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. 2021 May 13;21(1):909.
doi: 10.1186/s12889-021-10972-w.

The role of gender power relations on women's health outcomes: evidence from a maternal health coverage survey in Simiyu region, Tanzania

Henri M Garrison-Desany  1 , Emily Wilson  2 , Melinda Munos  2 , Talata Sawadogo-Lewis  2 , Abdoulaye Maïga  2 , Onome Ako  3 , Serafina Mkuwa  4 , Amy J Hobbs  2 , Rosemary Morgan  2
Affiliations

The role of gender power relations on women's health outcomes: evidence from a maternal health coverage survey in Simiyu region, Tanzania

Henri M Garrison-Desany et al. BMC Public Health. .

Abstract

Background: Gender is a crucial consideration of human rights that impacts many priority maternal health outcomes. However, gender is often only reported in relation to sex-disaggregated data in health coverage surveys. Few coverage surveys to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries that have high levels of reported gender inequality. Using various gender-sensitive indicators, we investigated the role of gender power relations within households on women's health outcomes in Simiyu region, Tanzania.

Methods: We assessed 34 questions around gender dynamics reported by men and women against 18 women's health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, outcomes, and sociodemographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women's decision-making, (2) household labor-sharing, (3) women's resource access, and (4) norms/beliefs. Gender indicators that were most proximate to the health outcomes in the DAG were tested using multivariate logistic regression, adjusting for sociodemographic factors.

Results: The overall percent agreement of gender-related indicators within couples was 68.6%. The lowest couple concordance was a woman's autonomy to decide to see family/friends without permission from her husband/partner (40.1%). A number of relationships between gender-related indicators and health outcomes emerged: questions from the decision-making domain were found to play a large role in women's health outcomes, and condoms and contraceptive outcomes had the most robust relationship with gender indicators. Women who reported being able to make their own health decisions were 1.57 times (95% CI: 1.12, 2.20) more likely to use condoms. Women who reported that they decide how many children they had also reported high contraception use (OR: 1.79, 95% CI: 1.34, 2.39). Seeking care at the health facility was also associated with women's autonomy for making major household purchases (OR: 1.35, 95% CI: 1.13, 1.62).

Conclusions: The association between decision-making and other gender domains with women's health outcomes highlights the need for heightened attention to gender dimensions of intervention coverage in maternal health. Future studies should integrate and analyze gender-sensitive questions within coverage surveys.

Keywords: Coverage surveys; Gender; Gender analysis; Tanzania; Women’s health.

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Conflict of interest statement

The authors declare no competing financial or non-financial interests.

Figures

Fig. 1
Fig. 1
Conceptual framework with directed acyclic graph notation of gender indicator variables and their associations between one another and with health outcomes
Fig. 2
Fig. 2
Conceptual framework of social power and equality in relationships and the impact of concordance or discordance in the relationship on health outcomes. Note: “Women +” refers to women’s endorsement of these gender variables as measured in our survey, while “Women -” refers to lack of endorsement. Similarly, “Men +” refers to men’s endorsement while “Men -” refers to their lack of endorsement of gender power dynamic variables. We hypothesize that men carry more social power in patriarchal societies than women, and that endorsing positive gender variables relates to greater equality within the relationship/marriage. We highlight here that it is the overlap and lack thereof of their gender variable endorsement (concordance or discordance of responses) that is of interest in this analysis of health outcomes
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References

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