Gender equity and sexual and reproductive health in Eastern and Southern Africa: A critical overview of the literature

Global Health Action, Volume 7, No. 1, Year 2014

Interpretation

Background: Gender inequalities are important social determinants of health. We set out to critically review the literature relating to gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa with the aim of identifying priorities for action. Design: During November 2011, we identified studies relating to SRH and gender equity through a comprehensive literature search. Results: We found gender inequalities to be common across a range of health issues relating to SRH with women being particularly disadvantaged. Social and biological determinants combined to increase women’s vulnerability to maternal mortality, HIV, and gender-based violence. Health systems significantly disadvantaged women in terms of access to care. Men fared worse in relation to HIV testing and care with social norms leading to men presenting later for treatment. Conclusions: Gender inequity in SRH requires multiple complementary approaches to address the structural drivers of unequal health outcomes. These could include interventions that alter the structural environment in which ill-health is created. Interventions are required both within and beyond the health system. © 2014 Eleanor E. MacPherson et al. During November 2011, we conducted a literature search of electronic databases for academic literature on gender equity and health in ESA. We developed key search terms which included sex, gender, men, women, reproductive health, disease, Southern and Eastern Africa. The two databases we used for these searches were Medline and Web of Knowledge. We also used a Google Search to ensure we included a range of literature. We limited the searches to include the following 16 countries in ESA: Uganda, the Democratic Republic of Congo (DRC), Kenya, Tanzania, Zambia, Malawi, Mozambique, Madagascar, Mauritius, Angola, Namibia, Botswana, Swaziland, Lesotho, South Africa, and Zimbabwe. We focused on these countries because they provided a range of countries including those with more and less stable political and economic systems and higher and lower HIV epidemics. We included studies for the review that related to gender equity and health (both inside and beyond the health system) in the 16 countries and excluded those that did not relate to gender equity and health. Once we had identified key papers, we reviewed each included paper through undertaking a thematic analysis. As a group, we discussed the key findings and identified broad themes to include in the final write up. In this paper, we have focused specifically on our findings related to SRH. We identified key themes in this area including: measures of gender inequalities; maternal mortality; abortion; unmet contraceptive needs; HIV risk, treatment and care; and gender-based violence. We brought these findings together and discussed as a group to identify key priorities for action to improve the response to address gender inequalities in SRH. Key limitations of this review were: first, the lack of primary data available for the ESA settings related to gender and health, although there were more data available for South Africa and Kenya than for other countries; second, there was a lack of empirical work that identified positive gender equity action in health; thus, the review was largely reliant on descriptive case studies; third, while men and boys are also affected by gender power relations, there were few studies available that focused on men and how gendered norms and expectations can impact on their health; fourth, in reviewing the papers, there were limited papers relating to sexually transmitted diseases other than HIV/AIDS and hence the focus is on HIV rather than the broader set of sexually transmitted infections (STIs).

AI Digest

Study Justification:

– Gender inequalities are important social determinants of health.
– The study aims to identify priorities for action in addressing gender equity and sexual and reproductive health (SRH) in Eastern and Southern Africa.

Highlights:

– Gender inequalities are common across a range of health issues related to SRH.
– Women are particularly disadvantaged, facing increased vulnerability to maternal mortality, HIV, and gender-based violence.
– Health systems significantly disadvantage women in terms of access to care.
– Men fare worse in relation to HIV testing and care due to social norms.
– Multiple complementary approaches are needed to address the structural drivers of unequal health outcomes.

Recommendations:

– Interventions are needed to alter the structural environment in which ill-health is created.
– Interventions should be implemented both within and beyond the health system.

Key Role Players:

– Researchers and academics in the field of gender equity and SRH.
– Policy makers and government officials responsible for health and gender policies.
– Non-governmental organizations (NGOs) working on gender equity and SRH.
– Health professionals and service providers.
– Community leaders and advocates for gender equity and SRH.

Cost Items for Planning Recommendations:

– Research and data collection: funding for surveys, interviews, and data analysis.
– Training and capacity building: resources for educating health professionals and service providers on gender equity and SRH.
– Program implementation: funding for interventions and initiatives aimed at addressing gender inequalities in SRH.
– Monitoring and evaluation: resources for tracking progress and assessing the impact of interventions.
– Advocacy and awareness campaigns: funding for raising awareness and promoting gender equity in SRH.
– Collaboration and coordination: resources for facilitating partnerships and collaboration among key stakeholders.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a comprehensive overview of the literature on gender equity and sexual and reproductive health in Eastern and Southern Africa. The abstract summarizes the key findings and themes identified in the literature review. However, the abstract does not provide specific details about the methodology used in the literature search and review process. To improve the strength of the evidence, the authors could include more information about the search strategy, inclusion and exclusion criteria, and data analysis methods used in the review. Additionally, providing more information about the sample size and characteristics of the included studies would enhance the credibility of the findings.

Abstract

During November 2011, we conducted a literature search of electronic databases for academic literature on gender equity and health in ESA. We developed key search terms which included sex, gender, men, women, reproductive health, disease, Southern and Eastern Africa. The two databases we used for these searches were Medline and Web of Knowledge. We also used a Google Search to ensure we included a range of literature. We limited the searches to include the following 16 countries in ESA: Uganda, the Democratic Republic of Congo (DRC), Kenya, Tanzania, Zambia, Malawi, Mozambique, Madagascar, Mauritius, Angola, Namibia, Botswana, Swaziland, Lesotho, South Africa, and Zimbabwe. We focused on these countries because they provided a range of countries including those with more and less stable political and economic systems and higher and lower HIV epidemics. We included studies for the review that related to gender equity and health (both inside and beyond the health system) in the 16 countries and excluded those that did not relate to gender equity and health. Once we had identified key papers, we reviewed each included paper through undertaking a thematic analysis. As a group, we discussed the key findings and identified broad themes to include in the final write up. In this paper, we have focused specifically on our findings related to SRH. We identified key themes in this area including: measures of gender inequalities; maternal mortality; abortion; unmet contraceptive needs; HIV risk, treatment and care; and gender-based violence. We brought these findings together and discussed as a group to identify key priorities for action to improve the response to address gender inequalities in SRH. Key limitations of this review were: first, the lack of primary data available for the ESA settings related to gender and health, although there were more data available for South Africa and Kenya than for other countries; second, there was a lack of empirical work that identified positive gender equity action in health; thus, the review was largely reliant on descriptive case studies; third, while men and boys are also affected by gender power relations, there were few studies available that focused on men and how gendered norms and expectations can impact on their health; fourth, in reviewing the papers, there were limited papers relating to sexually transmitted diseases other than HIV/AIDS and hence the focus is on HIV rather than the broader set of sexually transmitted infections (STIs).

Materials

N/A

Innovations

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health:

1. Mobile health (mHealth) interventions: Utilize mobile phones and other digital technologies to provide information, reminders, and support to pregnant women and new mothers. This can include text messages with health tips, appointment reminders, and access to telemedicine consultations.

2. Community health workers: Train and deploy community health workers to provide maternal health education, counseling, and basic healthcare services in underserved areas. These workers can help bridge the gap between communities and formal healthcare systems.

3. Telemedicine: Implement telemedicine platforms to enable remote consultations between pregnant women and healthcare providers. This can help overcome geographical barriers and improve access to specialized care, especially in rural areas.

4. Maternal health vouchers: Introduce voucher programs that provide pregnant women with subsidized or free access to essential maternal health services, including antenatal care, delivery, and postnatal care. This can help reduce financial barriers and increase utilization of healthcare services.

5. Maternity waiting homes: Establish safe and comfortable accommodation near healthcare facilities for pregnant women who live far away. This allows them to stay closer to the facility as they approach their due date, ensuring timely access to skilled birth attendants and emergency obstetric care.

6. Task-shifting and training: Train and empower midwives, nurses, and other healthcare providers to take on expanded roles and responsibilities in maternal health. This can help address workforce shortages and improve access to quality care, particularly in resource-limited settings.

7. Public-private partnerships: Foster collaborations between public and private sectors to leverage resources, expertise, and innovation in improving maternal health. This can involve initiatives such as public-private healthcare facilities, telemedicine partnerships, or corporate social responsibility programs.

8. Quality improvement initiatives: Implement evidence-based quality improvement programs in healthcare facilities to enhance the safety and effectiveness of maternal health services. This can involve training healthcare providers, improving infrastructure, and strengthening infection prevention and control measures.

9. Health financing reforms: Advocate for policy changes and investments in healthcare financing to ensure universal access to maternal health services. This can include expanding health insurance coverage, increasing public funding for maternal health, and exploring innovative financing mechanisms.

10. Community engagement and empowerment: Promote community participation and empowerment in maternal health decision-making processes. This can involve community-led initiatives, support groups, and awareness campaigns to raise awareness about maternal health rights and encourage women to seek timely care.

It is important to note that the effectiveness and feasibility of these innovations may vary depending on the local context and resources available.

AI Innovations Description

Based on the information provided, the recommendation to improve access to maternal health in Eastern and Southern Africa is to address gender inequity in sexual and reproductive health (SRH) through multiple complementary approaches. This can include interventions that alter the structural environment in which ill-health is created and interventions both within and beyond the health system.

Some key priorities for action to address gender inequalities in SRH include:

1. Measures of gender inequalities: Develop and implement comprehensive measures to assess and monitor gender inequalities in SRH, including indicators related to maternal mortality, abortion, unmet contraceptive needs, HIV risk, treatment and care, and gender-based violence.

2. Maternal mortality: Implement strategies to reduce maternal mortality rates, focusing on improving access to quality maternal healthcare services, including antenatal care, skilled birth attendance, and emergency obstetric care.

3. Abortion: Ensure access to safe and legal abortion services, where permitted by law, to prevent maternal deaths and complications from unsafe abortions.

4. Unmet contraceptive needs: Increase access to a wide range of contraceptive methods and promote family planning services to meet the unmet contraceptive needs of women, enabling them to make informed choices about their reproductive health.

5. HIV risk, treatment, and care: Address gender disparities in HIV testing and care by promoting early testing and treatment for both men and women. Challenge social norms that discourage men from seeking healthcare services and engage men in HIV prevention and care programs.

6. Gender-based violence: Implement comprehensive strategies to prevent and respond to gender-based violence, including intimate partner violence and sexual violence. This can involve strengthening legal frameworks, providing support services for survivors, and promoting gender equality and respectful relationships.

It is important to note that these recommendations should be tailored to the specific context and needs of each country in Eastern and Southern Africa. Additionally, addressing gender inequity in SRH requires collaboration and coordination among various stakeholders, including governments, healthcare providers, civil society organizations, and communities.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Strengthening healthcare infrastructure: Investing in healthcare facilities, equipment, and trained healthcare professionals in areas with limited access to maternal health services can help improve access and quality of care.

2. Mobile health (mHealth) interventions: Utilizing mobile technology to provide information, reminders, and support to pregnant women and new mothers can help bridge the gap in accessing maternal health services, especially in remote areas.

3. Community-based interventions: Implementing community-based programs that involve local healthcare workers, traditional birth attendants, and community leaders can help increase awareness, education, and access to maternal health services.

4. Financial incentives: Providing financial incentives, such as cash transfers or vouchers, to pregnant women and their families can help reduce financial barriers and encourage utilization of maternal health services.

5. Transportation support: Addressing transportation challenges by providing affordable and accessible transportation options for pregnant women can help ensure timely access to maternal health services, particularly in rural areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that will be affected by the recommendations, such as pregnant women in a particular region or country.

2. Collect baseline data: Gather data on the current access to maternal health services, including factors such as distance to healthcare facilities, availability of healthcare providers, and utilization rates.

3. Develop a simulation model: Create a mathematical or computational model that incorporates the various factors influencing access to maternal health services, such as healthcare infrastructure, mHealth interventions, community-based programs, financial incentives, and transportation support.

4. Input data and parameters: Input the baseline data and parameters into the simulation model, including information on the target population, the effectiveness of each recommendation, and any assumptions or constraints.

5. Run simulations: Use the simulation model to run multiple scenarios, varying the parameters and assumptions to simulate the impact of different combinations of recommendations on improving access to maternal health.

6. Analyze results: Analyze the simulation results to determine the potential impact of each recommendation and identify the most effective strategies for improving access to maternal health.

7. Validate and refine the model: Validate the simulation model by comparing the simulated results with real-world data, and refine the model based on feedback and additional data.

By using this methodology, policymakers and healthcare providers can gain insights into the potential impact of different innovations and recommendations on improving access to maternal health, helping them make informed decisions and prioritize interventions.

Author

Dima Health

Statistics:

Citations: 23

Identifiers:

DOI: 10.3402/gha.v7.23717

Research Areas:

Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Angola, Botswana, Congo, Eswatini, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Multi-Countries, Namibia, South Africa, Tanzania, Uganda, Zambia, Zimbabwe

Study Design:

Cross Sectional Study

Study Approach:

Qualitative

Participants Gender:

Male & Female