECD. Retrieved August 10, 2021, from https://data.oecd.org/healthstat/life-expectancy-at-birth.htm

8

Please see the regression analysis on life expectancy and the Index in the Appendix.

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What are the goals for the Index?
The Index aims to provide country
leaders and policymakers withan indicator that will help them
improve the current lives of womenand increase their longevity andquality of life in the future.

13

The Hologic Global Women’s Health Index | Global Report

By using a global ranking of countries and territories
and pinpointing what contributes to the greatest
differences in women’s health scores, leaders cansee where they stand relative to the rest of the world,
identify their areas of strength and opportunities for
improvement, and use those insights to direct theirpolicies more effectively.

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Global Results
All countries and territories have room to improve on women’s health.
Higher scores on the overall Hologic Global Women’s
Health Index mean more women in a country arehaving positive health and healthcare experiences.
The world’s score of 54 out of 100 signals global
leaders have significant work to do to improve
women’s health.

In fact, leaders in all countries and territories do.
No one country or territory scores higher than 69 out
of 100 on the Index. But results also reveal extreme
inequality across the globe.9

Scores worldwide range from a high of
69 in Taiwan to a low of 36 in Peru.

CHART 2:

Women’s Health Around the World
Hologic Global Women’s Health Index
35		

9

14

75

Please see page 65 for Index scores by country and territory.

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CHART 3:

Hologic Global Women’s Health Index by Demographic
OverallGlobal female population54

Age 15-50

53

Age 51-75

57

Age 76+65

Elementary education or less51

Secondary education/Some education
beyond secondary

55

Four years beyond high school and/or
received a 4-year college degree

59

Age

Education

Age at first pregnancy

Age 18 or younger48

Age 19-24

54

Age 25 or older

58

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

15

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Most countries and territories with the highest scores on the Index havehigher-than-average preventive care.
All the countries and territories withthe highest scores on the overall
Index are high-income economies.10

Women in these countries almost universally havetheir basic needs met, with scores in the Basic Needs
dimension in the 90s in most countries except for
Latvia and Estonia. And except for Switzerland, all ofthem also post Preventive Care dimension scores thatare well above the global average of 19.

TA B L E 1 :Top Countries/Territories on the Hologic Global Women’s Health Index
5 D IME N SIO N S O F WO ME N ’ S H E A LT H

Hologic
Women’s
Health Index

1

2

3

4

5

Preventive
Care

Emotional
HealthOpinions of
Health and Safety

Basic
Needs

Individual
Health

GLOBA L AV ERAGE

54

19

68

70

68

75

Taiwan, Province of China

69

24

89

85

93

85

Austria

67

29

78

89

93

76

Finland

65

23

75

88

95

79

Latvia

65

44

76

64

84

72

Norway

65

23

74

93

93

74

Germany

65

29

75

81

93

72

Netherlands

64

23

73

87

96

74

Denmark

64

24

77

86

94

67

Australia

64

32

72

76

92

75

Estonia

64

26

77

78

89

78

Switzerland

64

19

76

90

93

78

Note: Higher scores indicate more women are having positive health and healthcare experiences.
Source: Hologic Global Women’s Health Index, 2020

1016

According to World Bank country-income classifications

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The countries and territories with the lowest scores on the Index all share highincome inequality and weak or destabilized infrastructure for healthcare.
The countries and territories withthe lowest scores on the Index are a
mix of mostly low and lower middleincome economies and some upper
middle-income economies.

Few countries and territories in this group score
well in meeting women’s basic needs, with nocountry scoring above the global average of 68 inthis dimension. Only Lebanon and Tunisia — whose
healthcare systems were on the verge of collapse in
2021 — come close.11,12 Most countries and territories
in this group also score below the global average of
19 on the Preventive Care dimension.

TA B L E 2 :Bottom Countries/Territories on the Hologic Global Women’s Health Index
5 D IME N SIO N S O F WO ME N ’ S H E A LT H

Hologic
Women’s
Health Index

1

2

3

4

5

Preventive
Care

Emotional
HealthOpinions of
Health and Safety

Basic
Needs

Individual
Health

GLOBA L AV ERAGE

54

19

68

70

68

75

Mali

42

10

56

51

54

62

Bolivia

42

21

55

35

47

72

Tunisia

42

16

48

44

65

58

Lebanon

41

16

45

48

67

54

Ecuador

40

20

49

43

40

70

Republic of the Congo

38

13

55

44

42

55

Gabon

38

14

58

33

33

68

Iraq

37

18

39

51

46

53

Venezuela

37

16

54

27

37

72

Peru

36

18

41

32

44

62

Note: Higher scores indicate more women are having positive health and healthcare experiences.
Source: Hologic Global Women’s Health Index, 2020

17

11

Associated Press. (2021, June 10). No more kidney dialysis? Lebanese hospitals issue warning. https://apnews.com/article/beirut-middle-east-lebanon-businesshealth-7ff67b0bc6154b0fc1eaca63c04baa21

12

Reuters. (2021, July 8). Tunisia says health care system collapsing due to COVID-19. https://www.reuters.com/business/healthcare-pharmaceuticals/tunisia-sayshealth-care-system-collapsing-due-covid-19-2021-07-08/

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Regional Rankings
The wide range in overall Index scores at the regional level, from a high of 64
in Australia/New Zealand to a low of 44 in South America illustrates the healthinequity that exists for women across the planet.
As a region, Australia/New Zealand outscores all others on the overall Index. The health systems in the two countries
share some similarities. Both have been able to successfully minimize inequities across a wide range of determinantsof health, including age at the time of first pregnancy, education and household income.
CHART 4:

Hologic Global Women’s Health Index
By region
Australia/New Zealand

64
REGION SPOTLIGHT:

Eastern Asia

60

Australia/New Zealand

Northern America

60

Europe58

With strong scores on the Index, women inAustralia and New Zealand can expect tolive long lives, and they already do: 85 inAustralia and 84 in New Zealand.

Southern Asia

53

Central Asia

53

South-eastern Asia

52

Sub-Saharan Africa

48

Caribbean

48

Northern Africa

47

Western Asia

47

Central America

47

South America

19

44

The Hologic Global Women’s Health Index | Global Report

But even in the world’s healthiest andwealthiest countries, there are differencesin outcomes between groups in society that
illustrate the substantial room they have to
grow. In Australia for example, even though
women are living years longer than men,they are also experiencing more of the total
disease burden than men and they are
more likely to suffer from multiple chronic
conditions and experience sexual violence.

Note: Higher scores indicate more women are having positive
health and healthcare experiences.
Index scores range from 0 to 100. For more information on how
these scores are calculated, please see page 70.

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A woman’s age at her first pregnancy sharply affects her health outcomes.
In nearly all regions, women who
report first becoming pregnant at
an age younger than 19 score worsein every one of the five dimensions
compared with women who firstbecame pregnant at a later age.

Early childbearing or pregnancy in adolescence canhave lasting negative effects on women’s and girls’
education, their livelihoods and their health. Many ofthese girls drop out of school, further limiting theiropportunities for training and employment, and they
become more vulnerable to a life of poverty and exclusion.13
Further, maternal conditions, including infections, areamong the top causes of disability-adjusted life years
and death among girls between ages 15 and 19.14

A notable exception to this is Australia/New Zealand, where
women score equally on the Index regardless of the age at
the time of their first pregnancy (scoring 65 at any age).

CHART 5:

Hologic Global Women’s Health Index
By age at first pregnancy
18 or younger

19-24

25 or older

Australia/New Zealand

65

65

65

Eastern Asia

58

60

61

Northern America

54

63

61

Europe53

56

60South-eastern Asia

52

51

56

Southern Asia

49

53

57

Northern Africa

49

47

47

Sub-Saharan Africa

48

49

48

Central Asia

46

54

49

Central America

44

48

49

Caribbean

44

49

48

Western Asia

41

46

53

South America

39

44

48

35

I N DE X SCORE

75

Source: Hologic Global Women’s Health Index, 2020

20

13Adolescent pregnancy. (n.d.). UNFPA - United Nations Population Fund. Retrieved August 10, 2021, from https://www.unfpa.org/adolescent-pregnancy

14

Early childbearing and teenage pregnancy rates by country. (2021, July 20). UNICEF DATA. https://data.unicef.org/topic/child-health/adolescent-health/The Hologic Global Women’s Health Index | Global Report© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

Higher education level is associated with better health outcomes.
Ensuring people have access toquality education throughout theirlives is a crucial social determinantof health, according to the World
Health Organization (WHO).15 Thisis particularly true for women.

Women with at least some formal education are more likely
than those without to use contraception, marry later, have fewer
children and be better informed about their health and that of
their children.16
In nearly every region, women who have completed college ora four-year degree post higher scores on the Index than thosewith less education. In Australia and New Zealand, however,
the impact of education level on Index scoring is virtuallynonexistent, meaning those with less education (64) post
essentially the same scores as those with more education (63).

CHART 6:

Hologic Global Women’s Health Index
By education
Elementary education or less
Secondary education/Some education beyond secondary
Four years beyond high school and/or received a 4-year college degree
Australia/New Zealand

–

64

63

Caribbean

45

47

56

Central America

42

48

54

Central Asia

51

53

56

Eastern Asia

59

61

64

Europe55

58

61

Northern Africa

46

48

50

Northern America

–

59

63

South America

42

44

51

South-eastern Asia

49

53

58

Southern Asia

51

55

55

Sub-Saharan Africa

47

48

55

Western Asia

39

49

54

35

I N DE X SCORE

75

Note: Sample sizes for women in the lowest education group in Australia/New Zealand and Northern America are too small to report results.
Source: Hologic Global Women’s Health Index, 2020
15 CSDH. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social
Determinants of Health. Geneva, World Health Organization.
16 The Effect of Girls’ Education on Health Outcomes: Fact Sheet. (n.d.). PRB. Retrieved August 10, 2021, from https://www.prb.org/resources/the-effect-of-girlseducation-on-health-outcomes-fact-sheet

21

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Household income is strongly related to health disparities.
Low living standards in and withincountries are powerful determinantsof health inequity. In countries at
all levels of income, the lower aperson’s socioeconomic position,
the worse their health.17

This plays out in nearly all regions of the world, where
women in the richest 20% of a population’s income
distribution are substantially more likely to score higher
on the Index than those in the poorest 20%.
Social protection programs like Australia/New Zealand’s
universal healthcare systems are typically associated withlower mortality rates among the disadvantaged and mostvulnerable populations.18 These programs and policies
may help explain why the gap between the richest andpoorest in the region is narrower in Australia/New Zealandthan any other region of the world.

CHART 7:

Hologic Global Women’s Health Index
By regional income level
Poorest 20%

Second 20%

Middle 20%

Australia/New Zealand

61

62

65

64 67

Eastern Asia

54

58

60

65 66

Europe

53

57

59

61 62

Northern America

51

59

64

63 65

Southern Asia

49

51

54

56 53

Central Asia

48

51

51

57 58

South-eastern Asia

47

51

54

54 58

Caribbean

45

46

47

48 54

Sub-Saharan Africa

45

45

48

49 52

Western Asia

45

42

48

48 52

Central America

42

41

46

55 54

Northern Africa

41

46

50

48 54

South America

39

40

46

48 53

Fourth 20%
35

Richest 20%
I N DE X SCORE

75

Source: Hologic Global Women’s Health Index, 2020

22

17

CSDH. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social
Determinants of Health. Geneva, World Health Organization.

18

Ibid.

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Women in high-income countries and territories represent 17% of thewomen surveyed, but they have at least a seven-point lead on the Index
over all other women globally.
Women in high-income economies tend to be moreeducated, give birth later in life and be more financiallysecure than those at other levels of country income,so it is not surprising that many live longer, healthierlives than other women. In addition, many women in
high-income countries are more likely able to afford
elective or uncovered services via out-of-pocket
payments or private insurance.

Women in high-income economies scorea 61 on the Index. However, the scoreson the Index drop with each subsequent
country-income group level after that,eventually widening to a 12-point gap
between women living in high-income
economies and low-income economies.

CHART 8:

Hologic Global Women’s Health Index
By income level
High income

61

Upper middle income

54

Lower middle income

51

Low income49

For the current 2021 fiscal year, low-income economies are defined as those with a Gross National Income (GNI) per capita, calculated using the World Bank Atlas
method, of $1,035 or less in 2019; lower middle-income economies are those with a GNI per capita between $1,036 and $4,045; upper middle-income economies
are those with a GNI per capita between $4,046 and $12,535; high-income economies are those with a GNI per capita above $12,535.
Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

23

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Countries and territories that spend more per capita on healthcare tend to earnhigher scores on the overall Index, except for the United States.
Countries and territories that spend more per capita on
healthcare tend to earn higher scores on the overall Index— except for the U.S., which spends the most and scoresa 61. Most of the countries that lead the world on the Index
also lead the world in how much of their wealth they funnel
back into their health system — including places such as
Austria (67), Norway (65) and Switzerland (64).22 And theinverse is true for the countries and territories that spend
the least on healthcare — such as the lowest-ranking
country, Peru (36).

In many countries and territories around the world,
particularly the higher-income ones, higher healthcare
expenditures per capita usually translate into
better healthcare outcomes, including longer life
expectancies for men and women.19 The U.S., however,is a well-documented exception. The country spends
nearly twice as much as an average Organisation of
Economic Co-operation and Development (OECD) country
does on healthcare, but it has a lower life expectancy.20,21

CHART 9:Health Expenditure Per Capita and the Hologic Global Women’s Health Index
75

70
Austria
Finland

Latvia65

Portugal

New
ZealandVietnam60

NorwaySwitzerland
UnitedStatesIreland

Japan
Italy

55

CanadaCyprusEthiopia

Greece
50

Iran

45

Brazil40 Republicof the Congo

35

Peru
0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,00019 Duba, J., Berry, J., Fang, A., & Baughn, M. (2018). The Effects of Health Care Expenditures as a Percentage of GDP on Life Expectancies. Research in Applied
Economics, 10(2), 50. https://doi.org/10.5296/rae.v10i2.12654
20 U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? (2020, January 30). The Commonwealth Fund.
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

24

21

Health resources – Health spending – OECD Data. (n.d.). The OECD. Retrieved August 10, 2021, from https://data.oecd.org/healthres/health-spending.htm

22

Ibid.

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25

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The 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 — are strongly related to
women’s life expectancies at birth.

These dimensions account for morethan 80% of why some women
live longer than others do.23

Opinions of
Health and Safety

Basic Needs

Preventive Care

23

26

Individual Health

Emotional Health

Please see the regression analysis on life expectancy and the Index in Appendix 1.

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27

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PR E V ENTIV E CA RE:

Relatively Few Women Tested for
Serious Diseases
Preventive care aims to help people avoid illnesses
and detect medical problems, ideally before theonset of symptoms. The right test, screening or
immunization at the right time can save people’s lives
and help them stay healthy and even live longer.
Because testing is an essential first step toward better
health, the Hologic Global Women’s Health Index asks
women whether they had been tested* in the past
12 months for four of the most frequent, fast-growing
and/or most damaging diseases for women globally:high blood pressure, cancer, diabetes and sexuallytransmitted diseases and infections (STDs/STIs).
Testing or screening recommendations for these
diseases vary based on people’s age, gender andthe healthcare resources available to them in theircommunities. While the 12-month period asked about
is not a globally agreed cadence, in the future theIndex will capture testing over a two- to three-year
period, which fits with most health advice.

Why these diseases?
• Heart disease is the leading cause of death in both
men and women globally (CDC, 2020b).

• Cancer is the second-leading cause of deathglobally and was responsible for an estimated
9.6 million deaths in 2018. Globally, about one
in six deaths is due to cancer (CDC, 2020a;
WHO, 2021c).

• Obesity and diabetes-related diseases are a

growing concern worldwide and associated withheart disease as well as increased incidence of
certain cancers (CDC, 2021b; WHO, 2021b, 2021).

• STDs/STIs have an outsized, potentiallydevastating effect on women’s reproductive healthand fertility (compared to men) (CDC, 2021a).

* The survey questionnaire asked people whether they had been “tested” forthese four conditions rather than “screened”, the clinical term typically used
to refer to scheduled preventive tests. This wording choice was made to help
ensure the questions were easily comprehensible to all respondents.

The future will be better for women when as many women as possible have beentested in accordance with existing WHO medical standards and other guidance forhigh blood pressure, cancer, diabetes and STDs/STIs.
In the present, preventive care is a high bar and requires a robust healthcare
system with public communication, adequate numbers of healthcare workers,
technical training and equipment to screen large numbers of people.
But as of 2020, relatively few women worldwide reported getting preventive
care with testing for cancer, high blood pressure, diabetes or STDs/STIs.

28

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Measuring Preventive Care
The Preventive Care dimension of the overall index measures whether women in the past year
have been 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 out of the four questions. The resulting score is a simple mean of the positive answers. Higherscores on the Preventive Care dimension mean more women are getting tested for these health factors.

CHART 10:

Women’s Preventive Care by Demographic
OverallGlobal female population19

Age 15-50

16

Age 51-75

28

Age 76+28

Elementary education or less17

Secondary education/Some education
beyond secondary

18

Four years beyond high school and/or
received a 4-year college degree

24

Age

Education

Age at first pregnancy

Age 18 or younger23

Age 19-24

21

Age 25 or older

22

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

29

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CHART 11:

High Blood Pressure Testing
To the best of your knowledge, were you tested for any of the following in the past 12 months?
(% Yes, high blood pressure)
0%		

100%

W H O FAC TS:
More than three-quartersof cardiovasculardisease deaths takeplace in low- andmiddle-income countries.

On average, only one in three women worldwide had their blood pressure tested in theprevious 12 months — despite heart disease being the leading cause of death globally.24
Blood pressure testing varies widely across the globe, from a low of 14% among women in Ivory Coast and Turkey
to a high of 76% of women in Latvia. Although Latvia scores highest on the Preventive Care dimension of the Index,
heart disease remains the No. 1 cause of death for men and women.25

24 The top 10 causes of death. (2020, December 9). The World Health Organization. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
25 Strengthening Latvia’s secondary and tertiary prevention policies | OECD Reviews of Public Health: Latvia: A Healthier Tomorrow | OECD iLibrary. (n.d.). OECD.
Retrieved August 10, 2021, from https://www.oecd-ilibrary.org/sites/2be1eb8b-en/index.html?itemId=/content/component/2be1eb8b-en

30

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CHART 12:

Cancer Testing
To the best of your knowledge, were you tested for any of thefollowing in the past 12 months?
(% Yes, cancer)
0%		

100%

W H O FAC TS:
The most common causesof cancer death in 2020
(for men or women) were:• Lung (1.8 million deaths)• Colon and rectum(935,000 deaths)• Liver (830,000 deaths)• Stomach (769,000 deaths)• Breast (685,000 deaths)- Countries that have

Globally, no country or territory has tested morethan 38% of women for any type of cancer — and ina host of countries, the percentage is less than 10%.
Worldwide, just 12% of women said in 2020 that they have beentested for any type of cancer in the past 12 months. But numbers
were in the single digits in roughly 40 countries and territories.
This includes less than 1% of women who say they were tested inPakistan, where breast cancer rates are thought to be the highest in
Asia, but like in many lower-income countries, the true numbers are
unknown.26,27
Women in South Korea were the most likely in the world to say
they were tested for cancer in that period, with 38% saying they
had been.

succeeded in reducing breast
cancer mortality have beenable to achieve an annual
breast cancer mortality
reduction of 2% to 4%
per year.

- For women aged 50 to 69, theWHO recommends screenings
every two years.

• Cervical cancer- Cervical cancer is the

fourth-most common cancer
among women globally, withan estimated 570,000 new
cases in 2018.

- Scaling up screening

and treatment of cervicalpre-cancer lesions would
reduce mortality by morethan one-third by 2030.

26 The Global Cancer Observatory. (2021, March). Pakistan Fact Sheet. https://gco.iarc.fr/today/data/factsheets/populations/586-pakistan-fact-sheets.pdf
27 Murad, R. (2017). Breast cancer awareness in Pakistan. The Journal of Bahria University Medical and Dental College. https://applications.emro.who.int/imemrf/J_
Bahria_Univ_Med_Dent_Coll/J_Bahria_Univ_Med_Dent_Coll_2017_7_2_64_65.pdf

31

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CHART 13:

Diabetes Testing
To the best of your knowledge, were you tested for any of the following in the past 12 months?
(% Yes, diabetes)
0%		

100%

W H O FAC TS:• The number of people withdiabetes rose from 108 million
in 1980 to 422 million in 2014.
Prevalence has been risingmore rapidly in low- andmiddle-income countries than in
high-income countries.

In countries with high obesity rates, suchas the U.S., about one in three womenreport being tested for diabetes.

• In 2019, an estimated 1.5 million
deaths were directly causedby diabetes.

Although it’s the sixth leading cause of death for women, worldwide,
fewer than one in five women (19%) report being tested for diabetes
in the past year.28 Reported diabetes testing ranges widely across theglobe, from a low of 6% among women in Nigeria, where the WHO
estimates that diabetes or high blood glucose kills more women thanmen annually, to a high of 46% of women in Portugal.29

32

28

The top 10 causes of death. (2020, December 9). The World Health Organization. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

29

World Health Organization — Diabetes Country Profiles. (2016). The World Health Organization. https://www.who.int/diabetes/country-profiles/nga_en.pdf?ua=1

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CHART 14:

Sexually Transmitted Diseases/Infections Testing
To the best of your knowledge, were you tested for any of the following in the past 12 months?
(% Yes, sexually transmitted diseases/infections)
0%		

100%

W H O FAC TS:• More than 1 million sexuallytransmitted infections (STIs) are
acquired every day worldwide.

• More than 290 million women
have a human papillomavirus(HPV) infection — the primarycause of cervical cancer.

In nearly half of the countries and territories
in the study, fewer than one in 10 women had
been tested for STDs/STIs in the past year.

• Milestones for each country

to reach by 2030 to eliminate
cervical cancer:- 90% of girls fully vaccinatedwith the HPV vaccine by
the age of 15

STDs/STIs can have serious long-term consequences, including
fertility problems and an increased risk of cervical cancer for women.30
However, worldwide, only about one in nine women (11%) say they
had been tested for an STD/STI in the past 12 months. In fact, in 56
countries and territories, fewer than one in 10 women said they had.

- 70% of women screened

Testing percentages vary widely worldwide. Nearly half of women incountries such as Zambia (48%), South Africa (47%) and Tanzania (47%),
which continue to see high rates of HIV infections, say they had beentested in the past year. These numbers may reflect the increasing
availability of HIV testing in many of these countries, particularly during
prenatal care.31

with cervical diseasereceive treatmentusing a high-performance
test by the age of 35, andagain by the age of 45- 90% of women identified

In a handful of countries and territories including Japan, which was
involved in a high-profile HPV vaccine controversy in 2013 that led it tosuspend recommending the vaccine, as few as 2% of women say they
had been tested for any STD or STI. 32
30 Sexually transmitted infections (STIs). (2019, June 14). The World Health Organization. https://www.who.int/news-room/fact-sheets/detail/sexually-transmittedinfections-(stis)
31

Awopegba, O. E., Kalu, A., Ahinkorah, B. O., Seidu, A. A., & Ajayi, A. I. (2020). Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insightfrom demographic and health surveys of 16 countries. PLOS ONE, 15(11), e0242001. https://doi.org/10.1371/journal.pone.0242001

32 Muranaka, R. (2016, November 28). Stopping the spread of Japan’s antivaccine panic. WSJ. https://www.wsj.com/articles/stopping-the-spread-of-japansantivaccine-panic-1480006636

33

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Preventive Care Dimension
Higher scores on the Preventive Care dimensionof the Index mean more women are getting tested
for these health factors. Worldwide, countries andterritories do not perform well on this dimension of
the Index, with a global score of 19.

Country-level scores on the Preventive
Care dimension range from a low of 8
in Ivory Coast to a high of 44 in Latvia.
Women 50 and younger and those withless than a primary education score lowest.

TA B L E 3 :Top and Bottom Countries and Territories on Preventive CareHIGHESTLOWEST

Country

Preventive Care

Country

Preventive Care

Latvia44

Guinea12South Africa

43

Philippines

12

Portugal

42

Benin

12

Zambia

40

Ghana

11

Jamaica37

Nigeria

11

Thailand35

Turkey10

Mongolia

35

Mali

10

South Korea

32

India

10

Uruguay32

Myanmar9

Vietnam32

Ivory Coast

8

United States

32

Chile

32

Australia

32

Source: Hologic Global Women’s Health Index, 2020

34

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Countries and territories with the highest scores typically test for high bloodpressure and other conditions.
Most of the countries with the highest scores on thePreventive Care dimension have relatively high levelsof testing for high blood pressure, such as Latvia,
which scores well on most measures except for
testing for STDs/STIs.

The two African countries at the top of the list, South
Africa and Zambia, have relatively high testing for
STDs/STIs.

CHART 15:

Testing in the Top Countries for Preventive CareHigh Blood Pressure

CancerDiabetes

STDs/STIs

Latvia

76

35

43

23

South Africa

58

25

43

47

Portugal

64

35

46

22

Zambia

59

29

23

48

Jamaica

61

17

36

34

Thailand

50

31

37

22

Mongolia

47

22

30

39

South Korea

38

38

38

17

Uruguay

71

13

30

16

Vietnam

47

26

30

26

United States

56

21

34

19

Chile

57

17

36

18

Australia

59

27

29

12

Source: Hologic Global Women’s Health Index, 2020
Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

Few women were tested for any of the four conditions in countries and territories
with the lowest scores.
Most of the countries with the lowest scores on thePreventive Care dimension are low- to lower-middle
income countries.

35

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In Ivory Coast, just 14% of women were tested for highblood pressure in the past year; less than 10% were
tested for any of the other conditions.

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36

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Most women (88%) believe checkups help improve people’s health, but many (40%)
haven’t seen a healthcare professional in the past 12 months.
The questions that Hologic and Gallup asked
about women’s perceptions of the value of regularcheckups or whether they’d spoken with a healthcare
professional in the past 12 months are not factored
into the overall Index score.33 However, the results
do provide some insight into the low numbers of
women being tested for cancer, diabetes, high bloodpressure and STDs/STIs.

Majorities of women in all the countries
and territories surveyed perceivethat regular medical checkups help
improve people’s health. Worldwide,
the percentages of women who
believe this range from a low of
72% in Hungary to a high of 100% in
Tanzania. In many countries, women
universally agree about the value ofcheckups with health professionals.

Women’s belief in the value of regular checkups
did not necessarily translate into action, such as
personally speaking with a healthcare professional in
the past 12 months. In the majority of countries, there
were significant gaps between women’s perceptions
and actions. In Tanzania, for example, although 100%of women say regular checkups improve women’s
health, 70% say they had spoken with a healthcare
professional in the past 12 months. And in Myanmar,
97% say regular checkups improve health, but 38%
had spoken with a health professional in the past year.
The availability of healthcare may factor into thedisconnect. In Tanzania, there is less than one doctor
for every 1,000 people in the country. But it is also
possible that women in some of these countries did
not have checkups during the past year because of
the COVID-19 pandemic, as many American womenreported in a recent Kaiser Family Foundation
Women’s Health survey.34 The next administration of
the Hologic Women’s Health Index study should shedsome light on this.

33 For more information on which questions are included in the Index and why, please see Appendix 1.
34 Women’s Experiences With Health Care During the COVID-19 Pandemic: Findings from the KFF Women’s Health Survey. (2021, April 16). KFF. https://www.kff.
org/womens-health-policy/issue-brief/womens-experiences-with-health-care-during-the-covid-19-pandemic-findings-from-the-kff-womens-health-survey/

37

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CHART 16:

Perceptions of the Value of Prevention and Having Talked to a Healthcare Professionalin the Last 12 Months% Talked to healthcare professional in past 12 months% Checkup with healthcare professional helps people improve healthFemale population 0

MyanmarBenin
Zimbabwe
Nigeria
Ghana
Philippines
Ivory Coast
Cambodia
BoliviaParaguay
Gabon
MexicoIndia
Mauritius
Ethiopia
JordanSaudi Arabia
El Salvador
China
Republic of the Congo
Mali
Sri Lanka
Taiwan, Province of China
Iran
SenegalIndonesia
Peru
UgandaGeorgia
Namibia
LebanonHong Kong, S.A.R. of China
Albania
Tunisia
Tanzania
Algeria
United Arab Emirates
Pakistan
Laos
Kazakhstan
EcuadorNicaragua
Japan
North Macedonia
Cameroon
TurkeyKenya
IsraelEgypt
Venezuela
Iraq
Kyrgyzstan
Bahrain
Malaysia
MoroccoColombia

38

100

38
39

47
48
45
48
46
47

54
54
54

41

57

41

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79

60

55
55
57
50

57
50

55

61

62

56

51
50

58
58

47

57
53

59

89

83

89

62

87

82
80
66

70

66
76

95
95
94

89

96

82

77

84

100

96

87

84

66
63
65
63
66
64
68
63
62
68
69
70

97

87

64

56

52

84
91

63

97

86

61

57

97

92
91
93
76

49

97
92
94
95
91
93
89
90
95
95
93
95

93
94
91
92
90
93
91
94
89
87
93
95
95

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CHART 16 CONTINUED:

0

Bangladesh
Costa Rica
BrazilArgentina
Thailand
Dominican Republic
KosovoNepal
Montenegro
Lithuania
CroatiaSouth Africa
ZambiaVietnamMongolia
Romania
CyprusChile
Malta
Uzbekistan
UruguaySouth Korea
Switzerland
Bosnia and Herzegovina
IrelandUnited Kingdom
Italy
FranceSpain
GreeceSlovenia
Jamaica
RussiaUnited States
Portugal
Iceland
SerbiaSlovakia
CanadaNetherlands
Moldova
Germany
Estonia
Austria
Bulgaria
Czech Republic
UkraineDenmark
PolandSwedenAustralia
Belgium
Tajikistan
Finland
Hungary
New ZealandLatviaNorway39

The Hologic Global Women’s Health Index | Global Report

100

65

89

69

73
73

68

91

74

61
63
65
67

74
75
70

82
84
86
88
78

77

83

79
78
81
81

82

87

89

86
88
85

83
83

86
86

92
91
92
93

85

77

72

88

84

79

76

90

79

84

87

90

97

95

93
91
94
92

77
75

75

93
94

90

80
78

97
97
96

87

78

73

65

93

97

97
98

94
96
97
94
94
94

90
90
92
89
90
92

86
83
84
87
82
78
84
81
89
87
80
80
91
91
93
93
83
82
86
85
76
92
87
89
82
81
90

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E M OTIO NA L H EA LT H :Stress, Worry Are Major
Challenges for WomenStress, worry, sadness, anger andother emotions are all a normal part oflife. But when these feelings become
chronic, they can be overwhelming
and interfere with people’s ability
to carry out everyday tasks.

They can become unhealthy and signal more serious
conditions such as anxiety and depressive disorders,or other mental health diagnoses.35
Moreover, there is a growing body of evidence thatemotional health can positively or negatively affectcardiovascular health and cardiovascular risk factors.36

The future will be better for women if as many women as possible do notexperience worry, sadness, stress or anger a lot in a typical day.
In the present, reducing the incidence of these negative feelings — particularly
stress and worry — are major challenges. But doing so can lead to better healthoutcomes for women. Women’s experiences with health problems (the Individual
Health dimension) and their ability to afford food (the Basic Needs dimension) areboth related to a higher incidence of feeling negative emotions.

35 Depression (major depressive disorder) - Symptoms and causes. (2018, February 3). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/
symptoms-causes/syc-20356007
36 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-Body Connection: A Scientific Statement From the American Heart Association. Circulation,
143(10). https://doi.org/10.1161/cir.0000000000000947

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Measuring Emotional Health Issues
Feelings and emotions are life’s intangibles that “hard data” like GDP or mortality rates were notdesigned to capture. The Emotional Health dimension of the Hologic Global Women’s Health Indexgauges women’s daily experiences of negative feelings with four questions that have been asked aspart 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 toanswer at least three out 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.

CHART 17:

Women’s Emotional Health by Demographic
OverallGlobal female population68

Age 15-50

67

Age 51-75

69

Age 76+81

Elementary education or less

66

Secondary education/Some education
beyond secondary

69

Four years beyond high school and/or
received a 4-year college degree

69

Age

Education

Age at first pregnancy
Age 18 or younger59

Age 19-24

67

Age 25 or older

70

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

41

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Women in 2020 were worried, stressed, sad and angry,
along with the rest of the world.
About four in 10 women say they experienced worry (40%) and stress(38%) during a lot of the day before the survey, while about one infour say they experienced sadness (26%) and anger (23%).
CHART 18:

40%
Worry

38%
Stress26%
Sadness

23%
Anger

Women aren’t alone in feeling this way. People worldwide in 2020 were feeling the worst they had in 15
years. Global experiences of worry, stress, sadness and anger continued to rise in 2020 and set new records.
Stress alone increased from 35% to 40% worldwide in the span of a year.37

EMOTIONAL HEALTH DIMENSION
Higher scores on the Emotional Health dimension of the Index mean fewer women are experiencing negative
feelings on a given day. Overall, women worldwide score a 68 on the Emotional Health dimension. At thecountry level, women’s scores range widely from a high of 89 in Taiwan to a low of 39 in Iraq. Worldwide,
those younger than age 75 are more likely to experience negative feelings, as are those who experienced
their first pregnancy before age 19.

37 Ray, J. (2021, July 26). 2020 Sets Records for Negative Emotions. Gallup.com. https://news.gallup.com/poll/352205/2020-sets-records-negative-emotions.aspx

43

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Women in countries in turmoil experience the worst Emotional Health.
Many of the countries where women post the lowest
scores on the Emotional Health dimension reflected
the political or economic strife engulfing theircountries in 2020 — with protests taking place from
Iraq to Uganda.38

With a score of 39, women’s
Emotional Health scores in Iraq,
where unrest intensified in late 2020,
were the worst in the world.39
Majorities of women in Iraq experienced each of thenegative feelings — with 57% reporting that they’dbeen angry during a lot of the previous day.

TA B L E 4 :Top and Bottom Countries and Territories for Women’s Emotional Health Issues
HIGHESTLOWEST
Emotional Health
IssuesCountry

Emotional Health
IssuesTaiwan, Province of China

89

Uganda53

Kazakhstan

86

Malta

51

Mauritius

84

Turkey51

Russia

79

Iran

50

India

79

Ecuador49

Austria

78

Egypt

48

Estonia

77

Tunisia48

Denmark

77

Lebanon45

Hong Kong, S.A.R. of China

76

Peru

41

United Kingdom

76

Iraq

39

Latvia76

Switzerland

76

Kyrgyzstan

76

Country

Source: Hologic Global Women’s Health Index, 2020

38 Athumani, H., & Wroughton, L. (2020, November 20). 37 dead in Uganda protests after arrest of presidential candidate Bobi Wine. Washington Post.
https://www.washingtonpost.com/world/africa/uganda-protests-bobi-wine/2020/11/20/efe106ec-2aa6-11eb-9c21-3cc501d0981f_story.html
39 Abduh-Zahra, Q. (2020, October 25). Tear gas fired as thousands mark one year of Iraq protests. ABC News. https://abcnews.go.com/International/wireStory/
thousands-rally-iraq-mark-year-protests-73815550

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Women in Taiwan, Kazakhstan and Mauritius are least likely to experience negative
feelings on a daily basis.
Women in Taiwan, who also score wellon other dimensions of the overall
Index, score highest on the Emotional
Health dimension with an 89.

45

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This means many women in the territory are notexperiencing negative emotions — in fact, thepercentages of Taiwanese women who say they weresad, angry or worried are all in the single digits. Womenin Kazakhstan and Mauritius also scored high on thisdimension in 2020, with levels of stress, anger, worry
and sadness that were remarkably similar to their low
levels in previous years.

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O PINIO NS O F H EA LT H A N D SA F E T Y:

Healthcare, Safety Contribute to Longer
Lives for Women
Women’s (and men’s) satisfaction with the availabilityof quality healthcare where they live and theirperceptions of the quality of the prenatal care thatwomen receive in their communities are largely missing
from global statistics. But including them could help
save lives: According to the WHO, “most maternal
deaths are preventable with timely management
by a skilled health professional working in a
supportive environment.”40

Finding out how safe women feel in these samecommunities is also a critical social determinant of theirhealth. In environments where women feel personallysecure, adolescent fertility rates and maternal mortality
rates are lower and health expenditures per capita
are higher.41

Women’s satisfaction with the quality and availability of their healthcare options andtheir safety walking alone at night are all highly related to their life expectancy at birth.

The future will be better for women if as many women as possible agree there
is high-quality healthcare and prenatal care in the city or area where they live andthey feel safe walking alone at night.
In the present, majorities of women worldwide can answer these questions
affirmatively, but there are many — well over half a billion — who cannot. This
includes an estimated 800 million women who do not feel safe walking alone atnight where they live.

40 WHO. (2021a). Maternal health. World Health Organization. https://www.who.int/health-topics/maternal-health#tab=tab_1
41

46

Gallup World Poll Methodology 2021

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Measuring Opinions of Health and Safety
The Opinions of Health and Safety dimension of the Hologic Global Women’s Health Index gauges women’ssatisfaction with access to quality healthcare in general, whether they think pregnant women receivehigh-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 their pregnancies, or not?

• In the city or area where you live, are you satisfied or dissatisfied with the availability ofquality 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 out of the three questions. The resulting score is a simple mean of the positive answers. Higherscores on the Opinions of Health and Safety dimension mean more women feel safe and satisfied with thequality and availability of healthcare where they live.

CHART 19:

Opinions of Health and Safety by Demographic
OverallGlobal female population70

Age 15-50

70

Age 51-75

73

Age 76+82

Elementary education or less72

Secondary education/Some education
beyond secondary

70

Four years beyond high school and/or
received a 4-year college degree

70

Age

Education

Age at first pregnancy

Age 18 or younger61

Age 19-24

72

Age 25 or older

76

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

47

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Most women are satisfied with the availability of quality healthcare where they
live and think most pregnant women in their communities receive high-quality
prenatal care.
• About seven in 10 women are satisfied with the availability of quality healthcare (68%) and think most pregnant

women receive high-quality care (69%). This satisfaction is lower among women living in rural areas and those who
experienced their first pregnancy before age 19.

• Men and women largely share similar views on the availability of quality healthcare, but many men do notknow if pregnant women get high-quality care. Nearly one in 10 men say they don’t know if most women
receive high-quality care during their pregnancies — rising to as high as one in three in some countries such as
Latvia (35%) and Lithuania (33%).

48

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CHART 20:

Opinions of Maternal Care by Demographic
OverallGlobal female population69

Age 15-50

69

Age 51-75

69

Age 76+70

Elementary education or less

67

Secondary education/Some education
beyond secondary

69

Four years beyond high school and/or
received a 4-year college degree

70

Urban

67

Rural

50

Urban (a large city/ a suburb of a large city)

70

Rural (a rural area or on a farm/a small town or village)

67

Age

Education

Urbanicity

Age at first pregnancy

IncomeAge 18 or younger64

Age 19-24

72

Age 25 or older

72

Poorest income quintile 20%

64

Second 20%

68

Middle 20%

71

Fourth 20%

70

Richest income quintile 20%

71

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

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Countries with higher numbers of nurses and midwives have higher levels ofagreement that pregnant women receive high-quality care.
CHART 21:

Opinion of Availability of High-Quality Care for Women and Average Number ofNurses and Midwives
100
Saudi
ArabiaSri Lanka

NorwaySwitzerland
Belgium
IcelandGermany

IrelandJapan

Estonia

CyprusLithuania

60

RussiaNigeria

Chile

BrazilMoldovaParaguay40

UnitedStatesUnitedKingdom

Tanzania
JordanAustralia

CanadaMalaysia

80

FinlandNetherlands

Austria

Ukraine

Peru
20

0

50

0

2

4

6

8

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10

12

14

16

18

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Nearly one in three women worldwide — more than 800 million — do not feel safe
walking alone at night in their communities. Fewer women than men feel safe.
• About two in three women worldwide (65%) say they feel safe walking alone at night where they live, while about

one in three (32%) say they do not. However, majorities of women in many Latin American and sub-Saharan Africancountries say they do not feel safe walking alone at night where they live. Many of these countries have highintentional homicide rates, which Gallup finds is strongly linked to feelings of security.42• Consistent with previous Gallup research, women are less likely to say they feel safe than men are. In 2020, nearlyeight in 10 (79%) men said they feel safe, compared with about two in three women (65%).43

Women’s opinions of their health and safety in their areas are strongly related totheir life expectancy.
CHART 22:

Opinions of Health and Safety and Life Expectancy
100

BahrainTajikstan80

United ArabEmirates
Netherlands
China

NorwaySwitzerland

Japan

Uzbekistan

South Korea

Laos

60

Ethiopia

Nigeria
GuineaNamibia

GreeceMongolia
MoroccoZimbabwe

40

Costa Rica

Egypt

Benin

UgandaGabon

Ecuador
Algeria

Chile

Bolivia
Peru
Venezuela

20

60

65

70

75

80

85

42 World Poll Methodology 2021
43 Nsubuga, F., & Crabtree, S. (2012, July 6). Women Feel Less Safe Than Men in Many Developed Countries. Gallup.com. https://news.gallup.com/poll/155402/
Women-Feel-Less-Safe-Men-Developed-Countries.aspx

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Opinions of Health and Safety
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. Overall, women worldwide score a 70 on the Opinions of
Health and Safety dimension.

At the country level, women’s scores on the Opinions of Health and Safety dimension
range from a high of 95 in the United Arab Emirates to a low of 27 in Venezuela —which has the fourth-highest intentional homicide rate for women in the world.44,45
Women aged 50 and younger, those living in rural areas and those who experienced their first pregnancy before age
19 are more likely to post lower scores.

44 Statista. (2021, July 29). World’s most dangerous countries 2021, by homicide rate. https://www.statista.com/statistics/262963/ranking-the-20-countries-with-themost-murders-per-100-000-inhabitants/
45 Intentional homicides, female (per 100,000 female) | Data. (n.d.). World Bank. Retrieved August 10, 2021, from https://data.worldbank.org/indicator/VC.IHR.PSRC.
FE.P5?most_recent_value_desc=true

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Satisfaction with healthcare and safety is almost universal in the United ArabEmirates and Norway.
Nearly all women in the United Arab Emirates andNorway are content with the health and safety situationsin their countries. More than nine in 10 in each country
say they feel safe walking alone at night where they
live, and just as many say they are satisfied with theavailability of quality healthcare.

Most of the other countries and territories with thehighest scores in this dimension are high-income
economies (except for Tajikistan) with well-developed
healthcare systems and infrastructure.

TA B L E 5 :Top and Bottom Countries and Territories on Opinions of Health and Safety
HIGHESTLOWEST
Opinions of Healthand Safety

Country

Opinions of Healthand Safety

United Arab Emirates

95

Mexico42

Norway93

Paraguay

41

Bahrain

90

Chile

41

Switzerland

90

Uganda41

Austria89

Algeria39

Slovenia

89

Brazil39

Finland

88

Bolivia

35

Netherlands

87

Gabon

33

Tajikistan

86

Peru

32

Denmark86

Venezuela

27

Country

Source: Hologic Global Women’s Health Index, 2020

Latin American and sub-Saharan African countries have the lowest scores.
Negative perceptions of safety largely contribute to
the poor performance of the countries with the lowest
scores in this dimension.

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Majorities of women in nearly all the Latin American and
sub-Saharan African countries with the worst scores inthis dimension say they do not feel safe walking alone
at night where they live.

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CHART 23:

Feel Safe Walking Alone at Night
Do you feel safe walking alone at night in the city or area where you live? (% No)
0%		

54

100%

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Most women and men identify domestic violence as a widespread problem
where they live.
Although domestic violence is very much a major
public health and safety problem — more than halfa billion women across their lifetimes are subjectedto physical or sexual violence by an intimate partner— the question that Hologic and Gallup asked about
this important subject was not included in the Index.
In testing, the question results were not consistentor highly related to any of the dimensions of health.
However, Gallup and Hologic will continue tomonitor and study results on this question in futureadministrations of the Index.

The findings reveal the extensive scopeof the problem around the world. Twoin three women worldwide — or about
1.7 billion women — say domestic
violence is a widespread problem in theircountry. And nearly six in 10 men agree.
Worldwide, the percentage of women who say
domestic violence is widespread ranges from a low of
24% in the United Arab Emirates to a high of 94% in
Peru and Turkey.

CHART 24:

Women’s Perception of Domestic Violence
Domestic violence can be physical, psychological, or involve sexual acts done to someone against their will by aperson they live with. In your opinion, is domestic violence a widespread problem, or not? (% Yes)

0%		

55

100%

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BASIC NEEDS:

Food, Shelter Are Necessities Many
Women Cannot Afford
Having enough resources to meet daily needs suchas having enough nutritious food to eat — and being
able to find safe, affordable housing — are all basic
needs for healthy living.
Of the social determinants of health, food insecurity
likely has one of the most extensive influences on
people’s health: Adults who are food insecure —meaning they lack regular access to enough safeand nutritious food — are disproportionately at risk ofobesity and chronic diseases including hypertension,
diabetes, cancer and heart disease.46,47

Establishing a baseline for how many women are
struggling to afford food now and monitoring that in
the years to come is critical. The COVID-19-related
disruptions that pushed hundreds of millions of themost vulnerable populations — including women —into acute food insecurity in 2020 are expected tocontinue through at least 2022.48

The future will be better for women if as many women as possible say they are
not struggling to afford the food or shelter that they or their families need. When
women can meet their basic needs, their life expectancies go up and the mortality
rates of mothers and children go down.49
In the present, hundreds of millions of women worldwide cannot afford the foodand shelter that they or their families need.

46 Coleman-Jenkins, A., & Gregory, C. (2017). Food Insecurity, Chronic Disease, and Health Among Working-Age Adults. USDA. https://www.ers.usda.gov/webdocs/
publications/84467/err-235_summary.pdf?v=5079.8
47 Hunger. (n.d.). Food and Agriculture Organization of the United Nations. Retrieved August 10, 2021, from http://www.fao.org/hunger/en/
48 Food Security and COVID-19. (n.d.). World Bank. Retrieved August 10, 2021, from https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19
49 Gallup World Poll Methodology, 2021

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Measuring Basic Needs
The Basic Needs dimension of the Hologic Global Women’s Health Index gauges women’s ability to meettheir 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 thatyou or your family needed?

• 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?

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.

CHART 25:

Women’s Basic Needs by Demographic
OverallGlobal female population68

Age 15-50

66

Age 51-75

74

Age 76+87

Elementary education or less

59

Secondary education/Some education
beyond secondary

71

Four years beyond high school and/or
received a 4-year college degree

81

Age

Education

Age at first pregnancy

Age 18 or younger52

Age 19-24

66

Age 25 or older

73

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

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More than one in three women worldwide — nearly 900 million — couldn’t afford
the food their families needed at times in the past year.
In 2020, 34% of women — or nearly 900 million women — struggled to afford food in the past year. Most of these
women are aged 50 and younger, with a primary school education or less and experienced their first pregnancy
before the age of 19.

Nearly 700 million women didn’t have enough money for shelter.
Just shy of three in 10 (29%) women — or nearly 700 million — say there had been times in the past year when they
were unable to afford adequate shelter or housing for themselves or their families. Again, these women were often
aged 50 and younger, less educated and experienced their first pregnancies early in life.

BASIC NEEDS DIMENSION
Higher scores on the Basic Needs dimension of the Index mean fewer women in a country are struggling to afford
the food and shelter they need. Women worldwide score a 68 on this dimension of the overall Index. At the country
level, women’s scores on the Basic Needs dimension range from a low of 29 in Namibia to a high of 96 in the
Netherlands.
Worldwide, women aged 50 and younger, those with primary education or less, rural women and those who
experienced their first pregnancy before age 19 scored worst on the Basic Needs dimension.

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Women in sub-Saharan Africa and Latin America score worst on basic needs.
Reinforcing the value of these two questions assummary poverty measures, countries with the lowest
scores on the Basic Needs dimension are almost all
sub-Saharan African and Latin American countries —the two regions where women are struggling mostto meet their basic needs. In all these countries,
women’s difficulties with basic needs pre-date
the pandemic.

In Namibia, for example, which scores the worst
in the world on Basic Needs, the percentageof women who could not afford food for theirfamilies has been holding above 70% since 2019.
Drought and food shortages in the past few
years have stressed low-wage earners in thisupper-middle-income country.50

TA B L E 6 :Top and Bottom Countries and Territories for Women’s Basic Needs
HIGHESTCountry

LOWEST
Basic Needs

Country

Basic Needs

Netherlands

96

Benin

38

Finland95

Nigeria

38

Malta

95

Dominican Republic

37

Japan

94

Venezuela

37

Denmark

94

El Salvador

35

Ireland93

Cameroon

34

Norway93

Zambia34

Taiwan, Province of China

93

Gabon

33

Austria

93

Kenya

33

Sweden93

Zimbabwe

33

Switzerland

93

Namibia29

United Kingdom

93

Germany

93

Source: Hologic Global Women’s Health Index, 2020

Women in many high-income countries almost universally have their basic needs met.
Countries where women have the highest scoreson the Basic Needs dimension are exclusively
high-income economies where worries about foodand shelter are relatively nonexistent.

In the Netherlands, for example, the“yes” responses to both questions in2020 were in the low single digits.

50 Namibia | World Food Programme. (2021, June 24). World Food Programme. https://www.wfp.org/countries/namibia

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INDIV IDUA L H EA LT H :The World Needs to Help WomenManage Pain
Health-related statistics such as life
expectancy, infant mortality anddisease rates provide a great deal of
insight into a country’s overall health.

However, these statistics shed little light on how
individuals see health problems affecting their qualityof life and keeping them from doing the things thatpeople their age normally do.

The future of women’s health will be better if as few women as possible
have health problems that prevent them from doing things that women their
age normally do, and they aren’t in physical pain daily.
In the present, this will be no small task: Worldwide, more than half abillion women experience physical pain on any given day, with life-limiting
health problems.

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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 toanswer both questions. The resulting score is a simple mean of the positive answers. Higher scores on the
Individual Health dimension mean fewer women are experiencing health problems and pain on a given day.

CHART 26:

Women’s Individual Health by Demographic
OverallGlobal female population75

Age 15-50

79

Age 51-75

61

Age 76+63

Elementary education or less

68

Secondary education/Some education
beyond secondary

77

Four years beyond high school and/or
received a 4-year college degree

84

Age

Education

Age at first pregnancy

Age 18 or younger63

Age 19-24

71

Age 25 or older

75

Index scores range from 0 to 100. For more information on how these scores are calculated, please see page 70.

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More than half a billion women worldwide spent a lot of the previous day in pain.
• Three in 10 (30%) women — or more than 750 million worldwide — report experiencing physical pain during a lot of
the previous day.

• In 2020, women continued to be more likely than men to report experiencing pain. The gender gap was four
points globally, with 30% of women and 26% of men experiencing pain during a lot of the previous day.

More than half a billion women have health problems that keep them fromnormal activities.
• One in five (20%) women — or more than 500 million women — say they have health problems that prevent themfrom doing things people their age normally do.

• Women are also more likely than men to suffer from these problems. Again, four points separate women and men,with 20% of women versus 16% of men saying they have health problems that keep them from doing things people
their age normally do.

INDIVIDUAL HEALTH DIMENSION
Higher scores on the Individual Health dimension of the Index mean fewer women are experiencing health problems
and pain on a given day. Women worldwide score a 75 on the Individual Health dimension of the Index. At thecountry level, scores on the Individual Health dimension range from a low of 48 in Egypt to a high of 85 in Malaysia,
Taiwan and Kazakhstan.
Worldwide, women aged 51 and older, those with the lowest level of education and those who experienced their firstpregnancy before age 19 are most likely to have the worst Individual Health scores.

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Individual Health scores lowest in mostly lower-income countries.
Countries with the lowest scores for women’s Individual
Health are largely a mix of low to lower middle-income
countries, except for upper middle-income Albania. In
nearly all these countries, at least half of women reportexperiencing pain the previous day. In places suchas Ukraine, Congo and Senegal, the percentage ofwomen reporting health problems is about twice theglobal average.

In a number of these countries, the picture in 2020
looked more dire than the previous year. In Egypt,which has the lowest score on this dimension, thepercentage of women reporting that they experienced
pain rose from 46% to a world-high 67%, and thepercentage with health problems rose from 27% to 35%.

TA B L E 7 :Top and Bottom Countries and Territories for Women’s Individual Health
HIGHESTLOWEST

Country

Individual HealthCountry

Individual Health

Malaysia

85

Ukraine59

Taiwan, Province of China

85

Tunisia

58

Kazakhstan

85

Albania56

Ethiopia

84

Tajikistan

55

Vietnam

83

Congo

55

Israel82

Lebanon54

Ireland

82

Iraq

53

United Arab Emirates

81

Senegal51

Hong Kong, S.A.R. of China

81

Egypt

48

Source: Hologic Global Women’s Health Index, 2020

Malaysia, Taiwan and Kazakhstan earn high marks.
The countries and territories with the highest scores for
women’s Individual Health are led by Malaysia, Taiwan(which also leads the global Index) and Kazakhstan.
Women in Malaysia and Taiwan have the lowest
incidence of health problems in the world.

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Women in Kazakhstan are also the least likely of
women worldwide to say they experienced physicalpain — just 12% say they experienced pain theprevious day.

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Conclusion
The inaugural Hologic Global Women’s Health Index
provides a sobering baseline account of the stateof women’s health worldwide. The results clearly
illustrate how uneven and slow progress in women’s
health has been over the past few decades, and how
fragile gains for women are.
The survey reveals that every country or territory in
the world — high-income and low-income alike —has work to do to help women lead healthier, safer
and potentially longer lives. With country scores on
the overall Index ranging from 36 to 69, the results
also highlight global inequities that leave womenin many countries and territories without the basic
services that others may take for granted. Theseand other disparities illustrate why data like thosecollected by the Hologic Global Women’s HealthIndex are so urgently needed and why they should beconsistently tracked.

Every country or territory has room to improve inthe five dimensions of women’s health identified in
the research, but overall, the world is weakest in thedimension of Preventive Care. Relatively few womenreport being tested in the past year for four of themost serious diseases and conditions for women —high blood pressure, cancer, diabetes or STDs/STIs.
More than six in 10 women worldwide — over 1.5
billion — did not get tested for any of them.
Testing rates in 2020 may have been somewhat
lower than in other years, with many women forgoingcheckups and other non-emergency procedures
during the past year because of the pandemic. Futureadministrations of the Index will shed light on theextent to which COVID-19 affected women’s use ofhealth services — and provide guidance for mitigatingsuch effects in future crises.

A BO UT HO LO G IC
We are an innovative medical technology company primarily focused on improving women’s health and well-being
through early detection and treatment.
Our purpose — to enable healthier lives everywhere, every day — is driven by a passion to become global
champions for women’s health. We succeed by fulfilling our promise to bring The Science of Sure® alive throughproduct quality, clinical differentiation, customer relationships and our team’s talent and engagement.
Hologic intends to conduct this survey in partnership with Gallup for years into the future.

A BO UT GALLU P
Gallup delivers analytics and advice to help leaders and organizations solve their most pressing problems.
Combining more than 80 years of experience with its global reach, Gallup knows more about the attitudes andbehaviors of employees, customers, students and citizens than any other organization in the world.

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Index Scores by Country and Territory
Rank

65

Country/Territory

Hologic Global Women’s
Health Index

1

Taiwan, Province of China

69

2

Austria67

3

Finland65

4

Latvia65

5

Norway65

6Germany

65

7

Netherlands

64

8

Denmark

64

9Australia

64

10

Switzerland

64

11

Estonia64

12

United Kingdom

63

13

Iceland

63

14

New Zealand

62

15

Sweden62

16

Portugal

62

17

Mauritius

62

18

Israel62

19

Czech Republic

62

20

Ireland

62

21

South Korea

62

22

Saudi Arabia

61

23France

61

24

Japan

61

25

Belgium

61

26

United States

61

27

Vietnam60

28

Hungary

60

29

China

60

30

Slovenia

60

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Index Scores by Country and Territory(C ON T IN UE D )

Rank

66

Country/Territory

Hologic Global Women’s
Health Index

31

Malta

60

32

Hong Kong, S.A.R. of China

60

33

United Arab Emirates

60

34

Slovakia

59

35

Croatia

58

36

Italy

58

37

Kazakhstan

58

38

Spain

58

39

Uruguay

58

40

Lithuania

57

41

Serbia57

42

Jamaica57

43

Canada57

44

Romania

57

45

Bulgaria

57

46

Thailand56

47

Malaysia

56

48

Cyprus56

49

Mongolia

55

50South Africa

55

51

Kosovo55

52

Poland

55

53

India

55

54

Ethiopia

54

55

Moldova

54

56

Tanzania

53

57

Greece53

58

Russia

53

59

Chile

52

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Index Scores by Country and Territory(C ON T IN UE D )

67

Rank

Country/Territory

Hologic Global Women’s
Health Index

60

Montenegro

52

61

Bangladesh

52

62

Paraguay

52

63

Cambodia

52

64

Uzbekistan

51

65

Argentina

51

66

Sri Lanka

51

67

Kyrgyzstan

51

68

Zambia51

69

Bosnia and Herzegovina

51

70

Indonesia

51

71

Costa Rica

50

72

Algeria

49

73

Laos

49

74

Kenya

49

75

North Macedonia

49

76

Ghana

49

77

Myanmar48

78

Nicaragua

48

79

Namibia

48

80

Tajikistan

48

81

Ukraine48

82

Albania48

83

Morocco

48

84

Nepal

48

85

Egypt

47

86

Philippines

47

87

Mexico47

88

Georgia46

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Index Scores by Country and Territory(C ON T IN UE D )RankCountry/Territory

Hologic Global Women’s
Health Index

89

Benin

46

90

Pakistan

46

91

Iran

45

92

Senegal45

93

Dominican Republic

45

94

Ivory Coast

45

95

Colombia

44

96

El Salvador

44

97

Brazil44

98

Cameroon

44

99

Turkey44

1 0 0 Burkina Faso

43

10 1

Zimbabwe43

1 0 2 Nigeria

43

1 0 3 Uganda

42

10 4 Guinea42

1 0 5 Mali

42

1 0 6 Bolivia

42

1 0 7 Tunisia

42

10 8 Lebanon

41

1 0 9 Ecuador

40

11 0

Republic of the Congo

38

11 1

Gabon

38

11 2

Iraq

37

113

Venezuela

37

11 4

Peru

36

Two countries, Bahrain and Jordan, do not have overall Hologic Global Women’s Index scores becausesome component questions were not fielded in these countries.

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APPENDIX 1

About 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 andimproves women’s health in the future.
The Gallup World Poll has collected data since 2005 in more than 160 countries and territories and 150+ 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 easilytranslated, well understood 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 (and what it does not) to not oversimplify
complex issues and topics and to avoid overstating policy conclusions. We aim to be transparent with our
methodology and what the Index 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.
The WHO listed the top 10 issues for women’s health
20 years after countries signed pledges in the 1995
Beijing Declaration and Platform of Action, addingthat women still face many health problems, which wemust recommit to address (Bustreo, 2015).
These included:• Cancer• Reproductive health• Maternal health• HIV• STDs/STIs• Violence against women• Mental health• Noncommunicable diseases• Age-related (teenage pregnancies, older women

may have fewer pensions and benefits, less accessto healthcare and social services and greater riskof poverty, which are compounded by the morewidespread health challenges associated with old age)

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

This process of working with experts and existingknowledge sources identified three key objectivesof the survey:
1) Capturing Knowledge, Attitudes and Behaviors(KAB model) related to health, which is a common
framework for health surveys across many
cultures and languages (Bhattacharya et al., 2018;
Fan et al., 2018; Mustafa et al., 2008; Okobia et al.,2006; Zhang et al., 2020).
2) Focusing on female-specific health issues.

a. prenatal health, pregnancy and delivery
b. health consequences of gender-based
violence: sexual and physical violencec. increasingly common causes of death:heart and lung disease, cervical, lung andbreast cancer and obesityd. aging-related diseases are increasing while
infectious diseases are decreasing
3) Bringing attention to actionable areas to increase

female longevity
a. increasing years of education to improve
the life expectancy of womenb. reducing domestic violence, sexual assault
and femicide
c. not only diagnosing early conditions sothey are more treatable but also having
services to provide care

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

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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 (Table1). 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 understoodacross different countries, cultures and languages.
These questions are also discussed in greater detail in the subsequent section.

Hologic Survey Module Included in the 2020 Gallup World Poll
Topic

Question

Why it matters

Value ofpreventive care

• Do you think going to a healthcare

Knowledge and attitudes toward preventive healthcare
are the first two dimensions of “Knowledge, attitudes andbehavior 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 behavior (orpractice) (Bhattacharya et al., 2018; Fan et al., 2018; Mustafa etal., 2008; Okobia et al., 2006; Zhang et al., 2020).

Experience ofpreventive care

• In the past 12 months, have

Knowledge and Attitudes need to lead to concrete Behaviors,
which are shaped by individual and social barriers.

• To the best of your knowledge,• Heart disease is the leading cause of death in both men andprofessional, such as a medical
doctor or a nurse, at least once
every 12 months for a checkup,
can help people improve theirhealth, or not?

you talked to a healthcare
professional, such as a medical
doctor or nurse, about yourown health?

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

women (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 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

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

• How many children do you,

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, 2021; UNICEF, 2021;
World Bank, 2021).

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.

women in the city or area
where you live receive highquality healthcare during theirpregnancies, or not?

Pregnancy

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

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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 ofresources in the community and gender.
The framing of this item specifically addresses people’s knowledge and attitudes (“do you think”) toward preventive care andprovides 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 foundit 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 illness helps decrease mortality rates. Many of the top risk factors leading to illness and premature
death can be prevented.

• Reduced medical expense through early detection.
Experience of preventive care
In 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 havetaken action to seek annual preventive care (behavior or practice).
The concept of a checkup is described in simple and broad terms (“have you talked to a healthcare professional […] about your own
health”), to capture unscheduled, informal consultations as well as annual checkups. The question echoes the specific timeframe
used in the previous question (“the past 12 months”) to aid with recall and help yield more precise responses.
The question also defines who we consider a medical professional. In some countries, a nurse may be considered “less than” adoctor 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 withhealth knowledge, especially in countries with less access to medical infrastructure.

Implications• Highlight potential differences and service inequalities between populations.
• Increase public knowledge regarding personal care behaviors.

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Experience of preventive care (continued)
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 timeframe 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 the commonlyused terminology.
Following the question about discussing health with a healthcare professional, the four types of specific screenings were chosenbecause 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 is responsible for an estimated 9.6 million deaths in 2018. 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 associated with heart disease as well as
increased incidence of certain cancers (CDC, 2021b; WHO, 2021b, 2021).

• 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 illness helps decrease mortality rates.
• Underscores the importance of understanding the role of annual screenings in improving health and curtailing 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, 2021).
- Diabetes is one of the fastest-growing health challenges of the 21st century, with the number of adults living withdiabetes having more than tripled over the past 20 years (IDF, 2019).

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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 their region or country.
By asking people about “most pregnant women” they are encouraged to consider a broad majority of women, regardless of theirsocioeconomic status and beyond their own social circle.

Implications• Most maternal deaths are preventable with timely management by a skilled health 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-fourpercent 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).
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 ofchildren. A woman’s age at first pregnancy and number of children can impact her overall health, number of years of education,
employability, household income, time available to manage personal health, mental health, etc. (PRB, 2011; UNFPA, 2021; UNICEF,
2021; WHO, 2020; World Bank, 2021).
Notably, the question about the age at first pregnancy is the only question asked only of women in the survey as part of theHologic survey module.
The questions are extremely simple allowing respondents to answer accurately and easily.

Implications• Adolescent mothers (ages 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 birth weight, preterm delivery andsevere neonatal conditions (UNFPA, 2021; WHO, 2020).

• Adolescent pregnancy takes an enormous toll on a girl’s education and income-earning potential. Many girls who become

pregnant are pressured or forced to drop out of school. Leaving school jeopardizes a girl’s future economic prospects andexcludes her from other opportunities in life (UNFPA, 2021).

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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 name], or not?
Rationale
Domestic violence has dramatic health and safety consequences for women of all socioeconomic backgrounds around theworld. The belief that domestic violence is widespread and thus negatively affects health and safety could potentially lead tothe deconstruction of harmful norms, such as victim-blaming, and optimistically lead to a cultural awakening, as seen during the#metoo movement. Cultural movements and grassroots initiatives focusing on domestic violence can be strong forces in callingfor social and legislative change, putting pressure on leaders to act.
This question allows respondents to express their view of the incidence of domestic violence, without having to discuss 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 the question ofgravity 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 and survivors but
also awareness of the national debate on the issue.

Implications• Domestic violence against women is a major public health and education problem globally and can damage physical, mental
and financial well-being (UNFPA, 2021; UNHCR, 2021; WHO, 2021d; World Bank, 2019).

• Across their lifetime, one in three women, around 736 million, are subjected to physical or sexual violence by an intimate
partner or sexual violence from a non-partner — a number that has remained largely unchanged over the past decade(WHO, 2021).

• 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 other services
as needed- School and educational interventions to challenge discriminatory attitudes and beliefs, including comprehensive
sexuality education- Targeted investment in sustainable and effective evidence-based prevention strategies at local, national, regional andglobal levels- Strengthening data collection and investing in high-quality surveys on violence against women and improving

measurement of the different forms of violence experienced by women, including those who are most marginalized(WHO, 2021)• 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)).

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

Items Considered for Inclusion in the Hologic Global Women’s Health Index1
Topic
Attitudes andbehaviors regarding
preventative care

Question• 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

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

Food and shelter
accessibility• Have there been times in the past 12 months when you did not have enough money to buy food thatduring their pregnancies, or not?

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

healthcare?

you or your family needed?

• 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?

1

78

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

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 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 (Struggling, Suffering, Thriving).

normally can do?

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

Items marked in blue are from the Hologic World Poll module in 2020, all other items are Gallup historical items collected since 2005.

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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 (87% of women globally answered in the affirmative).

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.

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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 spoken to a healthcare professional about health and 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 61.4% of the total variance of the selected items.

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:• Bahrain: Values are missing for the questions regarding domestic violence, not having enough money for foodand feeling safe walking alone at night.

• Jordan: Values are missing for the questions regarding experiencing physical pain, worry, sadness, stress andanger for a lot of the day yesterday.

• Saudi Arabia: Values are missing for the question regarding testing for STDs/STIs.
• Iran: Values are missing for the question regarding testing for STDs/STIs.
To achieve a valid score, a respondent needs to answer “Yes” or “No” to at least three out of four items for factor 1,
three out of four items for factor 2, two out of three items for factor 3, two out of three items for factor 4 and two outof two items for factor 5.

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4Weighting and aggregation approach

Each sub-index score is calculated for each factor by taking the simple average of its corresponding recoded items.
The Index score is calculated by taking a weighted sum of the five sub-index scores, with weights proportional toeach 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

0.16
0.8

0.17

0.7

0.6

0.26

0.5

0.4

0.3

0.30

0.2

0.1

0.0
Preventive Care81

Emotional Health

Opinions of
Health and Safety

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Basic Needs

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5Data normalization

Variables were recoded for inclusion in the Index as follows:
For a list of variable codes please see section 7. 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.
• WELL_RESTED: set to 1 if WP60 = 1, 0 if WP60 = 2, NA for any other value.
• TREATED_WITH_RESPECT: set to 1 if WP61 = 1, 0 if WP61 = 2, NA for any other value.
• SMILE_LAUGH: set to 1 if WP63 = 1, 0 if WP63 = 2, NA for any other value.
• LEARN_SOMETHING: set to 1 if WP65 = 1, 0 if WP65 = 2, NA for any other value.
• ENJOYMENT: set to 1 if WP67 = 1, 0 if WP67 = 2, 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.
• CHECKUP_IMPROVE_HEALTH: set to 1 if H1. = 1, 0 if H1. = 2, NA for any other value.
• DOMESTIC_VIOLENCE: set to 1 if H7. = 1, 0 if H7. = 2, NA for any other value.
• LIFE_THRIVING: set to 1 if INDEX_LE = “Thriving”, 0 if INDEX_LE = “Struggling” or “Suffering”, NA for any other value.

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6Multivariate 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 Index explain 86% of the female life expectancy at birth at
the country level.
FIGURE 2:

GDP2019_standard

Individual Health

Basic Needs

Opinions of Health and Safety

Emotional HealthPreventive Care

Life_expectancy_at_birth_years_Female

Correlation Among Dimensions of the Index and to Female Life Expectancy at Birthand GDP 2019 by Country/Territory

1.0
Life_expectancy_at_birth_years_Female

Preventive Care

Emotional Health

Opinions of Health and Safety

Basic Needs

0.8
0.6
0.4
0.2
0.0
-0.2
-0.4

Individual Health

GDP2019_standard

-0.6
-0.8
-1.0

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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)
Weighted Residuals:
Min

1Q

Median3Q

Max-139333

3138631424708

14845090

Estimate Std.

Errort value

Pr (>|t|)(Intercept)

53.084

4.255

12.476<2e-16 ***Preventive Care

9.324

3.941

2.366

0.019815*

Emotional Health-12.679

3.966-3.1960.001838**

Opinions on Health and Safety-5.1592.950-1.7490.083223

Basic Needs

26.1801.861

14.069<2e-16 ***Individual Health21.142

6.117

3.456

0.000792***-28401404
Coefficients:

Signif. codes: 0 ‘***’ 0.001 ‘**’ 0.01 ‘*’ 0.05 ‘.’ 0.1 ‘ ’ 1
Residual standard error: 5565000 on 105 degrees of freedom
Multiple R-squared: 0.8657, Adjusted R-squared: 0.8594
F-statistic: 135.4 on 5 and 105 DF, p-value: <2.2e-16

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7Survey module

H1	Do you think going to a healthcare professional, such as a medical doctor or 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)

85

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

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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(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?

86

Yes

No

(DK)

(Refused)

1

2

8

9

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References in this section
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.
CDC. (2021b, March 22). Adult Obesity. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/
adult/causes.html
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
IDF. (2019). Worldwide toll of diabetes. International Diabetes Federation. https://www.diabetesatlas.org/en/sections/worldwide-toll-of-diabetes.html
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.
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. (2021). Adolescent pregnancy. United Nations Population Fund. https://www.unfpa.org/adolescent-pregnancy
UNFPA. (2021). 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, May). 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/factsheets/detail/maternal-mortality

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WHO. (2020, January 31). Adolescent pregnancy. World Health Organization. https://www.who.int/news-room/factsheets/detail/adolescent-pregnancy
WHO. (2020, 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/maternalhealth#tab=tab_1
WHO. (2021b). Obesity and overweight. World Health Organization. https://www.who.int/westernpacific/health-topics/
obesityWHO. (2021c, March 3). Cancer. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cancer
WHO. (2021, March 9). Devastatingly pervasive: 1 in 3 women globally experience violence. World HealthOrganization. https://www.who.int/news/item/09-03-2021-devastatingly-pervasive-1-in-3-women-globallyexperience-violence
WHO. (2021d, March 9). Violence against women. World Health Organization. https://www.who.int/news-room/factsheets/detail/violence-against-women
WHO. (2021). Violence Against Women Prevalence Estimates, 2018. World Health Organization. https://www.who.int/
publications-detail-redirect/9789240022256
WHO. (2021, April 13). Diabetes. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/diabetes
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). The World Bank Data.
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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APPENDIX 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 2020 survey and further
information about the data analysis presented in this report.

Methodology
The Hologic Global Women’s Health Index was included as a module within the Gallup World Poll in 2020. Since
2005, the World Poll has regularly surveyed people in more than 160 countries using mixed methods of telephone
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.
However, 2020 was far from a typical year. The unprecedented challenges presented by the coronavirus pandemic
forced Gallup to pause its global data collection in March 2020 to thoroughly assess risk and prepare contingency
plans for data collection. By May, the continued prevalence of COVID-19 made it clear that there was too much riskof community transmission to conduct face-to-face data collection in 2020. Nonetheless, Gallup recognized theimportance of finding a way to collect representative, high-quality data during this critical period and prepared acontingency methodology. This new methodological approach was driven by several key considerations, including
the safety of Gallup World Poll interviewers and respondents and retaining high levels of representativity. Ultimately,
the 2020 Hologic Global Women’s Health Index survey was conducted primarily by phone (Computer-Assisted
Telephone Interviewing — 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 and took this guidance into account throughout the interviewing process, including following social
distancing measures for telephone interviews conducted in a call center (however, most CATI data collection was
done remotely).

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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 master-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 master-language version. For example, theRussian master-language questionnaire was created first (translation from English to Russian), then was translated
from Russian into other languages 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 anindependent 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.

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 based on their experience in nationwide survey research studies in themode 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 suchas e-learning and video conferencing. The changes were largely necessary to address the lack of telephone datacollection experience, technical and infrastructural limitations and compressed timelines.

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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 on 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
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.

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How the sample generation/selection process works
Due to the immense challenges presented by the coronavirus pandemic, interviewing for the Hologic
Global Women’s Health Index was conducted solely by telephone. In some countries, Gallup and its datacollection partners contacted respondents on landline or mobile telephones; in a small but growing numberof countries, respondents were contacted by mobile phone only.
Regardless of the approach, how were potential survey participants identified and contacted? This process
is known, in technical terms, as sample generation and selection. The general idea is straightforward: Gallup
and its data collection partners must first establish a list of all potential participants (known as the samplingframe) and then use random-based methods to contact individuals from that frame. In 2020, this process
worked as follows:
1) In any given the country, the first step was to construct the landline and/or mobile frames using either

True RDD or List-Assisted RDD (explained below).
2) Second, telephone numbers were drawn using random processes. This is done by drawing a seed(typically an exchange) using a simple random sample and then a random number (4-6 digits long) isappended to create a random telephone number.
a) Generally, the mobile frame is constructed using pure RDD, where all assigned exchanges (basedon information from the Telecom authority) by mobile service providers are used to generate theframe of all possible mobile numbers. The exchanges are used as seeds and a random numberof the appropriate length (depending on the country, this could be anywhere from 4-6 digits) is
added to the seed to generate a random telephone number. As mobile exchanges are assigned
to service providers, the frame is stratified explicitly by mobile service provider. Within eachstratum, a fixed sample of telephone numbers (sample size is determined by market share of theservice provider, expected working rate and response rate) is selected using a simple random
sample. In countries where Gallup has information on differential response or working rates byservice provider, that information is taken into account while determining the sample size to draw
from each service provider.
b) In the case of landline using True RDD, the frame is constructed similarly using assigned
exchanges to each geography/region (instead of service provider) based on information provided
by Telecom Authority as seeds and generating all possible numbers first, then selecting a fixedsample size (using a simple random sample within each stratum), which is estimated based on
population size in each region and estimated working/response rate. The difference between
the True RDD approach to constructing the frame and List-Assisted RDD is how the initial seeds
are generated. In the List-Assisted approach, the frame is constructed by accessing various
publicly available list sources that provide a comprehensive list of valid exchanges. The more
sources accessed, the more comprehensive the frame. Unique exchanges identified from thesesources form the seed for the random number generation process. Due to the nature of the frame
generation process, List-Assisted RDD has a higher working rate because exchanges in the frame
come from public list sources and therefore tend to be more active.

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Traditional telephone countries
Gallup typically uses dual-frame (landline and mobile telephone) Computer-Assisted Telephone Interviewing (CATI)
as the mode of data collection in Northern America, Western Europe, wealthy Asian and the Pacific countries or
territories including Japan, Australia, New Zealand, Taiwan and Gulf Cooperation Council (GCC) countries. Due tolimited landline usage, the sampling frame is mobile telephone only in a growing number of countries (e.g., Libya,
Finland and UAE). The split between expected landline and mobile completes in a dual-frame design is based on theinformation Gallup has on landline and mobile use in those countries from past surveys and other secondary data,
as well as the demographic distribution of the final landline/mobile sample in relation to targets. There were no otherchanges to the design, stratification or execution of the telephone list samples in traditional telephone countries
in 2020.
In traditional telephone countries and areas, respondent selection followed the same procedure as in previous years:• For respondents contacted by landline, random respondent selection was performed within the household(among eligible respondents aged 15 and older), either by asking for the person aged 15 or older who has thenext birthday or randomly selecting a respondent from a list of all eligible household members (as provided by
the person Gallup originally contacted).

• For respondents contacted by mobile telephone, no further selection was performed (other than confirming the
respondent was at least 15 years of age).

Thirty-two of the 116 countries and territories included in the Hologic Global Women’s Health Index were traditional
telephone countries — meaning, the mode of interviewing did not change in 2020 compared with the last year
Gallup interviewed there. In these countries, the coverage error (percentage of target population not accessible
for sampling) remains negligible according to Gallup estimates — typically, no more than 1% of the 15 andolder population.

New telephone countries
In countries and territories where interviews were conducted by telephone for the first time (i.e., previously face-toface countries in Central and Eastern Europe, Latin America, former Soviet states, developing Asia, the Middle East
and Africa), Gallup used one of two methods:• dual-frame (landline and mobile telephone) RDD, where landline presence and use are 20% or higher based on
historical Gallup estimates• mobile telephone RDD in countries with limited-to-no landline presence (<20%)
To ensure greater transparency and control over the sampling process, RDD samples for all the new telephonecountries, except Israel and Uzbekistan, were purchased from Sample Solutions Europe. Stratification of landline
frame was by geography and, where market share information for mobile service providers was known, the mobile
frame was explicitly stratified by the service providers, and sample drawn was proportional to the market share.
In new telephone countries with combined landline/mobile telephone coverage of 80% or higher, these same
respondent selection procedures were applied:• For respondents contacted by landline telephone, random respondent selection was performed within thehousehold (among eligible respondents aged 15 and older), either by asking for the person aged 15 or older who
has the next birthday or randomly selecting a respondent from a list of all eligible household members.

• For respondents contacted by mobile telephone, no further selection was performed (other than confirming
respondent is at least 15 years of age).

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In new telephone countries with low combined landline/mobile telephone coverage (below 80%), random
respondent selection within the household (among eligible household members aged 15 and older) was performed,
regardless of if the respondent was contacted by landline or mobile telephone. The decision to include both modes(landline and mobile) in random respondent selection, rather than landline only, was done to increase coverage
and representation of individuals in these countries who are less likely to own a mobile phone themselves but haveaccess to such a device through someone else in their household.
The majority of countries included in the Hologic Global Women’s Health Index were new telephone countries.
According to Gallup estimates, the coverage expected is 90% or greater for most countries.1 In some nations, such as
Russia or China, the coverage is estimated closer to 95%.
This under-coverage — though unavoidable, given the scope of the public health challenges in 2020 — may have
implications for the underlying sample composition in some countries (i.e., the overall demographic profile of all
respondents interviewed in a nation). In many nontraditional telephone countries, samples skewed toward specificdemographic characteristics, often — though not always — toward more educated, younger individuals. To help
adjust for these imbalances, Gallup (where it considered necessary) relied on an expanded set of demographic
factors when calculating post-stratification weights (further discussed in ‘Data weighting’).

Scripting and testing
Local data collection partners continue to program the surveys in traditional telephone countries, and Gallup
continues to test them for accuracy prior to launch.
To ensure consistency in survey programming, Gallup used one of two methods in each new telephone country.
Using their own CATI data collection platform, local data collection partners prepared their own script and provided
Gallup with links to test the program logic and generate synthetic data used to confirm that the questionnaire wasprogrammed correctly. For the remaining countries, Gallup scripted all the country surveys on a single platform(SurveyToGo) and tested them before making them available to local data collection partners.

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

1

94

Gallup estimates that coverage may be less than 80% in a limited number of countries, including Ethiopia, Zambia or Venezuela. Gallup estimates of coverage
error primarily come from 2019 World Poll data collected in previously face-to-face countries. Gallup estimated what percentage of the 15+ population had
access to a landline or mobile phone. In several countries, Gallup enhanced those estimates with additional information from recently conducted large-scale,
face-to-face surveys such as Demographic and Health (DHS) and, in some cases, more recent United Nations Telecommunication Development Sector (ITU-D)
estimates.

The Hologic Global Women’s Health Index | Global Report© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

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
and performed in multiple stages.
Gallup constructed a probability weight factor (base weight) to account for selection of telephone numbers fromthe respective frames and correct for unequal selection probabilities that result from selecting one adult in landline
households and for dual users coming from both the landline and mobile frame. For instance, an individual in afive-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.

Adjustment to selection probabilities reflecting the relative frame sizes was a new
improvement to the weighting process in 2020 and was implemented in all telephonecountries, regardless of if the country was a traditional or nontraditional telephone country.
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 thesestatistics.
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.

95

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Sampling error/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 be derived 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 margin of error associated with the 95% confidence interval for various sample sizes
under the assumption of simple random sampling. They may be interpreted as indicating the approximate range (plusor 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, thesample size needed to ensure a sampling error (or half-width of confidence interval) of 0.05 at 95% confidence levelis around 400 cases when P = 0.5 (or 50%). A sample size of 300 will produce a sampling error close to 0.057 at 95%
level of significance when P = 0.5 (or 50%). With P = 0.4 (or 40%), a sample size of 300 will produce a sampling errorof 0.056. Table 1 shows estimated precision levels for different values of P and sample sizes under the assumption of
simple random sampling.

96

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GWHI_Global_091621v16_kn

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 variance obtained 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 theprecision under the assumption of simple random sampling by the square root of the design effect associatedwith this estimate.

97

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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 of size 1,000.

Country dataset details, Hologic Global Women’s Health Index
Country dataset details
Gallup Worldwide Research Data Collected From 2020a

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)dReasons for these differences could include household sampling, respondent sampling in the household, errors in self-reports of actual
attainment or dated population information.

98

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages*Handheld data collection.

2020

Albania15.1

Sep 7 –
Oct 6, 2020

1,000

1.41

3.7

Mobile Telephone

Albanian

2020

Algeria15.1

Oct 9 –
Oct 24, 2020

1,016

1.56

3.8

Landline andMobile Telephone

Arabic2020

Argentina

15.1

Sep 7 –
Nov 20, 2020

1,000

1.93

4.3

Landline andMobile Telephone

Spanish2020

Australia

15.1

Feb 04 –Mar 22, 2020

1,003

1.76

4.1

Landline andMobile Telephone

English2020

Austria

15.1

Aug 24 –Sep 19, 2020

1,000

1.68

4.0

Landline andMobile Telephone

GermanThe Hologic Global Women’s Health Index | Global Report

Exclusions(Samples are nationally
representative unless noted
otherwise)© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

Languages

Mode ofInterviewing

Marginof Errorb

DesignEffecta

Number ofInterviews

Data Collection
Date

Wave

Country

Data Collection
Year

99

Exclusions(Samples are nationally
representative unless noted
otherwise)

Includes only Bahrainis,
Arab expatriates andArabic English non-Arabs who were able
to complete the interview in
Arabic or English

2020

Bahrain15.1

Aug 6 –
Aug 23, 2020

1,009

1.61

3.9

Landline andMobile Telephone

2020

Bangladesh

15.1

Oct 30 –Nov 28, 2020

1,013

2.43

4.8

Mobile Telephone

Bengali

2020

Belgium

15.1

Aug 19 –Sep 19, 2020

1,005

1.33

3.6

Landline andMobile Telephone

French,
Dutch

2020

Benin

15.1

Dec 11 –Dec 25, 2020

1,042

2.36

4.7

Mobile Telephone

Bariba, Fon,
French2020

Bolivia

15.1

Sep 25 –Oct 28, 2020

1,001

1.84

4.2

Mobile Telephone

Spanish2020

Bosnia andHerzegovina

15.1

Oct 16 –Nov 19, 2020

1,001

1.50

3.8

Landline andMobile Telephone

Bosnian2020

Brazil15.1

Sep 10 –Nov 11, 2020

1,002

1.85

4.2

Landline andMobile Telephone

Portuguese

2020

Bulgaria

15.1

Sep 17 –Nov 26, 2020

1,000

2.03

4.4

Landline andMobile Telephone

Bulgarian

1,007

2.52

4.9

Mobile Telephone

Dioula,French,Fulfulde,
Moore

2020

Burkina Faso

15.1

Feb 19 –Mar 4, 2021

2020

Cambodia

15.1

Oct 23 –Nov 15, 2020

1,002

2.73

5.1

Mobile Telephone

Khmer

2020

Cameroon

15.1

Sep 19 –Nov 8, 2020

1,000

2.63

5.0

Mobile Telephone

French,English,Fulfulde

2020

Canada15.1

Aug 3 –
Sep 21, 2020

1,006

1.46

3.7

Landline andMobile Telephone

English,French

2020

Chile

15.1

Sep 11 –Nov 16, 2020

1,000

1.52

3.8

Landline andMobile Telephone

Spanish

3,503

2.16

2.4

Mobile Telephone

Chinese

2020

China

15.1

Sep 8 –
Oct 28, 20202020

Colombia

15.1

Aug 21 –Oct 27, 2020

1,000

1.52

3.8

Landline andMobile Telephone

Spanish

2020

Congo

15.1

Dec 2 –
Dec 29, 2020

1,002

1.55

3.9

Face-to-Face(HH)*

French,Kituba,Lingala2020

Costa Rica

15.1

Sep 15, 2020
– Jan 4, 2021

1,000

1.67

4.0

Landline andMobile Telephone

Spanish2020

Croatia

15.1

Sep 22 –Nov 2, 2020

1,002

1.77

4.1

Landline andMobile Telephone

Croatian

The Hologic Global Women’s Health Index | Global Report

Northwest Territories, Yukon
and Nunavut (representing
approximately 0.3% of theCanadian population) were
excluded.

Tibet was excluded from thesample. The excluded areas
represent less than 1% of the
population of China© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

100Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2020

Cyprus15.1

Jul 20 –Sep 27, 2020

1,005

1.55

3.8

Landline andMobile Telephone

Greek,English

2020

Czech
Republic

15.1

Oct 9 –
Nov 28, 2020

1,004

1.50

3.8

Landline andMobile Telephone

Czech

2020

Denmark

15.1

Sep 14 –Oct 10, 2020

1,000

1.30

3.5

Mobile Telephone

Danish

2020

Dominican
Republic

15.1

Sep 24 –Oct 23, 2020

1,000

1.63

4.0

Landline andMobile Telephone

Spanish2020

Ecuador

15.1

Aug 26 –Oct 23, 2020

1,000

1.51

3.8

Landline andMobile Telephone

Spanish

2020

Egypt

15.1

Oct 24 –Nov 12, 2020

1,002

2.00

4.4

Landline andMobile Telephone

Arabic2020

El Salvador

15.1

Sep 23 –Nov 17, 2020

1,000

1.83

4.2

Mobile Telephone

Spanish2020

Estonia15.1

Oct 14 –Nov 20, 2020

1,000

1.54

3.8

Mobile Telephone

Estonian,
Russian

1,003

2.96

5.3

Mobile Telephone

Amharic,
English,Oromo,
TigrinyaExclusions(Samples are nationally
representative unless noted
otherwise)2020

Ethiopia15.1

Oct 5 –
Nov 1, 2020

2020

Finland

15.1

Mar 26 –May 13, 2020

1,000

1.42

3.7

Mobile Telephone

Finnish,Swedish2020

France15.1

Sep 7 –
Oct 2, 2020

1,000

1.52

3.8

Landline andMobile Telephone

French

2020

Gabon

15.1

Feb 19 –Mar 3, 2021

1,000

2.43

4.8

Mobile Telephone

French, Fang

2020

Georgia

15.1

Sep 25 –Nov 14, 2020

1,003

2.00

4.4

Landline andMobile Telephone

Georgian,
Russian2020

Germany

15.1

Aug 24 –Sep 19, 2020

1,000

2.14

4.5

Landline andMobile Telephone

German

2020

Ghana

15.1

Oct 2 –
Oct 30, 2020

1,000

2.19

4.6

Mobile Telephone

English,Ewe, Twi

2020

Greece15.1

Sep 23 –Oct 24, 2020

1,002

1.88

4.2

Landline andMobile Telephone

Greek

2020

Guinea15.1

Feb 19 –Mar 4, 2021

1,005

2.88

5.2

Mobile Telephone

French,Malinke,
Pular,
Soussou

2020

Hungary

15.1

1,001

1.83

4.2

Landline andMobile Telephone

Hungarian2020

Hong Kong,
S.A.R. ofChina

Oct 19 –Nov 17, 2020

15.1

Sep 3 –
Nov 8, 2020

1,005

1.26

3.5

Landline andMobile Telephone

Chinese2020

Iceland15.1

Aug 31 –Oct 12, 2020

501

1.49

5.3

Landline andMobile Telephone

Icelandic

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GWHI_Global_091621v16_kn

Languages

3,103

3.53

3.3

Mobile Telephone

Excluded population living
in Northeast states andremote island.

2020

Indonesia

15.1

Oct 31, 2020
– Jan 13, 2021

1,062

2.43

4.7

Mobile Telephone

BahasaIndonesia

2020

Iran

15.1

Aug 5 –
Aug 12, 2020

1,009

1.45

3.7

Landline andMobile Telephone

Farsi

2020

Iraq

15.1

Nov 1 –
Nov 23, 2020

1,000

1.69

4.0

Mobile Telephone

Arabic,Kurdish2020

Ireland

15.1

Aug 17 –Sep 12, 2020

1,000

1.62

3.9

Landline andMobile Telephone

English2020

Israel15.1

Sep 24 –Oct 19, 2020

1,057

1.38

3.5

Landline andMobile Telephone

Hebrew,
Russian,Arabic

2020

Italy

15.1

Aug 24 –Sep 16, 2020

1,000

2.53

4.9

Landline andMobile Telephone

Italian

2020

Ivory Coast

15.1

Dec 5 –
Dec 21, 2020

1,021

2.20

4.5

Mobile Telephone

French,Dioula2020

Jamaica

15.1

Sep 24, 2020
– Jan 4, 2021

502

1.47

5.3

Mobile Telephone

EnglishMarginof Errorb

Dec 28, 2020
– Jan 26, 2021

DesignEffecta

15.1

Number ofInterviews

India

Wave

2020

Assamese,
Bengali,
Gujarati,
Hindi,
Kannada,Malayalam,
Marathi,Odia,
Punjabi,
Tamil,
TeluguCountry

Mode ofInterviewing

Data Collection
Date

Data Collection
Year

101

Exclusions(Samples are nationally
representative unless noted
otherwise)

2020

Japan

15.1

Aug 7 –
Oct 8, 2020

1,016

1.22

3.4

Landline andMobile Telephone

Japanese

2020

Jordan15.1

Nov 3 –
Nov 20, 2020

1,012

1.46

3.7

Mobile Telephone

Arabic2020

Kazakhstan

15.1

Nov 7 –
Dec 4, 2020

1,000

1.57

3.9

Mobile Telephone

Russian,
Kazakh

2020

Kenya

15.1

Sep 30 –Nov 6, 2020

1,008

1.99

4.4

Mobile Telephone

English,Swahili/
Kishwahili

2020

Kosovo15.1

Oct 12 –Dec 12, 2020

1,000

1.73

4.1

Mobile Telephone

Albanian,
Serbian

2020

Kyrgyzstan

15.1

Oct 27 –Nov 20, 2020

1,000

1.33

3.6

Mobile Telephone

Kyrgyz,Russian

The Hologic Global Women’s Health Index | Global Report

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.

© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2020

Laos

15.1

Oct 28 –Nov 11, 2020

1,000

2.43

4.8

Mobile Telephone

Lao

2020

Latvia15.1

Sep 10 –Oct 31, 2020

1,001

1.62

3.9

Mobile Telephone

Latvian,Russian

2020

Lebanon

15.1

Oct 18 –Nov 26, 2020

1,050

1.33

3.5

Landline andMobile Telephone

Arabic2020

Lithuania

15.1

Oct 8 –
Nov 26, 2020

1,002

1.93

4.3

Mobile Telephone

Lithuanian

2020

Malta

15.1

Mar 8 –
Apr 24, 2020

1,001

1.46

3.7

Landline andMobile Telephone

Maltese,English

15.1

Oct 27, 2020 –Jan 26, 2021

Mobile Telephone

BahasaMalay,
Chinese,English2020

102

Malaysia

1,000

2.09

4.5

Exclusions(Samples are nationally
representative unless noted
otherwise)

2020

Mali

15.1

Dec 3 –
Dec 22, 2020

1,000

1.36

3.6

Face-to-Face(HH)*

French,Bambara2020

Mauritius

15.1

Jul 24 –Aug 27, 2020

1,000

1.69

4.0

Landline andMobile Telephone

Creole,English,French2020

Mexico15.1

Sep 08 –Nov 18, 2020

1,010

1.66

4.0

Landline andMobile Telephone

Spanish2020

Moldova

15.1

Oct 7 –
Nov 16, 2020

1,000

1.63

4.0

Mobile Telephone

Romanian/
Moldavian,Russian

2020

Mongolia

15.1

Nov 14 –Nov 30, 2020

1,000

1.58

3.9

Mobile Telephone

Mongolian

2020

Montenegro

15.1

Oct 15 –Dec 25, 2020

1,004

1.74

4.1

Landline andMobile Telephone

Montenegrin

2020

Morocco15.1

Oct 8 –
Nov 10, 2020

1,006

1.47

3.7

Landline andMobile Telephone

MoroccanArabic2020

Myanmar15.1

Oct 29 –Dec 4, 2020

1,000

1.84

4.2

Mobile Telephone

Myanmar,Burmese

1,000

1.76

4.1

Mobile Telephone

English,Oshivambo,
Afrikaans,
Kwangali

2020

Namibia15.1

Oct 5 –
Nov 16, 2020

2020

Nepal

15.1

Oct 18 –Dec 4, 2020

1,000

2.59

5.0

Mobile Telephone

Nepali

2020

Netherlands

15.1

Mar 11 –May 15, 2020

1,006

1.60

3.9

Landline andMobile Telephone

Dutch

The Hologic Global Women’s Health Index | Global Report

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.

© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

103

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2020

New
Zealand15.1

Feb 17 –Mar 23, 2020

1,002

1.56

3.9

Landline andMobile Telephone

English2020

Nicaragua

15.1

Nov 14 –Dec 28, 2020

1,002

2.06

4.4

Mobile Telephone

SpanishExclusions(Samples are nationally
representative unless noted
otherwise)

2020

Nigeria

15.1

Sep 25 –Nov 2, 2020

1,004

1.96

4.3

Mobile Telephone

English,Hausa,
Igbo, Pidgin
English,Yoruba2020

North
Macedonia

15.1

Nov 28 –Dec 17, 2020

1,003

1.44

3.7

Landline andMobile Telephone

Macedonian,
Albanian

2020

Norway15.1

Mar 24 –May 4, 2020

1,000

1.47

3.8

Landline andMobile Telephone

NorwegianDid not include AJK, GilgitBaltistan. The excluded area
represents approximately 5%of the population. Gendermatched sampling was usedduring the final stage of
selection.

2020

Pakistan

15.1

Jan 2 –
Feb 5, 2021

1,000

1.56

3.9

Face-to-Face
(HH)*

Urdu

2020

Paraguay

15.1

Nov 28 –Dec 28, 2020

1,000

1.28

3.5

Landline andMobile Telephone

Spanish

2020

Peru

15.1

Oct 29, 2020
– Jan 6, 2021

1,006

1.67

4.0

Landline andMobile Telephone

Spanish

1,000

1.92

4.3

Landline andMobile Telephone

Filipino,
Iluko,
Cebuano,Waray, Bicol

2020

Philippines

15.1

Sep 14 –Oct 26, 2020

2020

Poland15.1

Sep 25 –Oct 24, 2020

1,010

1.74

4.1

Landline andMobile Telephone

Polish2020

Portugal

15.1

Mar 20 –Apr 16, 2020

1,002

1.70

4.0

Landline andMobile Telephone

Portuguese

2020

Romania15.1

Dec 5, 2020 –Jan 25, 2021

1,000

1.44

3.7

Landline andMobile Telephone

Romanian

2020

Russia15.1

Aug 19, –Oct 2, 2020

2,022

1.68

2.8

Landline andMobile Telephone

Russian

1,043

1.80

4.1

Landline andMobile Telephone

Arabic,English,Hindi, Urdu

2020

Saudi Arabia

15.1

Aug 9 –
Aug 27, 2020

2020

Senegal15.1

Dec 5 –
Dec 23, 2020

1,000

1.36

3.6

Face-to-Face(HH)*

French,
Wolof

2020

Serbia15.1

Sep 18 –Oct 25, 2020

1,002

1.63

4.0

Landline andMobile Telephone

Serbian2020

Slovakia

15.1

Sep 9 –
Oct 9, 2020

1,001

1.51

3.8

Landline andMobile Telephone

Hungarian,
Slovak

2020

Slovenia

15.1

Mar 13 –Apr 18, 2020

1,001

1.97

4.3

Landline andMobile Telephone

SloveneThe Hologic Global Women’s Health Index | Global Report

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

© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

2020South Korea

15.1

Aug 25 –Oct 7, 2020

1,005

1.32

3.6

Landline andMobile Telephone

Korean

2020

Spain

15.1

Aug 24 –Sep 17, 2020

1,000

1.60

3.9

Landline andMobile Telephone

Spanish2020

Sri Lanka

15.1

Oct 31 –Dec 5, 2020

1,000

1.91

4.3

Mobile Telephone

Sinhala,
Tamil

2020

Sweden15.1

Mar 30 –Apr 29, 2020

1,000

1.41

3.7

Landline andMobile Telephone

Swedish2020

Switzerland

15.1

Sep 7 –
Oct 9, 2020

1,000

1.79

4.1

Landline andMobile Telephone

2020

Taiwan,Province of
China

German,French,Italian

15.1

Jul 9 –
Jul 31, 2020

1,000

1.54

3.8

Landline andMobile Telephone

Chinese2020

Tajikistan

15.1

Nov 15 –Dec 7, 2020

1,000

1.89

4.3

Mobile Telephone

Tajik

2020

Tanzania

15.1

Oct 6 –
Nov 8, 2020

1,001

2.56

5.0

Mobile Telephone

Swahili,
Kishwahili

2020

Thailand

15.1

Oct 22 –Dec 7, 2020

1,000

2.39

4.8

Mobile Telephone

Thai

2020

Tunisia15.1

Sep 19 –Oct 7, 2020

1,003

1.81

4.2

Landline andMobile Telephone

Arabic2020

Turkey15.1

Oct 3 –
Oct 23, 2020

1,000

1.68

4.0

Landline andMobile Telephone

Turkish

1,016

2.35

4.7

Mobile Telephone

Ateso,English,Luganda,Runyankole

1,001

1.68

4.0

Landline andMobile Telephone

Russian,
Ukrainian

4.2

Mobile Telephone

Marginof Errorb

1.91

DesignEffecta

1,019

Afrikaans,
English,Sotho,
Xhosa, Zulu

Number ofInterviews

Languages

Data Collection
Date

15.1

Mode ofInterviewing

Wave

South Africa

Country

Data Collection
Year

104

2020

Oct 21 –Dec 12, 2020

Exclusions(Samples are nationally
representative unless noted
otherwise)

2020

Uganda15.1

Oct 12 –Nov 8, 2020

2020

Ukraine15.1

Sep 20 –Oct 19, 2020

2020

United ArabEmirates

15.1

Aug 9 –
Sep 7, 2020

1,011

1.27

3.5

Mobile Telephone

Arabic,English,Hindi, Urdu

2020

UnitedKingdom

15.1

Aug 17 –Sep 12, 2020

1,000

1.50

3.8

Landline andMobile Telephone

English2020

UnitedStates15.1

Mar 16 –May 8, 2020

1,007

1.67

4.0

Landline andMobile Telephone

English,Spanish2020

Uruguay

15.1

Sep 24 –Nov 30, 2020

1,001

1.54

3.8

Landline andMobile Telephone

Spanish2020

Uzbekistan

15.1

Oct 26 –Nov 21, 2020

1,000

1.82

4.2

Landline andMobile Telephone

Uzbek,
Russian2020

Venezuela

15.1

Sep 19 –Nov 25, 2020

1,000

1.65

4.0

Landline andMobile Telephone

SpanishThe Hologic Global Women’s Health Index | Global Report

Includes only Emiratis, Arab
expatriates and non Arabs
who were able to complete
the interview in Arabic,
English, Urdu or Hindi© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

Data Collection
Year

Country

Wave

Data Collection
Date

Number ofInterviews

DesignEffectaMarginof Errorb

Mode ofInterviewing

Languages

2020

Vietnam

15.1

Dec 16, 2020
– Jan 8, 2021

1,000

2.15

4.5

Mobile Telephone

Vietnamese

2020

Zambia15.1

Oct 4 –
Oct 28, 2020

1,026

1.81

4.1

Mobile Telephone

Bemba,English,Lozi, Nyanja,
Tonga

2020

Zimbabwe15.1

Sep 21 –Oct 24, 2020

1,004

1.81

4.2

Mobile Telephone

English,Shona,
NdebeleExclusions(Samples are nationally
representative unless noted
otherwise)

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 to 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 used in this analysis
As the Hologic Global Women’s Health Index was fielded in 116 countries and territories, 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 116 different countries and territories. The major types of country groupings
used in this report are regional and country income breakdowns.
Regional groupings: The Hologic Global Women’s Health Index analysis relied on 13 different geographic regions,largely corresponding to the continental sub-region or ‘intermediary’ regions used by the United Nations Statistics
Division (UNSD). Ultimately, Gallup and Hologic decided on the groupings below.

105

The Hologic Global Women’s Health Index | Global Report© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

Regional groupings used in this report
In analyzing the results from 116 countries and territories in the Hologic Global Women’s Health Index, thisreport uses the following regional groupings:
Australia/New Zealand: Australia, New Zealand
East Asia: China, Hong Kong, S.A.R. of China, Japan, Mongolia, South Korea, Taiwan, Province of China
Europe: Albania, Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark,Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kosovo, Latvia, Lithuania, Malta,
Moldova, Montenegro, Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Russia, Serbia,
Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine, United Kingdom
South America: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, Venezuela
Central America: Costa Rica, El Salvador, Mexico, Nicaragua
Caribbean: Jamaica, Dominican Republic
Western Asia: Bahrain, Cyprus, Georgia, Iraq, Israel, Jordan, Turkey, Lebanon, Saudi Arabia,
United Arab Emirates
Northern America: Canada, United States
Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan
South Asia: Bangladesh, India, Iran, Pakistan, Nepal, Sri Lanka
South-eastern Asia: Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Thailand, Vietnam
Northern Africa: Algeria, Egypt, Morocco, Tunisia
Sub-Saharan Africa: Benin, Burkina Faso, Cameroon, Congo, Ivory Coast, Ethiopia, Gabon, Ghana, Guinea,
Kenya, Mali, Mauritius, Namibia, Nigeria, Senegal, South Africa, Tanzania, Uganda, Zambia, Zimbabwe

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, China has the largest population of the 116 countries included in the Hologic Global Women’s HealthIndex. China’s aged 15 and older population represents about 22% of the total 15 and older population across thecountries and areas surveyed, according to the national census figures Gallup used in its sampling and weighting
processes. Thus, when presenting global estimates in this report, respondents from China were given a greater
weight — that corresponds to their share of the population — in determining the final calculation.

106

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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.2 For this reason, theHologic Global Women’s Health Index examined these characteristics using standardized definitions of income andeducation (shown below) 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.3

Country income level
Countries were divided into four income groupings, as defined by the World Bank:• 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
Education
Countries have unique ways of classifying education levels, and these classifications need to be preserved during
data collection for weighting purposes. However, to make comparisons across countries by educational attainment,
consistent categories needed to be created. All education descriptions can be placed within three categories:
primary, secondary and tertiary. All responses regarding education were coded into their relevant category for global
comparison.

• Primary: Functional equivalent to completing primary education or lower secondary or less. This level is closest
to completing up to eight years of education. The exact definition will vary by country.

• Secondary: Functional equivalent to completing some secondary up to some tertiary education. This category
typically refers to individuals who have completed nine to 15 years of education but have not completed theequivalent of a bachelor’s degree. The exact definition will vary by country.

• Tertiary: Functional equivalent to completing four years of post-secondary tertiary education, or the equivalent ofa bachelor’s degree. This level typically refers to individuals who have completed approximately 16 or more yearsof education. The exact definition will vary by country.

107

2

As discussed in the Gallup World Poll Methodology and Codebook (pages 12-14).

3

See page 14 of the Gallup World Poll Methodology and Codebook.

The Hologic Global Women’s Health Index | Global Report© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

Employment
Gallup classified respondents into one of six employment categories based on a respondent’s combination ofanswers to a series of questions about employment.

• Employed full time for an employer: A respondent is considered employed full time for an employer if they are
employed by an employer and work for this employer for at least 30 hours per week.

• Employed full time for self: Respondents are considered employed full time for themselves if they are selfemployed and work at least 30 hours per week.

• Employed part time, do not want to work full time: Respondents who work either for an employer or themselvesand do not work more than 30 hours per week at either job are categorized as employed part time. Additionally,
when asked, these respondents indicate that they do not want to work more than 30 hours per week.

• Employed part time, want to work full time: Respondents who work either for an employer or themselves and do
not work more than 30 hours per week at either job are categorized as employed part time. Additionally, when
asked, these respondents indicate that they do want to work more than 30 hours per week.

• Unemployed: A respondent is unemployed if they report not being employed in the last seven days, either for an
employer or themselves. The respondent must also report actively looking for a job in the past four weeks AND
being able to begin work in the last four weeks.

• Out of the workforce: Respondents who are out of the workforce, were not employed within the last sevendays either for an employer or themselves, are not looking for work, AND/OR are not available to start work.
Respondents may be full-time students, retired, disabled or homemakers; however, some respondents will not
fall into any of these scenarios.

108

The Hologic Global Women’s Health Index | Global Report© 2021 Hologic, Inc. All rights expressly reserved.
GWHI_Global_091621v16_kn

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Hologic intends to conduct theHologic Global Women’s Health Index inpartnership with Gallup for years into the future.

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