Abstract
Women's autonomy and empowerment in their homes, communities, and societies at large have been shown, through many direct and indirect pathways, to be associated with maternal and infant health. A novel global measure—the Women, Peace, and Security (WPS) Index—that bridges insights from gender and development indices with those from peace and security has recently been developed to capture the constructs of women's inclusion, justice, and security, using indicators and targets in the Sustainable Development Goals. This paper adds to the growing literature about the importance of gender inequality to key mortality outcomes for women and children by investigating the associations between nations' WPS Index scores and maternal mortality ratios and infant mortality rates. We use a range of international databases to obtain country-level data from 144 nations on health, demographic, income, and gender equality indicators. The aim is to highlight the role of women's inclusion, justice, and security in explaining national rates of maternal and infant mortality. Fully adjusted Poisson regression models indicate that a one point (0.01) increase on the WPS Index score is associated with a 2.0% reduction in the number of maternal deaths and a 2.3% reduction in the number of infant deaths. For a country such as Sierra Leone, with a maternal mortality ratio of 1360 maternal deaths per 100,000 live births, a one point improvement in the WPS Index would correspond to a maternal mortality ratio of 1,332, or 28 fewer deaths per 100,000 births. These associations are ecological and apply to the average level of mortality at the country level rather than the likelihood or risk faced at the individual level. Although we cannot claim causality for the observed relations in the cross-country regressions, the findings and recurring patterns are both suggestive and encouraging about the potential contributions of women's inclusion, justice, and security to maternal and infant mortality.
Highlights
Global trends in key health outcomes over recent decades are encouraging, there is growing recognition of the deep-seated struc tural barriers to their improvement, including in gender inequality
This paper focuses on two key health outcomes used to measure progress against Sus tainable Development Goals (SDGs) 3—maternal mortality ratio (MMR) and infant mortality rate (IMR)
We find that when included in models separately, the incidence rate ratio (IRR) for the WPS Index exceed those for log gross domestic product (GDP) per capita
Summary
Global trends in key health outcomes over recent decades are encouraging, there is growing recognition of the deep-seated struc tural barriers to their improvement, including in gender inequality. The targets to reduce maternal and infant mortality and the goal to achieve gender equality and empower all women and girls provide further impetus to investigate the connections between these important agendas. This paper focuses on two key health outcomes used to measure progress against SDG 3—maternal mortality ratio (MMR) and infant mortality rate (IMR). These health metrics are widely used as measures of country progress and are important indicators of population health and socioeconomic development generally (Gruber, Hendren, & Town send, 2014, Reidpath & Allotey, 2003). Infant mortality has been declining, but still totaled 4.2 million infant deaths in 2016 (WHO, 2018a)
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