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

Amrita Namasivayam,¹ Donatus C Osuorah,² Rahman Syed,³ Diddy Antai<sup>3,4

1</sup>Department of Public Health, Division of Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden; ²Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria; ³Department of Public Health, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden; ⁴Division of Global Health and Inequalities, The Angels Trust, Abuja, Nigeria

Background: The role of gender inequities in explaining women's access to reproductive health care was examined in four countries (two sub-Saharan African and two South Asian countries). The extent of gender inequities varies across and within countries, and is rooted in the different cultural practices and gender norms within these different countries, and differences in the status and autonomy of women.
Methods: Demographic and Health Survey data from women aged 15–49 years within these countries were analyzed with multivariate logistic regression analysis to examine the role of multidimensional characteristics of gender inequities, operationalized as access to skilled antenatal care, tetanus toxoid injection during pregnancy, and access to skilled antenatal care.
Results: Significant associations were found between several dimensions of gender inequities (with the exception of decision-making autonomy) and reported use of maternal reproductive health care services. Several pathways of influence between the outcome and exposure variables were also identified.
Conclusion: Dimensions of gender inequities (with the exception of decision-making autonomy) differentially influenced woman's use of reproductive health care services, thus highlighting the urgent need for concerted and sustained efforts to change these harmful traditional values if several of these countries are to meet Millennium Development Goal-5.

Keywords: women, gender inequities, reproductive health care, Namibia, Kenya, Nepal, India