Gender inequities in women's access to maternal health care utilisation in Zambia: a qualitative analysis.

BACKGROUND: The role of gender inequities in women's ability to access maternal health care has mainly been analysed from either women's or men's perspective only. In this article, we explore the role of gender inequities in maternal health care utilisation from both men's and women's perspectives. METHODS: Thirty-six interviews were conducted with reproductive age women (n = 24), and men whose wives/partners gave birth within the last three years prior to our study in Zambia (n = 12). Our study sought to improve understanding of the normative environment in which women and men make decisions on maternal health care utilisation in Zambia. RESULTS: We found that men and women had different expectations regarding their gender roles in maternal health care utilisation, which created inequities reinforced by societal norms and traditions. Men make most household decisions including those related to reproductive health and they often have the major say in access to maternal health services despite not having holistic maternal health information which creates challenges in maternal health care utilisation. CONCLUSION: The study highlights the need for maternal health care utilisation decisions to be made by both men and women and that men should be fully involved in maternal health care from pregnancy until after child birth. Further, there is urgent need for concerted and sustained efforts to change traditional norms that reinforce these inequities and affect maternal health care utilisation if Zambia is to meet Sustainable Development Goal-3.1.

Variations in sex ratios estimated from census and survey data in Zambia, 1969-2014.

The sex ratio question has been an area of growing interest in population dynamics, especially in developing countries with respect to the issue of missing women, but few studies have examined this in sub-Saharan Africa. Both at birth and in the general population, sex ratios follow an expected demographic pattern in the absence of the interference of historical events affecting either males or females in a population. In Zambia, an unexpected demographic pattern of sex ratios is exhibited in census and survey data. This study used data from censuses and surveys conducted from 1969 to 2014 to examine variations in sex ratios in the Zambian population. It was found that sex ratio imbalances were largely due to data deficiencies due to age misreporting and under-enumeration. A consistent under-enumeration of young adult males in the 20-34 years age group was found. A systematic pattern of high sex ratios, above 100, for ages 40+ was found, represented by synthetic cohorts traceable from the 1969 census, progressing to the 2000 census and phased out in the 2010 census. Extremely high adult male mortality was found in 2010 in the 35-59 years age group, primarily attributable to HIV/AIDS. Understanding the demographic pattern of sex ratios in a population is relevant for policies to improve the quality of data collection systems, and socioeconomic development planning, for the young age group population, which is prone under-enumeration.