Gender relations and the utilization of contraceptives and antenatal care services in Kenya, Namibia and Nigeria

Yemi Adewoyin, Clifford O. Odimegwu

Abstract

The impacts of gender relations (GR) on reproductive health in sub-Saharan Africa (SSA) have received little attention. Virtually non-existent are studies that take cognizance of the socio-cultural diversity of SSA countries in assessing the impacts. Using Demographic and Health Survey data from Namibia, Kenya and Nigeria, this study investigated whether feminine gender relations (FGR) predict higher uptake of contraceptives and antenatal care services (ANC) in SSA. Results from univariate, bivariate and multivariate analyses showed that Namibia had the highest prevalence of FGR (20.0%) and contraceptive use (57.8%) while Nigeria had the lowest FGR (5.7%) but highest ANC utilization (42.1%). At the unadjusted levels, FGR predicted higher contraceptive use in Namibia and Nigeria but became insignificant when sociodemographic confounders were controlled for. Masculine gender relations (MGR) however predicted increased contraceptive and ANC utilization in the three countries at the unadjusted levels and contraceptive use in Kenya and Nigeria when adjusted. That MGR predicted higher odds of using contraceptives in a largely gender egalitarian Kenya and patriarchal Nigeria while FGR was insignificant even in the largely feministic Namibia, suggests that promoting equality in GR, rather than emphasizing female autonomy, possesses greater capacity for improving reproductive health outcomes in SSA. (Afr J Reprod Health 2022; 26[11]: 140-152).

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References

World Health Organization. Reproductive Health Fact Sheets. Geneva, World Health Organization; 2019. Available from: www.who.int/reproductivehealth/en.

UNICEF. Child Mortality. United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). 2019. https://data.unicef.org/topic/child-survival/under-five-mortality/

World Health Organization. Newborns: Reducing Mortality. Geneva, World Health Organization; 2019. Available from: www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality

United Nations, Department of Economic and Social Affairs, Population Division. Contraceptive Use by Method 2019: Data Booklet (ST/ESA/SER.A/435). 2019

Ganatra B, Gerdts C, Rossier C, Johnson BR, Tuncalp O, Assifi A, Sedgh G, Singh S, Bankole A, Popinchalk A, Bearak J, Kang Z and Alkema L. Global, Regional, and Sub-Regional Classification of Abortions by Safety, 2010-2014: Estimates from a Bayesian Hierarchical Model. The Lancet, 2017;390(10110): 2372-2381

UNICEF. Antenatal Care. Maternal Health. 2019. Available at https://data.unicef.org/topic/maternal-health/antenatal-care/

United Nations, Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2020 (POP/DB/CP/Rev2020). 2020

Do M and Kurimoto N. Women’s Empowerment and Choice of Contraceptive Methods in Selected African Countries. International Perspective on Sexual and Reproductive Health, 2021;38(1): 23-33

Adedini SA, Somefun OD and Odimegwu C. Gender Inequality and Maternal and Child Healthcare Utilization in Sub-Saharan Africa. Gender and Behaviour, 2014;12(4): 6050-6070

Jennings L, Na M, Cherewick M, Hindin M, Mullany B and Ahmed S. Women’s Empowerment and Male Involvement in Antenatal Care: Analyses of Demographic and Health Surveys (DHS) in Selected African Countries. BMC Pregnancy and Childbirth, 2014:297

Odimegwu C and Adedini S. Gender Equity and Fertility Intention in Selected Sub-Saharan African Countries. Gender and Behaviour, 2014;12(4): 5858-5881

Singh K, Bloom S and Brodish P. Gender Equality as a Means to Improve Maternal and Child Health in Africa. Health Care Women International, 2015; 36(1): 57–69.

Yaya S, Uthman OA, Ekholuenetale M and Bishwajit G. Women Empowerment as an Enabling Factor of Contraceptive Use in Sub-Saharan Africa: A Multi-Level Analysis of Cross-Sectional Surveys of 32 Countries. BMC Reproductive Health. 2018; 15:24

March C, Smyth IA and Mukhopadhyay M. A Guide to Gender Analysis Frameworks. Oxford: Oxfam. 1999

Pan American Health Organization. Gender Equality in Health: Improving Equality & Efficiency in Achieving Health for All. 2009

United Nations Population Fund (UNFPA). Gender at the heart of ICPD. The UNFPA strategic framework on gender mainstreaming and women’s empowerment. New York: UNFPA; 2011

Odimegwu CO and Adewoyin Y. Latent and Under-Explored Determinants of Contraceptive Use in Nigeria. Sexuality Research and Social Policy, 2020; doi.org/10.1007/s13178- 020-00495-1

Williamson LM, Parkes A, Wight D, Petticrew M and Hart GJ. Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reprod Health 2009; 6: 3

Haider TL and Sharma M. Barriers to family planning and contraception uptake in sub-Saharan Africa: a systematic review. International Quarterly of Community Health Education, 2012;33(4): 403–413

Blackstone SR, Nwaozuru U and Iwelunmor J. Factors Influencing Contraceptive Use in Sub-Saharan Africa: A Systematic Review. International Quarterly of Community Health Education, 2017;37(2): 79-91

Odimegwu C, Akinyemi J, Banjo OO, Olamijuwon E and Amoo E. Fertility, Family Size Preference and Contraceptive Use in Sub-Saharan Africa: 1990-2014. African Journal of Reproductive Health, 2018; 22(4):44-53

Okedo-Alex IN, Akamike IC, Ezeanosike OB and Uneke CJ. Determinants of Antenatal Care Utilisation in Sub-Saharan Africa: a Systematic Review. BMJ Open, 2019;9: e031890. doi:10.1136/ bmjopen-2019-031890. 1-14

Kyei-Nimakoh M, Carolan-Olah M and McCann TV. Access Barriers to Obstetric Care at Health Facilities in Sub-Saharan Africa - A Systematic Review. Systematic Reviews, 2017;6:110 DOI 10.1186/s13643-017-0503-x. 1-16

Finlayson K and Downe S. Why do Women not use Antenatal Services in Low-and-Middle-Income Countries? A Metasynthesis of Qualitative Studies. PLoS Med. 2013;10:e1001373

Ononokpono DN, Odimegwu CO, Imasiku ENS and Adedini SA. Contextual Determinants of Maternal Health Care Service Utilization in Nigeria. Women and Health, 2013;53(7): 647-668

Simkhada B, Teijlingen ER, Porter M and Simkhada P. Factors Affecting the Utilization of Antenatal Care in Developing Countries: Systematic Review of the Literature. J Adv Nurs, 2007;6: 244–60

Say L and Raine RA. A Systematic Review of Inequalities in the Use of Maternal Health Care in Developing Countries: Examining the Scale of the Problem and the Importance of Context. Bull World Health Organ, 2007;85:812–9

Adewoyin Y. Maternal Healthcare, Place Differentials and Regional Planning in Africa. In Adewoyin Y, Adeagbo A, Ogunkan D and Chakwizira J. (eds). Contemporary Issues in Urban and Regional Planning and Development in Africa: A Festschrift in Honour of Professor Aina Thompson Adeboyejo. PP 64-76. Ibadan: Ladoke Akintola University of Technology. 2020

Rossier C, Muindi K, Soura A, Mberu B, Lankoande B, Kabiru C and Millogo R. Maternal health care utilization in Nairobi and Ouagadougou: evidence from HDSS. Global Health Action, 2014;7: 24351

Manzi A, Munyaneza F, Mujawase F, Banamwana L, Sayinzoga F, Thompson DR, Ntaganira J and Hedt-Gauthier B. Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010. BMC Pregnancy Childbirth, 2014;14:290

Gudayu TW. Proportion and factors associated with late antenatal care Booking among pregnant mothers in Gondar town, North West Ethiopia. Afr J Reprod Health, 2015;19: 94–100.

Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan JA, Stevenson R, Brandes N and Baqui AH. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS One, 2015;9:e101893

Browne JL, Kayode GA, Arhinful D, Fidder SAJ, Grobbee DE and Klipstein-Grobusch K. Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana demographic and health surveillance data. BMJ Open, 2016;6:e008175

Manthalu G, Yi D, Farrar S and Nkhoma D. The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi. Health Policy Plan, 2016;31:1184–92

Straneo M, Fogliati P, Pellis I, Goodman C, Riva DD, Kisika F, Mpuya E and Putoto G. On the way to universal coverage of maternal services in Iringa rural district in Tanzania. who is yet to be reached? Afr Health Sci, 2016;16: 420–8

Assefa E and Tadesse M. Factors related to the use of antenatal care services in Ethiopia: application of the zero-inflated negative binomial model. Women Health, 2017;57:804–21

Gebre E, Worku A and Bukola F. Inequities in Maternal Health Services Utilization in Ethiopia 2000-2016: Magnitude, Trends, and Determinants. Reprod Health, 2018;15:119

World Economic Forum. Global Gender Gap Report 2020. WEF, Geneva. 2020

Equal Measures 2030. Harnessing the Power of Data for Gender Equality - Introducing the 2019 EM2030 SDG Gender Index. Equal Measures 2030, Surrey, United Kingdom. 2019.

Pratley P. Associations between Quantitative Measures of Women’s Empowerment and Access to Care and Health Status for Mothers and Their Children: A Systematic Review of Evidence from the Developing World. Soc Science and Medicine, 2016;169:119-131

Hou X and Ma N. The effect of women’s decision-making power on maternal health services uptake: Evidence from Pakistan. Health Policy and Planning, 2013;28 (2):176–84. doi:10.1093/ heapol/czs042

Sado L, Spaho A and Hotchkiss DR. The Influence of Women’s Empowerment on Maternal Health Care Utilization: Evidence from Albania. Social Science & Medicine, 2014;114:169-177

Adhikari R. Effect of Women’s Autonomy on Maternal Health Service Utilization in Nepal: A Cross Sectional Study. BMC Women’s Health, 2016;16(1):26

Osamor PE and Grady C. Women’s Autonomy in Health Care Decision-Making in Developing Countries: A Synthesis of the Literature. International Journal of Women’s Health, 2016;8:191-202

Sebayang SK, Efendi F and Astutik E. Women’s Empowerment and the Use of Antenatal Care Services in Southeast Asian Countries. DHS Working Paper No. 129. Rockville, Maryland, USA: ICF. 2017

Bentley R and Kavanagh AM. Gender equity and women’s contraception use. Australian Journal of Social Issues, 2008;43(1): 65-80

Fikre AA and Demissie M. Prevalence of institutional delivery and associated factors in Dodota Woreda (district), Oromia regional state, Ethiopia. Reproductive Health, 2012;9, 33

Islam MA, Islam MR and Banowary B. Sex Preference as a Determinant of Contraceptive use in Matrilineal Societies: a Study on the Garo of Bangladesh. European Journal of Contraception and Reproductive Health Care, 2009;14(4):301-6

Fapohunda BM and Orobaton NG. When women deliver with no one present in Nigeria. Who, what, where and so what? PLOS ONE 2013;8(7).

Dahiru T and Oche OM. Determinants of antenatal care, institutional delivery and post-natal care service utilization in Nigeria. Pan African Medical Journal, 2015;21;301

Channon MD. Son Preference, Parity Progression and Contraceptive Use in South Asia. Population Horizons, 2015;12(1): 24–36.

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