Can the health effects of widely-held societal norms be evaluated? An analysis of the United Nations convention on the elimination of all forms of discrimination against women (UN-CEDAW)

Background: Female life expectancy and mortality rates have been improving over the course of many decades. Many global changes offer potential explanations. In this paper, we examined whether the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) has, in part, been responsible for the observed improvements in these key population metrics of women's health. Methods: Data were obtained from the United Nations Treaty Series Database, the World Bank World Development Indicators database and, the Polity IV database. Because CEDAW is nearly universally ratified, it was not feasible to compare ratifying countries to non-ratifying countries. We therefore applied interrupted times series analyses, which creates a comparator (counterfactual) scenario by using the trend in the health outcome before the policy exposure to mathematically determine what the trend in the health outcome would have been after the policy exposure, had the policy exposure not occurred. Analyses were stratified by country-level income and democratization. Results: Among low-income countries, CEDAW improved outcomes in democratic, but not non-democratic countries. In middle-income countries, CEDAW largely had no effect and, among high-income countries, had largely positive effects. Conclusions: While population indicators of women's health have improved since CEDAW ratification, the impact of CEDAW ratification itself on these improvements varies across countries with differing levels of income and democratization.