Socioeconomic Barriers Research Articles

Socioeconomic disparities and bariatric surgery outcomes: A qualitative analysis

BackgroundDisparities in socioeconomic status (SES) have been associated with less weight loss after bariatric surgery. The objective of this study was to identify socioeconomic barriers to weight loss after bariatric surgery. MethodsWe performed semi-structured interviews with bariatric surgery patients and providers from April–November 2020. Participants were asked to describe their post-operative experiences regarding dietary habits, physical activity, and follow-up care. Interview data were coded using Directed Content Analysis based on domains in Andersen's Behavioral Model of Health Services Use and Torain's Surgical Disparities Model. Results24 patients (median of 4.1 years post-operatively; mean age 50.6 ± 10.7 years; 12 bypass and 12 sleeve; 83% female) and 21 providers (6 bariatric surgeons, 5 registered dietitians, 4 health psychologists, and 6 primary care providers) were interviewed. Barriers to weight loss included: 1) challenging employment situations; 2) limited income; 3) unreliable transportation; 4) unsafe/inconvenient neighborhoods; and 5) limited health literacy. ConclusionsInterventions targeting socioeconomic barriers to weight loss are needed to support patients, particularly those who are socioeconomically disadvantaged.

Integrating Gestational Diabetes Screening and Care and Type 2 Diabetes Mellitus Prevention After GDM Into Community Based Primary Health Care in South Africa-Mixed Method Study.

Background:Despite high gestational diabetes mellitus (GDM) prevalence in South Africa (9.1% in 2018), its screening and management are not well integrated into routine primary health care and poorly linked to post-GDM prevention of type 2 diabetes mellitus (T2DM) in South Africa’s fragmented health system. This study explored women’s, health care providers’ and experts’ experiences and perspectives on current and potential integration of GDM screening and prevention of T2DM post-GDM within routine, community-based primary health care (PHC) services in South Africa.Methods:This study drew on the Behaviour Change Wheel (BCW) framework and used a mixed method, sequential exploratory design for data collection, analysis and interpretation. Individual semi-structured interviews were conducted with key informants (n = 5) from both national and provincial levels and health care providers (n = 18) in the public health system of the Western Cape Province. Additionally, focus group discussions (FGDs) with Community Health Workers (CHWs n = 15) working with clinics in the Western Cape province. A further four FGDs and brief individual exit interviews were conducted with women with GDM (n = 35) followed-up at a tertiary hospital: Groote Schuur Hospital (GSH). Data collection with women diagnosed and treated for GDM happened between March and August 2018.Thematic analysis was the primary analytical method with some content analysis as appropriate. Statistical analysis of quantitative data from the 35 exit interview questionnaires was conducted, and correlation with qualitative variables assessed using Cramér’s V coefficient.Results:Shortage of trained staff, ill-equipped clinics, socio-economic barriers and lack of knowledge were the major reported barriers to successful integration of GDM screening and postnatal T2DM prevention. Only 43% of women reported receiving advice about all four recommendations to improve GDM and decrease T2DM risk (improve diet, reduce sugar intake, physical exercise and regularly take medication). All participants supported integrating services within routine, community-based PHC to universally screen for GDM and to prevent or delay development of T2DM after GDM.Conclusion:GDM screening and post-GDM prevention of T2DM are poorly integrated into PHC services in South Africa. Integration is desired by stakeholders (patients and providers) and may be feasible if PHC resource, training constraints and women’s socio-economic barriers are addressed.

67 Importance of Animal-Sourced Foods and Barriers to Their Adoption Globally

Abstract Globally, over 200 million children experience physical and mental underdevelopment due to a variety of reasons, particularly inadequate nutrition. In low-and middle-income countries (LMIC), hidden hunger, a condition in which diets are deficient in micronutrients essential for physical and mental development, is a common problem. Compared to plant-source foods, animal-source foods (ASF) contain higher quality and more bioavailable forms of several essential micronutrients as well as essential polyunsaturated fatty acids and higher quality protein. Due to the critical role these macro and micronutrients play in children's cognitive and physical development, ASF should be a vital component of their diets. Studies have demonstrated compelling evidence on the potential of ASF consumption by infants, children, pregnant, and lactating women to aid cognitive development of children. However, the evidence, is not conclusive, as some studies, especially those with confounding factors, showed no positive relationship between ASF consumption and cognitive development. Due to logistical, methodological and ethical difficulties, most studies that examined the effect of ASF on cognitive development are retrospective observational studies that do not enable effective separation of confounding factors. Producing conclusive evidence that can influence nutrition policy and guidelines will require large-scale, controlled interventional studies, preferably across countries or cultures. Unfortunately, per capita consumption of ASF, especially by infants, children, and mothers, in LMIC is very low compared to World Health Organization (WHO) recommendations. This is due to multiple and complex factors. First, there is the issue of unaffordability, which is due to a large extent to the low livestock productivity among smallholders who are the main livestock producers in LMIC. Even when ASF is affordable, there are many socio-economic, cultural, and religious barriers that limit ASF consumption by children and women. To prevent cognitive impairment among children in LMIC, concerted multisectoral approaches are needed. These should aim to improve livestock productivity in LMIC, generate robust policy-influencing evidence about their dietary importance and raise awareness about the value of ASF in the diet.

Beyond Enrolment and Appropriation Politics in Dalit Girls’ Education: Caste and Patriarchy Among Scavenging Communities of Urban Haryana, India

While contemplating on Dalit girls’ education, a large body of research and policy drafts generally draws from the integration of enrolment and appropriation politics (around being a ‘Dalit’ and ‘women’) to explore the educational experiences and challenges of Dalit girls in the Indian education system. However, less attention is given to what lies beyond the enrolment and appropriation politics in Dalit girls’ education. This article is based on an empirical study conducted among households associated with ‘Unclean’ occupations from two urban cities of Haryana. In order to position Dalit girls’ education beyond enrolment and appropriation politics, the article attempts to unmask the ‘multiple patriarchies’ embedded in the socio-economic barriers often pervading Dalit girls in the Indian education system. While doing so, the article demonstrates the inseparable intersectionality of caste and gender, through the workings of external Brahmanical as well as internal Dalit patriarchy simultaneously functioning against Dalit girls’ education. Eventually, the article calls for a need to position Dalit girls’ education in a Dalit feminist standpoint framework.

Perceived Educational Barriers in the New Normal Among Nursing Students

Due to the COVID-19 pandemic, the sudden shift from face-to-face lectures to online learning created barriers to students' learning process. These issues have prompted researchers to explore the perceived educational barriers in the new normal, especially among nursing students. This study aims to identify the perceived educational barriers of the new normal among the 200 nursing students at the University of Bohol. This is a quantitative-descriptive research design aided with a self-constructed questionnaire distributed using the online platform, following the ethical guidelines. The tool was pilot-tested and garnered a Cronbach's result of 0.721, which passes the acceptability standard. The gathered data were subjected statistically. Results have shown that respondents have been moderately affected by personal and technological barriers. Socioeconomic barriers were present but rarely affect the respondents. The study concludes that the demographic profile of 200 nursing students did not fully influence their perceived educational barriers. These perceived barriers only moderately affect the respondents; it reveals that distractions, lag devices due to multitasking, and noisy environments primarily affect the students.

Healthcare Access and Utilization Among Glaucoma Patients in a Nationwide Cohort.

Despite having lower socioeconomic status on several measures, glaucoma patients do not report more barriers to healthcare access and utilization than non-glaucoma patients. To characterize measures of socioeconomic status and barriers to healthcare access and utilization between patients with and without a diagnosis of glaucoma. Patients aged 65 years and over who enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, were extracted. We analyzed demographic information and several measures of socioeconomic status and healthcare access and utilization. Survey responses were compared by glaucoma status (any type) with Pearson χ 2 tests, univariable logistic regression, and multivariable logistic regression adjusting for age, gender, race/ethnicity, and insurance status. Of the 49,487 patients who answered at least 1 question on the All of Us Healthcare Access and Utilization Survey, 4441 (9.0%) had a diagnosis of glaucoma. Majority of the cohort was female (28,162, 56.9%) and nonHispanic White (42,008, 84.9%). Glaucoma patients were observed to have lower rates of education ( P =0.004), employment ( P <0.001), and home ownership ( P <0.001) on χ 2 tests. On multivariable logistic regression models, those with glaucoma were significantly more likely to speak to an eye doctor (Odds ratio: 2.46; 95% confidence interval: 2.16 to 2.81) and significantly less likely to have trouble affording eyeglasses (OR: 0.85 95% CI: 0.72 to 0.99) in the prior year than those without a diagnosis of glaucoma. No significant association was found for other measures of healthcare access and utilization by glaucoma status. Although glaucoma patients aged 65 years and over fared worse on several measures of socioeconomic status, no significant difference was found in measures of healthcare access and utilization.

Examining the relationship between household wealth and colorectal cancer screening behaviors among U.S. men aged 45–75

Colorectal cancer (CRC) is the third leading cause of cancer-related death among men in the United States (U.S.), particularly among men aged 45 years and older. Early-detection screening remains a key method of decreasing CRC-related deaths, yet socioeconomic barriers exist to planning and completing CRC screening. While accumulating evidence shows income disparities in CRC screening prevalence, a dearth of research has investigated wealth disparities. This study aimed to determine whether household wealth was associated with CRC screening uptake and future screening intent. In February 2022, we sent an online survey to potential participants; U.S. men aged 45–75 years were eligible to participate. We examined four CRC screening behaviors as outcomes: ever completing a stool-based or exam-based screening test, current screening status, and future screening intent. Household net wealth, determined by self-reported household wealth and debt, was the primary predictor. We used logistic regression to estimate odds ratios (ORs) and their 95% confidence interval (CI). Of the study participants (N = 499), most self-identified as Non-Hispanic White, were aged 50–64 years, and had previously completed a CRC screening test. Results revealed that, among men aged 45–49 years, higher net wealth decreased the odds of ever completing a stool- or exam-based test (OR = 0.58, 95% CI: 0.33, 0.98; OR = 0.55, 95% CI: 0.31, 0.94, respectively). By contrast, among men aged 50–75 years, higher net wealth increased the odds of being current with CRC screening (OR = 1.40, 95% CI: 1.03, 1.92). Net wealth was unassociated with CRC screening intent. These findings suggest that household net wealth, rather than income, is an important socioeconomic factor to consider in relation to uptake of CRC early-detection screening. The financial and social cognitive mechanisms linking household wealth to CRC screening behaviors merit future research and intervention.

Qualitative and Quantitative Analysis of Pediatric Post Neurosurgical Care in a Lower Middle-Income Country: The Zambian Experience

Pediatric postoperative neurosurgical care is an essential component of a child's treatment pathway. It is important to better understand how neurosurgeons in lower middle-income countries (LMICs) have been able to address socioeconomic and systemic factors to improve their patients' access to quality pediatric postoperative neurosurgical care. We aim to characterize the pediatric neurosurgical postoperative system in place in Zambia and to discuss how these efforts have been implemented to improve outcomes and address socioeconomic barriers to accessing health care. We acquired a patient list of 90 tenants of House of Hope (HOH)-an out-of-hospital center caring for children awaiting surgery, as well as those recovering from surgery. Of the patient list, 44 patients qualified for our study. Survey responses and occurrence of demographic and clinical characteristics were calculated. Non-normally distributed variables (age) were reported by median and interquartile range (IQR). Dichotomous variables were presented as percentages. Fisher's Exact test was applied to compare categorical data and hospital re-admission. A P-value of <0.05 was considered significant. Our study demonstrates two key findings: (1) low 30-day hospital re-admission rate of 9% and (2) favorable postoperative experience by patient families. Of the 44 patients, a majority were 1-year-old children (n= 31, 70%) and female (n= 24, 55%) (IQR 1-2 years). Presenting conditions included: hydrocephalus only (n= 35, 80%), hydrocephalus and myelomeningocele (n= 5, 11%), myelomeningocele only (n= 2, 5%), cerebral palsy (n= 1, 2%), and encephalocele (n= 1, 2%). Half (n= 22, 50%) of the patients lived in east Zambia, 8 (18%) lived in central, 8 (18%) in north, 5 (11%) in south, and 1 (2%) in west Zambia. We report the first qualitative and quantitative analysis of postoperative care for LMIC pediatric neurosurgical patients in the academic literature. Quality, patient-centered postoperative pediatric neurosurgical care that is rooted in addressing socioeconomic determinants of health produces good outcomes in LMICs.

Nativity and perinatal outcome disparities in the United States: Beyond the immigrant paradox

In the United States (US), epidemiologists have long documented paradoxically lower rates of adverse perinatal health outcomes among immigrant birthing people than what might be expected in light of socioeconomic and language barriers to healthcare, especially as compared to their US-born racial and ethnic counterparts. However, researchers have also documented significant variability in this immigrant birth paradox when examining within and across racial and ethnic subgroups. This review paper summarizes fifty years of research regarding differences in low, preterm birth, and infant mortality in the US, according to the nativity status of the birthing person. While there is ample evidence of the importance of nativity in delineating a pregnant person's risk of adverse infant outcomes, this review also highlights the relative paucity of research exploring the intersection of acculturation, ethnic enclaves, and structural segregation. We also provide recommendations for advancing the study of perinatal outcomes among immigrants.

Use of Mobile Apps and Wearables to Monitor Diet, Weight, and Physical Activity: A Cross-Sectional Survey of Adults in Poland.

BackgroundMobile health technologies (mHealth) such as mobile applications (mobile apps), and wearables are gaining popularity. Regular monitoring of public attitudes toward the use of mHealth is crucial to effectively implementing mHealth in healthcare. Therefore, this study aimed to assess the level of use of mobile apps and wearables to monitor diet, weight, and physical activity among adults in Poland and to identify factors associated with the willingness to use new technologies for health monitoring.Material/MethodsThis cross-sectional survey was carried out on a representative sample of 1070 adult inhabitants of Poland, between 1 and 4 July, 2022. A computer-assisted web interview (CAWI) technique was used. The study questionnaire included 20 closed questions on eating habits, lifestyle, and the use of eHealth mobile apps and wearables.ResultsAlmost one-quarter of respondents (23.2%) used wearables (a band or a watch) to monitor physical activity and 14.4% had a smart bathroom scale at home. Among adults in Poland, 16.3% used mobile apps to monitor physical activity and 13.3% used mobile apps to control their diet. Out of 19 different socioeconomic and lifestyle factors analyzed in this study, younger age, healthy diet, regular physical activity, and participation in organized sports activities were significantly associated (P<0.05) with the use of mobile apps and wearables.ConclusionsA lack of socioeconomic barriers to accessing mobile apps and wearables presented in this study suggests that mHealth technology can be used to promote a healthy lifestyle in different socioeconomic groups and can reduce health inequalities.

Digital Divide or Digital Provide? Technology, Time Use, and Learning Loss during COVID-19

COVID-19 school closure has caused a worldwide shift towards technology-aided home schooling. Given widespread poverty in developing countries, this has raised concerns over new forms of learning inequalities. Using nationwide data on primary and secondary school children in slum and rural households in Bangladesh, we examine how learning time at home during the early months of school closure varies by access to technology at home. Data confirms a significant socio-economic and gender divide in access to TV, smartphone, computer, and internet among rural households. However, the analysis of daily time use data shows only a modest return to a technology in terms of boosting learning time at home. The learning-grade gradient is shallow and insensitive to TV, smartphone, and computer access at home. We also find no evidence that technology access per se helps learning by boosting time spent in online schooling and private supplementary coaching/tutoring. While technology access matters in households where parents act as home tutors, the magnitude of such a complementary effect are not large. The results imply a loss of out-of-school learning time during school closure even in households with technology access. We consider additional hypotheses relating to institutional and socio-economic barriers to home-based learning in developing countries.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Exploring financial stress and resource deprivation as barriers to preferred contraceptive use in Wisconsin in 2021

ObjectiveThis study assessed a broad array of socioeconomic barriers in relation to preferred contraceptive use during a time of exacerbated personal and social financial strain (the COVID-19 pandemic). Study DesignUsing statewide data collected in early 2021 through the Survey of the Health of Wisconsin, we conducted bivariate analyses exploring the relationship between socioeconomic resources and preferred contraceptive use among Wisconsin women. ResultsThe survey garnered 1889 responses, with a response rate of 34%. The sample for the current study (N = 247) included only adult women of reproductive age who reported current contraceptive use. Nearly one-third (32.8%) of contraceptive users reported that they were not using their preferred method. We found that greater resource deprivation, including housing instability (had to relocate: p = 0.004; unable to pay rent and/or mortgage: p = 0.008), food insecurity (ran out of food: p = 0.003; worried about running out of food: p = 0.008), and greater financial stress (p < 0.001), were significantly associated with lowered likelihood of using one's preferred contraceptive method. ConclusionsFindings indicated that people lacking socioeconomic resources, including adequate food and housing, may be unable to access their preferred contraceptive method(s). Amidst competing demands on time and resources, the inability to obtain preferred contraceptive method(s) may represent system-wide barriers as well as people's lowered ability to prioritize and access care in light of socioeconomic struggles. ImplicationsHealth care providers and health systems should work to address structural barriers to care and bolster community resources in ways that promote patients’ reproductive autonomy. There is also a need for continued research on specific socioeconomic determinants of preferred contraceptive use and potential solutions that bolster community resources.

How young, disadvantaged fathers are affected by socioeconomic and relational barriers: a UK-based qualitative study

This article is based on the interviews of nine young, socially disadvantaged fathers from the UK. Young fathers are more likely to experience socioeconomic deprivation and disrupted pathways towards parenthood, which affect their participation in socially accepted trajectories of ‘father involvement’. Whilst this has received some attention in research, studies have largely neglected to examine the lived experiences of such fathers directly. The current article aims to address this gap, building upon the limited body of research that exists exploring the impact of socioeconomic and relational barriers on father involvement. In this study, three interrelated themes demonstrate the cyclical nature of generational disadvantage, reduced socioeconomic circumstances and disrupted relationships, providing a different perspective on the decreased levels of involvement exhibited by young fathers in prior research. The findings also enlighten our understanding of how these fathers can be better supported in policy and practice, thereby contributing to current academic debate.

Access to Hematopoietic Stem Cell Transplant in Canada for Patients with Acute Myeloid Leukemia

Hematopoietic stem cell transplant is a complicated intervention only offered in specialized centers. Access to transplants may vary based on the location of primary residence, income levels, age, and reported race or ethnicity. Using data from the Canadian Institute of Health (CIH) Discharge abstract database (DAD), all non-Quebec Canadians under the age of 65 with a diagnosis of AML between 2004 and 2015 were included in this study. Descriptive statistics were produced for the variables of interest: time period, age, sex, rurality, transplant status, proportion of visible minorities, proportion identifying as indigenous, and proportion of low-income families. Transplant rates were compared and reported using univariable and multivariable analysis. In multivariable analysis, time period, province of residence, gender, and age were significantly associated with the receipt of an allogeneic hematopoietic stem cell transplant. However, differences in transplant rates observed in indigenous patients, low-income families, and visible minorities were not found to be statistically significant. In non-Quebec Canada, transplant rates vary significantly with province of residence, with the highest rates recorded in Alberta. Contrary to findings previously reported in studies exploring access to transplant in the United States, a low-income level was not associated with lower rates of transplants. This might suggest that Canada’s universal health care insurance program is protective against socioeconomic barriers that impact access to health care services.

A not so special episode: laughing at abortion on television

ABSTRACT The Supreme Court’s decision to overturn Roe v. Wade has led many states to ban or severely limit abortion access, leaving women seeking reproductive healthcare more vulnerable than they have been in decades, especially marginalized women. Legal restrictions, alongside socioeconomic barriers and cultural stigmas around abortion, are reinforced by media representations that depict abortion as dramatic and solemn, and women who obtain abortions in negative terms. Since 2015, depictions of abortion on television have increased significantly, including on comedic television, which had rarely addressed the topic in years prior. The following article explores how 11 recent comedy television programs have chosen to tell stories about a major character obtaining an abortion and considers what these stories may have to offer in applying comedy to a social issue that has typically been treated with solemnity by the media.

“Why Patients Delay Seeking Dental Treatment - A Survey”?

Introduction: Patients, the world over, neglect their oral health and avoid visiting dentists unless they are faced with severe pain or discomfort. The reasons behind a patient’s procrastination for seeking dental help can be multifactorial and can be narrowed down to a few common fears and beliefs. An early study in the UK inferred that over one-third of dentate adults responded ‘I can’t be bothered really’ as a reason for putting off dental visiting (Todd JE, Walker AM, Dodd P.1978). The present study focuses on analyzing the factors that prevail in governing a patient’s hesitance to seek dental treatment, whether it is their first appointment or a revisit. Materials and Methods: In this study, we are going to use a survey to assess the physical and psychological and socio-economic barriers to oral health care. Methodology: The survey will be made online and distributed over internet websites that people commonly use. The survey will have some trick questions to reduce the number of invalid answers survey Results: The foremost reason why people avoided visiting dentists was that they were too busy. Second most common reason cited was the cost being high. Common beliefs, predominantly amongst female participants, was that dentist don’t listen, try to fool them into certain treatment procedures and demoralize them during visits. Discussion: Within the limitations of this study, we were able to ascertain that the most prevalent reason for avoiding a visit to a dental clinic was the ‘lack of time’ and the second most expressed reason regarded the expense involved. Most of the population examined visited a dentist less than once in two years and it was found that this factor was not governed by education levels or income, where it was seen that amidst our participants even the graduates and the higher income individuals failed to visit a dentist more often. On examining dental and prosthetic statuses, it was seen that most of the patients didn’t have any prostheses in their mouths, yet on checking their dental needs, it was found that they required some form of prosthesis ranging from a single crown to full dental rehabilitation (complete dentures).

The Role of Walkability, Socio-Economic and Parental Cognitive Characteristics in Long Walking Journeys to School

Previous research has identified the socio-economic, built environment, and psychological barriers to children walking to school. Long journeys, however, have been identified as a crucial constraint reducing the likelihood of walking to school. Determining a threshold to distinguish between long and short journeys, the present study sought to examine whether the contribution of the factors reducing walking to school differs between short and long journeys. Questionnaires were distributed among 7 to 12-year-old children in a neighborhood of Tehran ( n = 272) to be completed by parents. In addition, instead of walkability at the neighborhood level that considers walkability within a radial buffer from home or destination, we measured walkability along the school routes. ROC (Receiver Operating Characteristic) curve analysis found a threshold of 12.5 min to differentiate between long and short journeys. Walking journeys longer or shorter than the threshold were classified to be long or short, respectively. We developed two separate models, one to estimate walking for all (including long and short) journeys; and the other for only long journeys. Compared with all journeys, long walking journeys were explained by more built-environment variables. Parental attitudes toward walking were also significant in long walking journeys. However, analysis of interaction effects between walking time to school and the study variables confirmed that among all variables examined, the contribution of only environmental factors of crosswalks, walkways, and physically permeable frontages was significantly different between long and short walking journeys. Policy implications of the findings have been discussed.

Technological, Economic, Social and Environmental Barriers to Adoption of Small-Scale Biogas Plants: Case of Indonesia

By 2025, biogas is estimated to become a larger part of Indonesia’s energy mix. Biogas is a renewable energy source that also has economic and environmental advantages. Domestic biogas generation has been embraced in Indonesia as a response to the country’s energy security concerns in rural areas. Since the 1970s, 48,038 biogas plants have been built in the region. To fully develop this technology, Indonesia must discontinue relying on fossil fuels and substitute current fossil-fuel-based energy. This article provides an overview of renewable technology in Indonesia, as well as addressing domestic energy demands and referring to existing literature on the socio-technical and socio-economic barriers to biogas adoption in Indonesia. Based on a rigorous review of 71 publications published in Web of Science (WoS) between 2010 and 2021, this study explores existing barriers for biogas adoption by summarizing the current literature from technical, economic, social and environmental perspectives. Biogas adoption is a complex process with many interwoven components. Therefore, this research addresses a gap in the strategic planning and implementation process, providing policymakers with pathways to eliminate bottlenecks in renewable energy planning. Recommendations for future research are also proposed.

Assessment of the Impact of Level of Maternal Education on Maternal Deaths in Eastern Region of Ghana; A Human Rights-Based Approach

Objective: The Human Rights-based Aproach to Social Development aims to positively transform power relations among duty bearers and rights holders with particular attention on social, economic, and cultural rights. This study analyzes the impact of formal education, (an inalienable human right progressively predicting better health, longer life and better health services utilization), onmaternal mortality.Methodology: A retrospective descriptive audit of all institutional maternal death records was completed for data abstraction. All records were assessed for consistency with the ICD-10 maternal death case definition. Data were analyzed across documented levels of education with epi info 3.5.1.Results: Mean maternal age was generally higher among women with ≤ JHS level of education. Mean gestational age at death varied insignificantly across all levels of education. Women with JHS level of education accounted for the highest proportion of maternal deaths while deaths among women with ≥ SHS level of education, (i.e. ≥ 12 years of formal education), remained low. Deaths amongwomen with informal occupations decreased with increasing level of education. Maternal deaths among women with ≤ JHS level of education occurred in higher proportions among women with spouses or partners of similar levels of education. Women unexposed to formal education poorly attended ANC, mostly needed blood transfusions and were further largely grand multiparous.Conclusion: All female gender-specific socio-economic, socio-cultural, geographical and religious barriers to accessing ≥ 12 years of formal education should be a research priority and targeted for elimination within the context of the HRBA.