Gender dynamics affecting maternal health and health care access and use in Uganda

Rosemary Morgan, Moses Tetui, Rornald Muhumuza Kananura, Elizabeth Ekirapa-Kiracho, A. S. George

Research output: Contribution to journalArticle

Abstract

Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term.

Original languageEnglish (US)
Pages (from-to)v13-v21
JournalHealth Policy and Planning
Volume32
Issue number5
DOIs
StatePublished - Dec 1 2017

Fingerprint

Uganda
Delivery of Health Care
Patient Acceptance of Health Care
Attitude to Health
Pregnancy
Health Services Accessibility
Domestic Violence
Maternal Health
Maternal Mortality
Health Facilities
Interpersonal Relations
Workload
Pregnant Women
Decision Making
Mortality

Keywords

  • Gender
  • gender analysis
  • health systems
  • maternal health
  • Uganda

ASJC Scopus subject areas

  • Health Policy

Cite this

Gender dynamics affecting maternal health and health care access and use in Uganda. / Morgan, Rosemary; Tetui, Moses; Muhumuza Kananura, Rornald; Ekirapa-Kiracho, Elizabeth; George, A. S.

In: Health Policy and Planning, Vol. 32, No. 5, 01.12.2017, p. v13-v21.

Research output: Contribution to journalArticle

Morgan, R, Tetui, M, Muhumuza Kananura, R, Ekirapa-Kiracho, E & George, AS 2017, 'Gender dynamics affecting maternal health and health care access and use in Uganda', Health Policy and Planning, vol. 32, no. 5, pp. v13-v21. https://doi.org/10.1093/heapol/czx011
Morgan, Rosemary ; Tetui, Moses ; Muhumuza Kananura, Rornald ; Ekirapa-Kiracho, Elizabeth ; George, A. S. / Gender dynamics affecting maternal health and health care access and use in Uganda. In: Health Policy and Planning. 2017 ; Vol. 32, No. 5. pp. v13-v21.
@article{88ca2394cb5541999918e7879cf8da57,
title = "Gender dynamics affecting maternal health and health care access and use in Uganda",
abstract = "Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term.",
keywords = "Gender, gender analysis, health systems, maternal health, Uganda",
author = "Rosemary Morgan and Moses Tetui and {Muhumuza Kananura}, Rornald and Elizabeth Ekirapa-Kiracho and George, {A. S.}",
year = "2017",
month = "12",
day = "1",
doi = "10.1093/heapol/czx011",
language = "English (US)",
volume = "32",
pages = "v13--v21",
journal = "Health Policy and Planning",
issn = "0268-1080",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Gender dynamics affecting maternal health and health care access and use in Uganda

AU - Morgan, Rosemary

AU - Tetui, Moses

AU - Muhumuza Kananura, Rornald

AU - Ekirapa-Kiracho, Elizabeth

AU - George, A. S.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term.

AB - Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term.

KW - Gender

KW - gender analysis

KW - health systems

KW - maternal health

KW - Uganda

UR - http://www.scopus.com/inward/record.url?scp=85049631077&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049631077&partnerID=8YFLogxK

U2 - 10.1093/heapol/czx011

DO - 10.1093/heapol/czx011

M3 - Article

C2 - 29244103

AN - SCOPUS:85049631077

VL - 32

SP - v13-v21

JO - Health Policy and Planning

JF - Health Policy and Planning

SN - 0268-1080

IS - 5

ER -