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

Figures & data

Figure 1. Simplified depiction of select drivers of health inequity [5,6]

Table 1. Approaches to addressing gender inequality, with examples from Ethiopia

Approach	Brief description	Example of application in Ethiopia
Affirmative action [13]	Policies and guidelines specify opportunities for women in education or employment positions in which they are under-represented	A minimum of 5% of training and recruitment spaces are reserved for women
Gender mainstreaming [12]	Gender equality is a cross-cutting priority during the process of health development and implementation	The Federal Ministry of Health Gender Directorate seeks to facilitate gender mainstreaming at all levels of the health system [32]
Gender-based analysis [14]	Health data, monitoring, and assessments with gender equality as a primary goal	Production of sex and age disaggregated data
Gender responsive budgeting in health [32]	Allocation of resources to address gender inequality in health	Developing gender responsive budget guidelines to meet the particular health needs of men and women [15]
Health workforce initiatives [9,10]	Provide gender training and more female employment opportunities within the health sector at all levels	The Health Extension Program established an all-female cadre of community-based health workers (Health Extension Workers) to provide basic service delivery and health education [16]
Rights based [17]	Enshrine gender equality as part of human rights guaranteed by the state	Article 35 of the current 1994 Constitution of Ethiopia states that women have equal rights with men [18]
Women empowerment [11]	Support women in seeking leadership opportunities and increasing decision making power	Through the volunteer-based Women’s Development Army women are encouraged to show leadership in increasing health seeking behaviours among their neighbours
Women’s health agendas/initiatives [8]	Improve the visibility, access and quality of women-specific health services	Campaigns to increase skilled birth deliveries by providing ambulances and maternity waiting areas for rural communities

Table 2. Study participant characteristics

Administrative level	Number included in study	Job titles
National	5	Director, Coordinator, Expert
Regional	2	Director, Coordinator
Zonal	2	Director, Coordinator
Woreda	5	Director, Coordinator
PHCU	3	Director
Total	17

Table A1. Coding guide applied in the second stage of data analysis

Code	Description	Number of quotes identified	Thematic category
MNCH	Aspects of maternal, newborn and child health	13	Prioritizing a women’s health agenda
Access equity	Factors, other than gender, that prevent women from accessing the same level of health care	38
Health centre resources	Availability and quality of these resources in certain areas	25
Traditional gender roles	The perception of differences between men and women in terms of ability, lifestyle, and expectations	11	Recognizing traditional gender roles
Male involvement	The role men have in MNCH (e.g. decision making)	11
Empowerment	Women are encouraged to pursue opportunities to have a voice or improve social standing.	8
Health care professionals	Health workers, both male and female, that influence the community and health; also includes training and quality of care	47	Improving access to women’s health services at the community level
Partners of health	Any non-governmental organizations or actors that are involved in health care	4	Working with community political and religious leaders
Leader influence	Influential leaders that can impact health perception, although their primary role is not dedicated to health	8

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Data availability statement

The data that support the findings of this study are available from the corresponding author, NB, upon reasonable request.