Abstract
ABSTRACT Background: Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. While gender is regarded as an important determinant of health, there is a paucity of literature that considers the interface between how these two priorities are pursued. Objective: This article explores how government stakeholders understand gender issues (gender barriers and roles) in the promotion of maternal, newborn and child health equity in Ethiopia. Methods: Adopting an exploratory qualitative case study design, we conducted semi-structured interviews with 17 purposively-selected stakeholders working in leadership positions with the Federal Ministry of Health and Federal Ministry of Women and Children Affairs as part of a larger study regarding the promotion of health equity in maternal, newborn and child health. A post hoc content and thematic sub-analysis was done to explore how participants raised gender issues in conversations about health equity. Results: Efforts to address gender inequalities were synonymous with the promotion of a women’s health agenda, which was largely oriented towards promoting health service use. Men were predominant decision makers with regards to women’s health and health care seeking in both public and private spheres. Participants reported persisting gender-related barriers to health stemming from traditional gender roles, and noted the increased inclusion of women in the health workforce since the introduction of the Health Extension Program. Conclusions: The framing of gender as a women’s health issue, advanced through patriarchal structures, does little to elevate the status of women, or promote power differentials that contribute to health inequity. Encouraging leadership roles for women as health decision makers and redressing certain gender-based norms, attitudes, practices and discrimination are possible ways forward in re-orienting gender equality efforts to align with the promotion of health equity.
Highlights
Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector
Drawing from qualitative data gathered from public servants working at national and subnational levels, we identify key themes related to how gender inequality is understood and confronted in the promotion of health equity within the country’s program to improve MNCH
While the first theme addresses the question of how participants understand the relationship between gender and health, the three other themes address the question of how participants understand gender equality issues in the context of promoting equity in MNCH
Summary
Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. Addressing gender inequalities in health should align with and advance broader agendas to promote health equity – defined as the absence of avoidable, unfair, or remediable differences in health among subgroups of a population [2,3] – across multiple determinants of health, given that gender intersects with other determinants such as race/ethnicity, income, education, and social class [4] In this regard, addressing the causes and consequences of gender inequalities can shift the distribution of power, wealth, and risk within society to the benefit of disadvantaged groups (Figure 1) [5,6]. Assessing their effectiveness requires a grounded understanding of the dynamic conditions in which these approaches are implemented
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