Gender dynamics affecting maternal health services and care

• Maternal health interventions have been successful in increasing access to and utilization of maternal health services, however, failure to address underlying gender dynamics limits the sustainability of benefits generated.
• Gender power relations can be understood by how power is constituted and negotiated to: access to resources, division of labour, social norms, and decision-making, the intersection of which was found to affect maternal healthcare access and utilization.
• In order to address gendered inequities affecting women’s lack of maternal health care access and utilization, interventions are needed that challenge unequal gender roles and relations that perpetuate inequities in maternal health access and utilization.

Research has shown that gender inequities have a negative effect on maternal health and maternal healthcare access and utilization in multiple ways. On the demand side, gender divisions of labour, lack of access to and control over resources (e.g. finances, information, transport, supplies), gender norms, limited autonomy, and lack of decision-making power limit women’s ability to access maternal health care services. On the supply side, societal patterns of gender discrimination are often reflected within maternal health service delivery. For example, the lack of ‘women-centred’ services, such as family planning or abortion, maternal health services being treated as ‘women-only’ spaces, and the mistreatment of women and men by health providers are all manifestations of gender discrimination. In addition, the intersection of gender with other social stratifiers, such as age, race, class, ethnicity, geography, (dis)ability and sexuality compounds the effect of gender inequities on maternal health and health care for vulnerable and marginalized women, such as poor women in rural areas. Finally, men affect women’s access to prenatal care and women’s obstetric outcomes in their roles as partners, neighbours, community leaders, and health providers due to their control over household resources and decision-making. However, progress towards engaging men in maternal and child health has been slow, despite their key decision-making roles in maternal and newborn care-seeking behaviour and family planning.

Integrating gender into maternal and child health interventions has been found to positively affect intervention outcomes. A review of gender-integrated interventions in reproductive and maternal-child health, for example, found that while the effects of integrating gender into interventions were mixed, overall the studies suggested that addressing social and structural factors within maternal and child health interventions, such as gender norms and inequalities, is beneficial for effective intervention outcomes. In particular, out of 23 interventions, those which incorporated empowerment approaches, for example, by "empower[ing] women to take actions to address health issues, […] empower[ing] adolescents and their families and chang[ing] community norms around child marriage", had the strongest evidence in support of integrating gender into maternal and child health interventions.

While maternal health interventions have been successful in increasing access to and utilization of maternal health services, failure to address underlying gender dynamics limits the sustainability of benefits generated. More needs to be done if the root causes of barriers to maternal health access and utilization are to be effectively addressed. The community discussions reveal important gender dynamics affecting maternal health access and utilization. These have laid the foundation for future interventions to address gendered power relations within intervention design, implementation, and evaluation. Gender aware interventions, particularly those which are gender transformative, are needed if access to and use of maternal health care is to be improved in the long-term.