The gender gap and healthcare: associations between gender roles and factors affecting healthcare access in Central Malawi, June–August 2017

Archives of Public Health

Amee D. Azad¹  Sherry M. Wren²  Qian Ding³  Amber W. Trickey³  Anthony G. Charles⁴ 

[1] Stanford University School of Medicine, 291 Campus Drive, 94305, Stanford, CA, USA;Stanford University School of Medicine, 291 Campus Drive, 94305, Stanford, CA, USA;Palo Alto Veterans Healthcare System, Palo Alto, CA, USA;Stanford-Surgery Policy Improvement Research & Education Center, Stanford, CA, USA;University of North Carolina Department of Surgery, Chapel Hill, NC, USA;

关键词: Gender;    Inequality;    Disparity;    Gender role;    Access;    Healthcare;    Empowerment;   

DOI  :  10.1186/s13690-020-00497-w

来源: Springer

【 摘 要 】

BackgroundWomen in low and middle-income countries (LMICs) do not have equal access to resources, such as education, employment, or healthcare compared to men. We sought to explore health disparities and associations between gender prioritization, sociocultural factors, and household decision-making in Central Malawi.MethodsFrom June–August 2017, a cross-sectional study with 200 participants was conducted in Central Malawi. We evaluated respondents’ access to care, prioritization within households, decision-making power, and gender equity which was measured using the Gender-Equitable Men (GEM) scale. Relationships between these outcomes and sociodemographic factors were analyzed using multivariable mixed-effect logistic regression.ResultsWe found that women were less likely than men to secure community-sourced healthcare financial aid (68.6% vs. 88.8%, p < 0.001) and more likely to underutilize necessary healthcare (37.2% vs. 22.4%, p = 0.02). Both men and women revealed low GEM scores, indicating adherence to traditional gender norms, though women were significantly less equitable (W:16.77 vs. M:17.65, p = 0.03). Being a woman (Odds Ratio (OR) 0.41, 95% confidence interval (CI) 0.21–0.78) and prioritizing a woman as a decision-maker for large purchases (OR 0.38, CI 0.15–0.93) were independently associated with a lower likelihood of prioritizing women for medical treatment and being a member of the Chewa tribal group (OR 3.87, CI 1.83–8.18) and prioritizing women for education (OR 4.13, CI 2.13–8.01) was associated with a higher odds.ConclusionWomen report greater barriers to healthcare and adhere to more traditional gender roles than men in this Central Malawian population. Women contribute to their own gender’s barriers to care and economic empowerment alone is not enough to correct for these socially constructed roles. We found that education and matriarchal societies may protect against gender disparities. Overall, internal and external gender discrimination contribute to a woman’s disproportionate lack of access to care.

【 授权许可】

CC BY