The role of gender power relations on women’s health outcomes in Tanzania: evidence from a maternal health coverage survey in Simiyu, Tanzania

Authors

Serafina Mkuwa
AMREF Health Africa, Tanzania, Ali Hassan Mwinyi Road, Plot No. 1019, P.O Box 2773, Dar es Salaam
Aisa Muya
Amref Health Africa in Tanzania
Florence Temu
Amref Health Africa, Tanzania, Ali Hassan Mwinyi Road, Plot No. 1019, P.O Box 2773, Dar es Salaam
Henri Garrison-Desany
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
Emily Wilson
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
Melinda Munos
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
Maiga Abdouulaye
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
Talata Sawadogo-Lewis
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA
Rosemary Morgan
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD, 21205, USA

Synopsis

Background: Gender is an important element that impacts a large number of priority health outcomes. However, it is often reported in relation to sex-disaggregated data in health surveys, including coverage surveys. Few studies to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries which have high levels of reported gender inequality.

Objective: Using a variety of indicators to denote gender, we investigate the role of gender power relations within households on women’s health outcomes in Tanzania.

Methods: We assessed 34 questions around gender dynamics reported by men and women against 18 health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, results, and socio-demographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women's decision-making, (2) household labor-sharing, (3) women's resource access, and (4) norms/beliefs. We generated descriptive statistics of sex-specific gender responses to and within-household agreement on gender questions against health outcomes. Gender indicators considered most proximate to the health outcome via DAG were tested via logistic regression.

Results: The overall percent agreement within couples was 68.6%. Decision-making was found to have a significant role in women's health outcomes.  The lowest couple concordance was whether women decide to see family/friends (40.1%). Condoms and contraceptive outcomes had the most robust relationships to gender indicators. Women who reported being able to make their own health decisions had 1.57 odds (95% CI: 1.12, 2.20) of using condoms. Women who said they should decide the number of children reported high contraception use (OR: 1.79, 95% CI: 1.34, 2.39). Seeking care at the health facility was also associated with women making major household purchases (OR: 1.35, 95% CI: 1.13, 1.62).

Conclusions: The association between decision-making and other gender domains with women's health outcomes highlights the need for providing more attention to gender dimensions for intervention coverage. Future studies should integrate and/or analyze gender-sensitive questions within all surveys.

THS2020
Published
July 24, 2021