To assess the status of women’s empowerment and its associated factors using multidimensional empowerment index in Tigray, Ethiopia.

Community-based cross-sectional study.

Tigray regional state, Ethiopia.

A sample of married pregnant women (n=1477) whose gestational age was at least 8 weeks were the study participants.

The primary outcome of the study was women’s empowerment status, assessed using 24 indicators across five key domains: decision-making power, social independence, attitudes towards violence against women, social networking and household asset ownership. Equal weight was assigned to all domains and the weight assigned to each domain was distributed equally to the indicators within the corresponding domain. Women who scored at least 80% (ie, met 4 out of 5 domains) were considered as empowered.

In total, only 8.2% (95% CI 6.9 to 9.78) of women were empowered. Intrafamilial factors: husband’s education with primary (adjusted OR (AOR): 2.66 (1.30 to 5.43), secondary AOR: 4.69 (2.23 to 9.84) and tertiary AOR: 3.60 (1.20 to 10.83)) levels, being from model households (AOR: 4.38 (1.33 to 14.47)), households with middle (AOR: 3.50 (1.13 to 8.37)) or high (AOR: 3.10 (1.25 to 7.67)) wealth index, enrolment in productive safety net programmes (AOR: 2.37 (1.25 to 4.50)) and age at first pregnancy (AOR: 1.16 (1.08 to 1.24)) were positively associated with women’s empowerment. From the community-level characteristics, dowry (AOR: 1.82 (1.10 to 5.30)) and perceived good availability of justice for women and girls (AOR: 3.00 (1.05 to 8.60)) were positively associated with women’s empowerment. Conversely, the history of an adverse pregnancy outcome was negatively associated with women’s empowerment (AOR: 0.51 (0.26 to 0.99)).

The overall status of women’s empowerment in Tigray was very low. Husband’s education, being model household, wealth index, enrolment in productive safety net programmes, dowry practice, perceived good availability of justice for women and girls and age at first pregnancy were found to be significant factors associated with women’s empowerment. In view of these empirical insights, several policy recommendations are proposed. First, interventions should focus on the identified associated factors, particularly in areas with lower empowerment scores such as partner’s education, improving access to justice for women, addressing harmful community practices such as dowry and strengthening household economic status through social protection and livelihood programmes. Second, the promotion of gender-balanced household dynamics through awareness campaigns and policy incentives could make a substantial contribution to women’s empowerment in the study area.

Although the WHO and the Centers for Disease Control and Prevention (CDC) classify preconception health risks (PCHRs) into biomedical, behavioural and social categories, this classification remains theoretical, mainly inconsistent and lacks a scientifically robust framework. Data-driven clustering techniques may help clarify this complexity for policymakers and healthcare providers. This study aimed to assess the status of PCHRs and identify latent classes of these risks among women preparing for pregnancy.

This community-based cross-sectional study was conducted from 31 July to 16 August 2024 in Tigray, Ethiopia, among 865 married women planning to conceive within the next 6 months. Data were gathered through face-to-face interviews using a structured questionnaire. Risk factor indicators covering lifestyle behaviours, substance use, nutritional risks and related factors were developed based on guidelines from the WHO, the CDC and national recommendations. Latent class analysis (LCA) was employed to identify distinct classes of PCHRs, with the optimal number of classes determined using statistical fit indices, adequacy criteria and interpretability. The study also evaluated the overall distribution of PCHRs among participants.

The study took place in Tigray, Ethiopia, among married women intending to become pregnant within 6 months.

Burden of PCHRs and identified distinct latent classes of these risks within the participants.

All participants were exposed to at least four PCHRs, with 84.2% experiencing between 6 and 12 risk factors. The optimal LCA model identified four distinct classes of PCHRs: lifestyle behavioural risks (n=458, 52.9%), reproductive health risks and chronic medical conditions (n=106, 12.25%), nutritional risks and environmental exposure (n=149, 17.23%) and social determinants of health (n=152, 17.57%).

Our study reveals a high baseline level of PCHRs, with all participants exhibiting multiple risk factors for adverse pregnancy outcomes. The identification of four distinct risk profiles underscores the need for tailored risk-specific interventions, particularly in conflict-affected settings. Our findings point out the need for targeted preconception care and risk stratification in national health strategies to improve maternal and child health outcomes.