Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis

Abstract

BackgroundThis article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality.ObjectiveThe objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.MethodAn exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe.ResultsCountries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.ConclusionA potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends

“…The substantial decline that we observed in sex ratios over time could be attributed to a number of factors. While etiological insights are of primary interest, gender inequalities in healthcare access giving rise to referral biases, may also affect sex-differentials in incidence in the African setting [ [58] , [59] ]. There is some indication of this in sub-Saharan Africa, with present-day male referral bias having been reported in children [ 60 ] and middle-aged women [ 61 ] as well as historical reports of barriers faced by elderly women in rural areas [ 62 ].…”

Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study

“…Nigeria is the second largest contributor to maternal mortality worldwide and has a birth rate of five children per woman [22]. The country’s estimated 58,000 maternal deaths per year accounts for 19% of the global total pregnancy-related deaths [1, 23, 24]. Furthermore, maternal deaths are twice as likely among women in rural areas, compared to women in urban areas.…”

An intersectional analysis of maternal mortality in Sub-Saharan Africa: a human rights issue

“…The striking number of women who have prematurely died during pregnancy in Sub-Saharan Africa is largely due to gender biases in the distribution of health services and marginalization of women in these societies. A high correlation between maternal mortality ratios (MMRs)- the number of maternal deaths per 100 000 live births- and gender inequalities as it relates to the accessibility of health services has been found in Angola, Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe [2]. Scholars have investigated the systemic gender inequalities embedded within the fabric of many Sub-Saharan African countries, including Nigeria, Tanzania, and Kenya, where male-dominated social ideals and systemic mores continue to silence and marginalize African women [3].…”

“…Scholars have investigated the systemic gender inequalities embedded within the fabric of many Sub-Saharan African countries, including Nigeria, Tanzania, and Kenya, where male-dominated social ideals and systemic mores continue to silence and marginalize African women [3]. This gender inequality leads to societal vulnerability, where women are subjected to sexual violence and infectious diseases, such as HIV, that can lead to unwarranted pregnancies and further complicate such pregnancies, ultimately yielding higher rates of maternal mortality [2,3].…”

“…Other scholars have assessed how the intersection of gender and education converge on maternal mortality within Sub-Saharan Africa. The data suggests that illiterate pregnant women are less inclined to access the necessary health services and since their illiteracy hinders their ability to be adequately informed about maternal health care options, they feel ill equipped to make autonomous decisions over their own health [2,5]. The same pattern is present in the data behind the use of contraception, where less educated women are less likely to take part in protected sexual encounters [5].…”