Decomposing gender inequalities in self-assessed health status in Liberia

ABSTRACT

Background: Understanding the magnitude of inequalities and drivers for reducing gender-related health inequalities is crucial in developing countries. This is particularly the case for Liberia with its very high level of gender-related inequalities in health and health outcomes.

Objective: This paper assesses the magnitude of gender health inequalities and the relative contribution of different factors to health inequality in Liberia.

Methods: Data came from the Liberian Household Income Expenditure Survey 2014. A two stage sampling methodology was used and 4,104 households were randomly selected and interviewed. The main variable of interest is dichotomised, good versus poor self-assessed health. Gender-related health inequality is assessed using the Oaxaca–Blinder decomposition for non-linear models. The decomposition reveals the magnitude of inequality and contributions of different factors.

Results: We found large gender disparities (0.054, p < 0.01) characterised by women disadvantages in health status. In addition, the gender health disparities are mostly pronounced in rural areas. About 54% of the gender inequalities in health status were explained by the differences in endowments. Equalizing access to information, wealth and utilization of mosquito nets would reduce the gender gaps by 44, 5 and 4%, respectively.

Conclusions: Addressing gender health inequalities inter alia requires access to health information (i.e. electronic and print media), gender responsive interventions that improve wealth in key sectors (i.e. education, employment, social protection, housing, and other appropriate infrastructure). In addition, the government, private sector and civil society should ensure that the health sector provides access to quality mosquito nets and improved health services including preventive care in order to reduce disease burden.

SPECIAL ISSUE:

• Gender and Health Inequality

KEYWORDS:

• Gender inequality
• health
• non-linear
• decomposition
• Liberia

Responsible Editor

Isabel Goicolea, Umeå University, Sweden

Responsible Editor

Isabel Goicolea, Umeå University, Sweden

Acknowledgments

We thank anonymous referees for useful comments as well as the World Bank for making the Liberia Household Income and Expenditure Survey 2014-2015 data available.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The data used for this paper is based on a publicly available data set. The data are publicly available with all identifier information removed. The data were collected after the appropriate ethical approvals had been granted, and there was no special ethical issue to address. However, permission to use the data set was obtained from World Bank.

Funding information

No funding bodies had any role in the decision to publish, or preparation of the manuscript. Any opinion, finding and conclusion or recommendation expressed in this material is that of the author(s) and the institutions responsible for research design and data access do not accept any liability in this regard.

Paper context

While many studies have documented the gender disparities in health, few have evaluated the magnitude and drivers of gender inequalities. This paper quantifies the magnitude and drivers of gender inequalities in health using decomposition technique. We document substantial gender inequalities in health status, characterised by women disadvantages. Inequalities are mainly explained by the distribution of endowments. Programmes that equalise access to information, wealth creation interventions and mosquito nets would reduce the gender gaps in health.

Additional information

Notes on contributors

Conrad Murendo

CM acquired and analysed the data. CM and GM interpreted the data, drafted, and revised the manuscript. CM and GM read and approved the final manuscript.