Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

Abstract

Background: Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. While gender is regarded as an important determinant of health, there is a paucity of literature that considers the interface between how these two priorities are pursued. Objective: This article explores how government stakeholders understand gender issues (gender barriers and roles) in the promotion of maternal, newborn and child health equity in Ethiopia. Methods: Adopting an exploratory qualitative case study design, we conducted semistructured interviews with 17 purposively-selected stakeholders working in leadership positions with the Federal Ministry of Health and Federal Ministry of Women and Children Affairs as part of a larger study regarding the promotion of health equity in maternal, newborn and child health. A post hoc content and thematic sub-analysis was done to explore how participants raised gender issues in conversations about health equity. Results: Efforts to address gender inequalities were synonymous with the promotion of a women's health agenda, which was largely oriented towards promoting health service use. Men were predominant decision makers with regards to women's health and health care seeking in both public and private spheres. Participants reported persisting gender-related barriers to health stemming from traditional gender roles, and noted the increased inclusion of women in the health workforce since the introduction of the Health Extension Program. Conclusions: The framing of gender as a women's health issue, advanced through patriarchal structures, does little to elevate the status of women, or promote power differentials that contribute to health inequity. Encouraging leadership roles for women as health decision makers and redressing certain gender-based norms, attitudes, practices and discrimination are possible ways forward in re-orienting gender equality efforts to align with the promotion of health equity. ARTICLE HISTORY

Effect of Gender on the Utilization of Maternal and Child Health Services among Pastoralist Caregivers in Somali Region of Ethiopia

“…These findings in our study on men holding the balance of power in the household on most decisions is similar to the findings from previous studies in Ethiopia and other studies in Ghana and Senegal which reported that very few women had decision-making autonomy in relation to their health and reported that men were predominant decision makers with regards to women's health and health care seeking [2,[8][9][10] , This is also consistent with the findings from studies in Bangladeshi and rural India that showed than more than half of the women interviewed were not involved in decision-making about their own health care [11,12]. The limited autonomy or lack of decision-making power over their health or that of their children has been reported as a major barrier to women's ability to access maternal health care services [13 -15].…”

“…This is similar to a study in Ethiopia which reported that increased inclusion of women in the heath workforce are important to addressing the persistent gender-related barriers to health utilization of health services. [8] However bearing in mind the low literacy rate among women in the region that is responsible for the limited number of female health workers it may be difficult in short term to have adequate number of female health workers until the more women are supported and encouraged to go to school and the cultural barriers responsible for the low female literacy are addressed.…”

Perceptions of Inequity in the Provision and Utilization of Maternal, Newborn, and Child Health Services in Tigray, Ethiopia. A Qualitative Explorative Study

“…The lack of support from husbands and women being very busy with household chores, which is the common situation in Ethiopia (32), resulted in inadequate follow-up of antenatal care and delivery at home. These ndings suggest that the current gender equality weaknesses (14) cause inequities in the utilization of these services (16,33). As gender is socially and culturally constructed, women are affected by the sociocultural consequences resulting in maternal and child health inequities (7,34).…”

Maternal Social Support and Determinants of Health Facility Delivery in Rural Ethiopia

“…Further, recent studies examined the in uence of social support during pregnancy and childbirth on birth weight, length of gestation including fewer pregnancy complications for women with high levels of stress, reduce fear/anxiety, improve outcomes, and stimulate healing but not for those with low levels of stress (17,18), however, these studies do not fully account for the interpersonal, family and community interactions thought to facilitate or constrain service use as well as decision making; a social context in which individual determinants are known to operate. For example, the importance of social networks in Ethiopia have long recognized and exhibit different kinds of social interaction and rely more on family and friend ties, and often consult family and friends in case of illness and service use (17)(18)(19)(20). However, maternal social support as direct determinants of health facility delivery including the different dimensions of maternal social support and its complex interactions have not been extensively studied in Ethiopia.…”

“…Moreover, maternal social support can also be received in different contexts which leads to different healthcare seeking behaviors (32). For example, studies in SSA countries reported that pregnant women initiate ANC early and felt the importance of health facility childbirth, only when they are sick or experience any pregnancy-related health problems (32)(33)(34)(35). Early initiators emphasized that they go to the ANC and started to think health facility childbirth and need different supports from family and relatives if the pregnancy is under threat and or they are sick in the following comments.…”