Structural, programmatic, and sociocultural intersectionality of gender influencing access-uptake of reproductive, maternal, and child health services in developing regions of Ethiopia: A qualitative study.

Autor: Kebede Y; Faculty of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia., Teshome F; Faculty of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia., Binu W; School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia., Kebede A; Faculty of Public Health, Department of Epidemiology, Jimma University, Jimma, Ethiopia., Seid A; Department of Nursing, College of Medical and Health Sciences, Samara University, Semera, Ethiopia., Kasaye HK; Institute of Health Science, Wollega University, Nekemte, Ethiopia., Alemayehu YK; Faculty of Public Health, Department of Health policy and management, Jimma University, Jimma, Ethiopia.; MERQ Consultancy PLC, Jimma, Ethiopia., Tekalign W; IntraHealth International Ethiopia, Addis Ababa, Ethiopia., Medhin G; MERQ Consultancy PLC, Jimma, Ethiopia.; Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia., Abera Y; USAID Transform Health in Developing Regions, Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia., Tadesse D; USAID Transform Health in Developing Regions, Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia., Gerbaba MJ; Faculty of Public Health, Department of Epidemiology, Jimma University, Jimma, Ethiopia.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Mar 07; Vol. 18 (3), pp. e0282711. Date of Electronic Publication: 2023 Mar 07 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0282711
Abstrakt: Background: Gender remains a critical social factor in reproductive, maternal, and child health and family planning (RMNCH/FP) care. However, its intersectionality with other social determinants of the RMNCH remains poorly documented. This study aimed to explore the influence of gender intersectionality on the access uptake of RMNCH/FP in Developing Regional States (DRS) in Ethiopia.
Methods: We conducted a qualitative study to explore the intersectionality of gender with other social and structural factors and its influence on RMNCH/FP use in 20 selected districts in four DRS of Ethiopia. We conducted 20 Focus Group Discussions (FGDs) and 32 in-depth and key informant interviews (IDIs/KIIs) among men and women of reproductive age who were purposively selected from communities and organizations in different settings. Audio-recorded data were transcribed verbatim and analyzed thematically.
Findings: Women in the DRS were responsible for the children and families' health care and information, and household chores, whereas men mainly engaged in income generation, decision making, and resource control. Women who were overburdened with household chores were not involved in decision-making, and resource control was less likely to incur transport expenses and use RMNCH/FP services. FP was less utilized than antenatal, child, and delivery services in the DRS,as it was mainly affected by the sociocultural, structural, and programmatic intersectionality of gender. The women-focused RMNCH/FP education initiatives that followed the deployment of female frontline health extension workers (HEWs) created a high demand for FP among women. Nonetheless, the unmet need for FP worsened as a result of the RMNCH/FP initiatives that strategically marginalized men, who often have resource control and decision-making virtues that emanate from the sociocultural, religious, and structural positions they assumed.
Conclusions: Structural, sociocultural, religious, and programmatic intersectionality of gender shaped access to and use of RMNCH/FP services. Men's dominance in resource control and decision-making in sociocultural-religious affairs intersected with their poor engagement in health empowerment initiatives that mainly engaged women set the key barrier to RMNCH/FP uptake. Improved access to and uptake of RMNCH would best result from gender-responsive strategies established through a systemic understanding of intersectional gender inequalities and through increased participation of men in RMNCH programs in the DRS of Ethiopia.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Kebede et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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