‘I can’t leave everything in the hands of my husband’: Economic constraints and gender roles in care-seeking in post-Ebola Guinea

ABSTRACT

The 2014–2016 Ebola epidemic in West Africa had enduring effects on health systems and healthcare utilisation. This study explores the intersection of economic constraints and gender roles in Guinea to understand delays in care-seeking post-Ebola. In-depth interviews (n = 45) and focus group discussions (n = 24) were conducted with mothers, male heads of household, grandmothers, and health workers in rural and urban areas in Basse-Guinée and Guinée Forestière. A thematic analysis identified salient themes related to gender and economic constraints on health care-seeking. Participants, particularly men, emphasised the high cost of seeking care, which led to delays as women secured funds. Men’s engagement in care-seeking included providing funds and permission, picking up medication, and giving appointment reminders. As principal actors when ‘navigating’ the healthcare system, women were intimately involved in economic decisions and responsible for securing funds for services – even when lacking direct financial control. Essentialist descriptions of men as ‘providers’ and women as ‘navigators’, therefore, masked nuances in care-seeking and economic responsibilities. Programmes must acknowledge men’s engagement in care-seeking and address both the economic barriers women face when seeking care and their economic roles. Greater attention to the complex intersection of economic constraints and gender roles could address care-seeking delays.

KEYWORDS:

• Care-seeking
• Economic empowerment
• Emergency settings
• Guinea
• Qualitative research

Acknowledgements

The authors would like to acknowledge the interviewers and study team members in Guinea who supported this research project. The authors would also like to acknowledge the support of the HC3 Project team in Guinea that facilitated this effort. Finally, the authors would like to thank the participants in Guinea who so generously shared their experiences and perspectives with the research team.

Data availability statement

Participants of this study did not agree for the full data sets supporting these findings to be shared publicly. As a result, full data sets are not publicly available to minimise the risk of compromising participants’ privacy and confidentiality. Data that support the findings of this study may be made available upon request by the corresponding author (ZH) upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was made possible by the support of the American People through the United States Agency for International Development (USAID) Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-12-00058.