Women's health and well-being over the life course: conceptual framing supported by a scoping review

As a framework to conceptualise well-being, the capability approach (CA) combines structural drivers with personal freedoms, making it a compelling approach for understanding women's health and well-being (WHW). The WHW Project of the Exemplars in Global Health initiative chose the CA for its conceptual framing, while emphasising the influential role of gender and other intersecting inequalities (intersectional gender inequality) in shaping health and well-being over the life course. We discuss the Exemplars in Global Health - Women's Health and Well-being (EGH-WHW) Framework and a scoping review that supports it.

To identify well-established and/or validated CA-based frameworks and measures attuned to intersectional gender inequality that analyse women's well-being over the life course and across multiple geographies.If needed, to develop a new conceptual framework to analyse WHW over the life course through an intersectional gender inequality lens.

The scoping review, which was carried out between January and May 2024 and re-run in May 2025, adhered to the methodology by Arksey and O'Malley, Levac et al and Daudt et al, and the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. The EGH-WHW Framework was developed by a multidisciplinary Working Group comprising representatives of organisations in the WHW Project consortium.

The review drew upon database searches (Scopus, PubMed) and targeted online hand searches for CA-based frameworks and measures.

All CA-based frameworks and measures of multidimensional well-being were included. CA-based empirical research was considered if it applied a framework or measure; or if it analysed multidimensional well-being across multiple geographies.

Information about each type of CA-based application-its choice of well-being dimensions, methods, focus on inequality, intersectionality and the life course-was recorded in a data charting form. Thematic summative syntheses of publications about each CA-based framework or measure led up to an overall evaluative synthesis of the fit between existing work and our requirements.

The review culminated in 94 publications, including six frameworks and 14 measures that met only some of the WHW Project's requirements: multidimensionality of well-being; attention to intersectional gender inequality and the life course; as well as demonstrated and intended measurements across multiple geographies.

The review reaffirms the need for the EGH-WHW Framework, which recognises that WHW depend on their freedom 'to be' and 'to do', and proposes three interconnected clusters of dimensions depicting key capabilities, agency and functionings that are sensitive to intersectional gender inequality and the life course. Each dimension is mapped to specific indicators to support comparative assessments of country performance and drivers of progress across low-income and middle-income countries.

The EGH-WHW Framework distinguishes itself from other CA-based frameworks by incorporating both an intersectional gender lens and a life course perspective. The framework's conceptualisation of multidimensional well-being allows for a rich and nuanced foundation on which to build policies and programmes that address the complex determinants of health, well-being and human rights of different groups of girls and women.