The role of gender inequities in women's access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India

Namasivayam, Amrita; Osuorah, Donatus C; Rahman, Syed; Antai, Diddy

doi:10.2147/ijwh.s32569

Cited by 41 publications

(30 citation statements)

References 43 publications

(70 reference statements)

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“…Some studies used just one aspect of RH services [39-42] while others used multiple aspects [43-45]. However, very few studies assessed all four essential aspects of RH services as we did in our study.…”

Section: Discussionmentioning

confidence: 94%

Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Zaw

Liabsuetrakul

Htay

et al. 2012

BMC Health Serv Res

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BackgroundInequity of accessibility to and utilization of reproductive health (RH) services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar.MethodsA community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression.ResultsAlthough geographical accessibility was high (79.3%), financial accessibility was low (19.1%) resulting in a low overall accessibility (34.5%) to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge on types of providers and services significantly influenced the unmet needs of youths towards RH services.ConclusionDespite the availability of RH services, youth’s accessibility to and utilization of those services were unsatisfactory. The levels of youths’ unmet RH needs were alarmingly high.

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Section: Discussionmentioning

confidence: 94%

Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Zaw

Liabsuetrakul

Htay

et al. 2012

BMC Health Serv Res

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“…The rural disadvantage could be due to access, cost of services, distance and travelling time as well as opportunity cost of leaving place of work to attend health facility and lack of skilled personnel at these health facilities that can lead to poor outcome and poor satisfaction. This finding is not surprising considering the acknowledged spatial distribution of health facilities in low and medium income countries like Nigeria as well as low socioeconomic level of rural people that serves as financial barrier to access health service [ 55 , 56 ]. Regarding religion, though the odds ratio indicates increased utilization of health facility for delivery, this is not significant.…”

Section: Discussionmentioning

confidence: 99%

Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria

Dahiru¹,

Oche²

2015

Pan Afr Med J

211

206

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IntroductionUtilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average.MethodsWe analysed the 2013 Nigeria DHS to determine factors associated with utilization of these health MCH indicators by employing both bivariate and multivariate logistic regressions.ResultsOverall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal care strongly predicts both health facility delivery (OR = 2.16, 95%CI: 1.99-2.34) and postnatal care utilization (OR = 4.67, 95%CI: 3.95-5.54); while health facility delivery equally predicting postnatal care (OR = 2.84, 95%CI: 2.20-2.80).ConclusionImproving utilization of these three MCH indicators will require targeting women in the rural areas and those with low level of education as well as creating demand for health facility delivery. Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization.

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“…In contrast, there is a large body of literature FORUM on discrimination and women's health, [12][13][14][15][16][17][18][19][20][21] possibly in response to the historic under-representation of women in research informing medical practice. In 1993 the United States National Institutes of Health (NIH) was mandated by law to ensure that 'women and minority groups' were included in clinical research.…”

Section: Some More Equal Than Others?mentioning

confidence: 99%

Gender inequality: Bad for men's health

Cornell

2013

South. Afr. j. HIV med.

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FORUMMen's increased risk of death in ART programmes in sub-Saharan Africa is widely reported but poorly understood. Some studies have attributed this risk to men's poorer health-seeking behaviour, which may prevent them from accessing ART, being adherent to treatment, or remaining in care. In a multicentre analysis of 46 201 adults starting ART in urban and rural settings in South Africa, these factors only partly explained men's increased mortality while receiving ART. Importantly, the gender difference in mortality among patients receiving ART (31% higher for men than women) was substantially smaller than that among HIVnegative South Africans, where men had twice the risk of death compared with women. Yet, this extreme gender inequality in mortality, both within and outside of ART programmes, has not given rise to widespread action. Here it is argued that, despite their dominance in society, men may be subject to a wide range of unfair discriminatory practices, which negatively affect their health outcomes. The health needs of men and boys require urgent attention. Sub-Saharan Africa is the centre of the HIV epidemic, with an estimated 68% of all people HIV-infected.[1] Over the past 10 years, largely through international aid programmes, there has been a dramatic increase in the number of HIV-infected individuals who have started antiretroviral therapy (ART) in the region. Despite early concerns that women may be disadvantaged in ART programmes, disproportionately more women than men have accessed ART in Southern Africa.[2] In South Africa, for example, 60% of eligible women were receiving ART by mid-2011 compared with 41% of eligible men. [3] Men have a higher mortality than women when receiving ART. [4][5][6][7][8] Although the reasons for this are poorly understood, a number of possible explanations have been suggested; some implicitly blame men for their own poorer outcomes. For example, numerous studies have suggested that men's poorer 'health-seeking behaviour' may prevent them from accessing ART services, being adherent to treatment or remaining in care. But, is this based on evidence or is it an assumption that has gained currency through widespread usage?To date, there has been no systematic attempt to understand the phenomenon of gender differences on ART. In the past year, we explored the issue in an analysis including 46 201 adults initiating ART in 8 large urban and rural South African cohorts between 2002 and 2009.[5] As 60% of our patients had civil identification (ID) numbers, it was possible to confirm their vital status through linkage to the National Population Register, estimated to capture over 90% of deaths nationally. [9] We were also able to track patients with IDs after they were lost to follow-up (LTF) and confirm whether they were alive or dead. Men's increased mortality on ART unrelated to HIV/AIDSAt the start of treatment, on average men had lower CD4+ cell counts and more advanced HIV disease than women. After we adjusted for such gender differences at ART initiation, men still...

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The role of gender inequities in women's access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India

Cited by 41 publications

References 43 publications

Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria

Gender inequality: Bad for men's health

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