Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector Nicole Bergen a , Grace Zhub , Shifera Asfaw Yedenekal c , Abebe Mamoc , Lakew Abebe Gebretsadikc , Sudhakar Morankar c and Ronald Labonté d a Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; b Faculty of Medicine, University of Ottawa, Ottawa, Canada; cDepartment of Health, Behavior & Society, Institute of Health, Jimma University, Jimma, Ethiopia; d School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada 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 semistructured 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. ARTICLE HISTORY Received 12 August 2019 Accepted 29 November 2019 RESPONSIBLE EDITOR Isabel Goicolea, Umeå University, Sweden SPECIAL ISSUE Gender and Health Inequality KEYWORDS Determinant of health; gender barriers; gender equality; gender roles; health equity; safe motherhood; sub-Saharan Africa Background Gender equality, the absence of discrimination on the basis of sex/gender [1], has steadily gained traction as a key determinant of health and a priority for global health and development. Ideally, 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 also shift the distribution of power, wealth, and risk within society to the benefit of disadvantaged groups (Figure 1) [5,6]. The pathways towards such a transition vary considerably (Table 1). While some approaches prioritize alleviating men-women differences in health outcomes or service use [7], others promote women’s health agendas [8], address health workforce disparities [9,10], or redefine gender norms through women’s empowerment [11]. Gender-based assessments and evaluations of programs and policies, and gender mainstreaming efforts [12] – interventions in their own right – remain integral to the advancement of gender equality. Not all approaches yield the same level of reductions in gender health inequalities, or improvements in health equity at a population scale. Assessing their effectiveness requires a grounded understanding of the dynamic conditions in which these approaches are implemented. CONTACT Nicole Bergen Faculty of Health Sciences, University of Ottawa, 600 Peter Morand Cres, Ottawa, ON K1G 5Z3, Canada GLOBAL HEALTH ACTION 2020, VOL. 13, 1704530 © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (