Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa

Health Place. 2014 Sep:29:67-78. doi: 10.1016/j.healthplace.2014.06.001. Epub 2014 Jul 1.


In this study, we measure gender inequality both at individual level by women׳s household decision-making and at contextual level by permissive gender norms associated with tolerance of violence against women and assess their impact on maternal healthcare services utilisation in rural Africa. We apply multilevel structural equation modelling to Demographic and Health Survey (DHS) data from Ghana, Kenya, Tanzania and Uganda to gain better measure and effect of the gender norms construct. The results show that women in Ghana and Uganda, who live in areas where gender norms are relatively tolerant of violence against women, are less likely to use skilled birth attendants and timely antenatal care. In Tanzania, women who live in this type of environment are less likely to attend four or more antenatal visits. In contrast, the effects of a woman׳s decision-making authority on maternal health service use are less pronounced in the same countries.

Keywords: Maternal health service use; Multilevel and structural equation modelling; Sociocultural and gender norms; Sub-Saharan Africa; Women׳s autonomy.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Decision Making
  • Family Relations / psychology*
  • Female
  • Gender Identity
  • Health Services Accessibility
  • Health Surveys
  • Healthcare Disparities*
  • Humans
  • Maternal Health Services / statistics & numerical data*
  • Middle Aged
  • Patient Acceptance of Health Care
  • Pregnancy
  • Prenatal Care / methods
  • Rural Population
  • Spouse Abuse / psychology
  • Young Adult