The role of gender inequities in women’s access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India

Figures & data

Figure 1 Conceptual framework.

Table 1 Summary of definitions and measure of variables used in the study

Variables	Measures
Dimensions of gender inequities
Decision-making autonomy	Yes; no
Husband has other wives (polygyny)	Yes; no
Justifies wife beating	Yes; no
Age at first marriage	≤19 years; ≥20 years
Control over earnings	Yes; no
Age inequalities	Respondent younger than husband/partner
	Respondent same age as husband/partner
	Respondent older than husband/partner
Education inequalities	Respondent less educated than husband/partner
	Respondent is as educated as husband/partner
	Respondent more educated than husband/partner
Earning inequalities	Respondent earns less than husband/partner
	Respondent earns same as husband/partner
	Respondent earns more than husband/partner
Demographic and socioeconomic factors
Age of respondent	15–24; 25–34; >35 years
Educational attainment	No education; primary; secondary or higher
Number of children ever born	1–2; 3–4; ≥5 children
Place of residence	Urban; rural
Wealth index	Poor; middle; rich

Table 2 Characteristics of the women from Kenya, Namibia, India, and Nepal in the study

Variables	Countries
	Kenya (N = 8444)	Namibia (N = 9804)	India (N = 124,385)	Nepal (N = 10,793)
Decision-making autonomy	n = 4788	n = 3332	n = 85,943	n = 10,793
Yes	4660 (97%)	3070 (92%)	76,017 (88%)	6164 (57%)
No	128 (3%)	262 (8%)	9926 (12%)	4629 (43%)
Husband has other wives	n = 5041	n = 3562	n = 87,925	n = 8297
Yes	885 (18%)	649 (18%)	1980 (2%)	385 (5%)
No	4156 (82%)	2913 (82%)	85,945 (98%)	7912 (95%)
Justifies wife beating	n = 7975	n = 9010	n = 116,999	n = 10,724
Yes	3985 (50%)	3398 (38%)	52,733 (45%)	2578 (24%)
No	3990 (50%)	5612 (62%)	64,266 (55%)	8146 (76%)
Age at first marriage	n = 5904	n = 4259	n = 93,724	n = 8640
≤19 years	3617 (61%)	1511 (35%)	66,894 (71%)	7287 (84%)
≥20 years	2287 (39%)	2748 (65%)	26,830 (29%)	1353 (16%)
Control over earnings	n = 2355	n = 1516	n = 23,033	n = 2225
Yes	2173 (92%)	1334 (88%)	19,827 (86%)	306 (14%)
No	182 (8%)	182 (12%)	3206 (14%)	1919 (86%)
Age inequality	n = 5021	n = 3446	n = 88,078	n = 8243
Respondent is younger than partner	4734 (94%)	2823 (82%)	83,127 (94%)	7107 (86%)
Respondent is same age as partner	144 (3%)	206 (6%)	2632 (3%)	572 (7%)
Respondent is older than partner	143 (3%)	408 (12%)	2319 (3%)	564 (7%)
Education inequality	n = 5809	n = 3989	n = 93,199	n = 8652
Respondent is less educated than partner	2701 (46%)	1549 (39%)	48,506 (52%)	5503 (64%)
Respondent is as educated as partner	1843 (32%)	980 (24%)	28,252 (30%)	2559 (29%)
Respondent is more educated than partner	1265 (22%)	1460 (37%)	16,441 (18%)	590 (7%)
Earning inequality	n = 6154	n = 1486	n = 22,610	n = 2202
Respondent earns less than partner	1531 (67%)	1021 (69%)	16,751 (74%)	1904 (68%)
Respondent earns the same as partner	388 (17%)	174 (12%)	2678 (12%)	547 (25%)
Respondent earns more than partner	371 (16%)	291 (19%)	3181 (14%)	151 (7%)
Age of respondent	n = 8444	n = 9804	n = 124,385	n = 10,793
15–24 years	3511 (41%)	4081 (42%)	46,762 (37%)	4479 (41%)
25–34 years	2603 (31%)	2985 (30%)	38,520 (31%)	3101 (29%)
≥35 years	4933 (58%)	2738 (28%)	39,103 (32%)	3213 (30%)
Highest educational level	n = 8444	n = 9804	n = 124,373	n = 10,793
No education	1242 (15%)	775 (8%)	39,769 (32%)	5677 (52%)
Primary	4404 (52%)	2616 (27%)	17,756 (14%)	1908 (18%)
Secondary or higher	2798 (33%)	6413 (65%)	66,848 (54%)	3208 (30%)
Number of children ever born	n = 6102	n = 6636	n = 84,609	n = 7791
1–2	2393 (39%)	3494 (53%)	39,698 (47%)	3153 (41%)
3–4	1825 (30%)	1869 (28%)	30,150 (36%)	2679 (34%)
≥5	1884 (31%)	1273 (19%)	14,761 (17%)	1959 (25%)
Place of residence	n = 8444	n = 9804	n = 124,385	n = 10,793
Urban	2615 (31%)	4405 (45%)	56,961 (46%)	2949 (27%)
Rural	5829 (69%)	5399 (55%)	67,424 (54%)	7844 (73%)
Wealth index	n = 8444	n = 9804	n = 124,385	n = 10,793
Poor	2983 (35%)	3350 (34%)	31,729 (25%)	4212 (39%)
Middle	1455 (17%)	2223 (23%)	23,682 (19%)	1974 (18%)
Rich	4006 (48)	4231 (43%)	68,974 (56%)	4607 (43%)

Table 3 Odds ratios and 95% confidence intervals for the association between measures of gender inequities and women’s access to skilled antenatal care

Variables	Countries
	Kenya	Namibia	India	Nepal
	Adjusted OR (95% CI)	Adjusted OR (95% CI)	Adjusted OR (95% CI)	Adjusted OR (95% CI)
Gender inequities
Decision-making autonomy
Yes	1	1	1	1
No	0.53 (0.06–4.79)	1.45 (0.10–20.47)	0.89 (0.71–1.11)	0.86 (0.54–1.36)
Husband has other wives
Yes	1.14 (0.63–2.04)	1.39 (0.24–7.94)	0.82 (0.58–1.16)	0.65 (0.33–1.29)
No	1	1	1	1
Justifies wife beating
Yes	1.15 (0.07–1.88)	0.81 (0.26–2.52)	0.97 (0.85–1.10)	0.80 (0.57–1.13)
No	1	1	1	1
Age at first marriage
≤19 years	0.71 (0.40–1.24)	0.84 (0.25–2.85)	0.84 (0.69–1.01)	1.72 (1.08–2.73)
≥20 years	1	1	1	1
Control over earnings
Yes	1	1	1	1
No	1.35 (0.54–3.41)	1.25 (0.19–8.07)	1.18 (0.98–1.42)	1.11 (0.69–1.77)
Relationship inequality
Age inequality
Younger than partner	0.98 (0.21–4.47)	0 (0)^§	1.36 (0.96–1.92)	1.71 (0.86–3.39)
Same age as partner	1	1	1	1
Older than partner	0.46 (0.07–3.19)	0 (0)^§	1.21 (0.74–1.98)	1.04 (0.43–2.50)
Education inequality
Less educated than partner	1.60 (0.95–2.72)	0.74 (0.14–3.98)	1.26 (1.10–1.45)	0.46 (0.28–0.75)
Same education as partner	1	1	1	1
More educated than partner	1.34 (0.67–2.67)	0.15 (0.02–0.99)	1.14 (0.89–1.47)	0.72 (0.43–1.22)
Earning inequality
Earns less than partner	0.87 (0.46–1.71)	0.40 (0.07–2.17)	1.48 (1.22–1.80)	0.91 (0.62–1.35)
Earns the same as partner	1	1	1	1
Earns more than partner	1.24 (0.51–3.00)	1.42 (0.10–19.58)	1.31 (0.99–1.72)	0.48 (0.22–1.02)
Age of respondent
15–24 years	1.93 (0.76–4.93)	0.07 (0.01–0.64)	1.03 (0.80–1.32)	1.24 (0.64–2.43)
25–34 years	1.09 (0.62–1.92)	0.67 (0.17–2.66)	1.16 (0.97–1.40)	1.21 (0.72–2.02)
≥35 years	1	1	1	1
Highest educational level
No education	0.09 (0.03–0.25)	0.24 (0.04–1.57)	0.39 (0.32–0.49)	0.46 (0.28–0.75)
Primary	0.43 (0.19–0.98)	3.20 (0.72–14.35)	0.66 (0.52–0.84)	0.72 (0.43–1.22)
Secondary or higher	1	1	1	1
Number of children ever born
1–2	1	1	1	1
3–4	1.27 (0.59–2.74)	0.22 (0.04–1.10)	0.55 (0.47–0.65)	0.58 (0.37–0.89)
≥5	0.74 (0.32–1.72)	0.15 (0.02–1.20)	0.33 (0.27–0.40)	0.65 (0.37–1.17)
Place of residence
Urban	1	1	1	1
Rural	0.49 (0.22–1.14)	0.29 (0.07–1.26)	0.69 (0.58–0.82)	0.26 (0.18–0.37)
Wealth index
Poor	0.70 (0.34–1.43)	0.21 (0.04–1.03)	0.25 (0.19–0.31)	0.40 (0.28–0.58)
Middle	0.79 (0.37–1.73)	0.42 (0.09–1.88)	0.45 (0.35–0.58)	0.62 (0.39–0.97)
Rich	1	1	1	1

Note: Bold figures indicate statistical significance.

Abbreviations: CI, confidence interval; OR, odds ratio.

Table 5 Odds ratios and 95% confidence intervals for the association between measures of gender inequities and women’s access to maternal tetanus vaccination during pregnancy

Variables	Countries
	Kenya	Namibia	India	Nepal
	Adjusted OR (95% CI)	Adjusted OR (95% CI)	Adjusted OR (95% CI)	Adjusted OR (95% CI)
Gender inequities
Decision-making autonomy
Yes	1	1	1	1
No	0.93 (0.11–7.84)	1.87 (0.73–4.78)	1.03 (0.81–1.32)	0.83 (0.51–1.34)
Husband has other wives
Yes	0.98 (0.60–1.59)	1.13 (0.69–1.84)	0.82 (0.57–1.19)	0.42 (0.22–0.80)
No	1	1	1	1
Justifies wife beating
Yes	1.00 (0.68–1.48)	1.10 (0.74–1.65)	1.05 (0.92–1.20)	0.74 (0.51–1.05)
No	1	1	1	1
Age at first marriage
≤19 years	0.96 (0.62–1.47)	1.30 (0.87–1.93)	0.93 (0.76–1.15)	1.60 (0.94–2.71)
≥20 years	1	1	1	1
Control over earnings
Yes	1	1	1	1
No	1.19 (0.59–2.42)	0.79 (0.44 –1.41)	0.89 (0.73–1.09)	0.99 (0.61–1.65)
Relationship inequality
Age inequality
Younger than partner	0.92 (0.31– 2.69)	1.03 (0.57–1.85)	1.14 (0.77–1.68)	1.72 (0.86–3.44)
Same age as partner	1	1	1	1
Older than partner	0.59 (0.14–2.50)	1.07 (0.51–2.21)	0.84 (0.49–1.42)	0.75 (0.31–1.79)
Education inequality
Less educated than partner	1.07 (0.69–1.66)	1.28 (0.82–1.98)	1.33 (1.15–1.55)	1.37 (0.95–1.97)
Same education as partner	1	1	1	1
More educated than partner	0.80 (0.48–1.35)	1.02 (0.65–1.59)	1.11 (0.84–1.47)	0.72 (0.34–1.53)
Earning inequality
Earns less than partner	0.97 (0.58–1.64)	0.97 (0.58–1.64)	1.57 (1.28–1.92)	1.74 (1.16–2.62)
Earns the same as partner	1	1	1	1
Earns more than partner	0.85 (0.43–1.66)	1.38 (0.73–2.63)	1.54 (1.14–2.07)	0.74 (0.35–1.58)
Age of respondent
15–24 years	1.31 (0.64–2.69)	2.84 (1.42–5.68)	1.19 (0.91–1.55)	1.35 (0.68–2.71)
25–34 years	1.15 (0.72–1.82)	1.29 (0.83–1.99)	1.39 (1.14–1.68)	1.54 (0.92–2.57)
≥35 years	1	1	1	1
Highest educational level
No education	0.23 (0.11–0.47)	1.19 (0.55–2.55)	0.35 (0.27–0.46)	0.34 (0.18–0.63)
Primary	1.08 (0.66–1.78)	1.86 (1.13–3.36)	0.55 (0.41–0.72)	0.43 (0.23–0.80)
Secondary or higher	1	1	1	1
Number of children ever born
1–2	1	1	1	1
3–4	1.33 (0.77–2.29)	1.42 (0.94–2.14)	0.64 (0.53–0.77)	0.61 (0.38–0.99)
≥5	0.63 (0.34–1.18)	1.57 (0.85–2.89)	0.38 (0.30–0.47)	0.65 (0.35–1.22)
Place of residence
Urban	1	1	1	1
Rural	1.11 (0.67–1.83)	0.92 (0.61–1.39)	0.95 (0.79–1.14)	0.86 (0.58–1.27)
Wealth index
Poor	1.28 (0.73–2.24)	0.99 (0.55–1.81)	0.31 (0.23–0.40)	0.56 (0.37–0.84)
Middle	1.22 (0.67–2.24)	1.47 (0.91–2.39)	0.61 (0.46–0.80)	1.06 (0.62–1.80)
Rich	1	1	1	1

Note: Bold figures indicate statistical significance.

Abbreviations: CI, confidence interval; OR, odds ratio.

Table 4 Odds ratios and 95% confidence intervals for the association between measures of gender inequities and women’s access to institutional delivery

Variables	Countries
	Kenya	Namibia	India	Nepal
	Adjusted OR (95% CI)	Adjusted OR (95% CI)	Adjusted OR (95% CI)	Adjusted OR (95% CI)
Gender inequities
Decision-making autonomy
Yes	1	1	1	1
No	0.58 (0.12–2.89)	1.49 (0.35–6.29)	0.81 (0.65–1.02)	1.13 (0.65–1.96)
Husband has other wives
Yes	0.77 (0.53–1.13)	0.73 (0.30–1.79)	0.94 (0.66–1.35)	0.17 (0.05–0.63)
No	1	1	1	1
Justifies wife beating
Yes	0.88 (0.67–1.16)	0.50 (0.26–0.99)	1.10 (0.97–1.24)	0.76 (0.49–1.18)
No	1	1	1	1
Age at first marriage
≤19 years	0.61 (0.45–0.82)	0.53 (0.27–1.05)	0.67 (0.58–0.79)	2.63 (1.62–4.29)
≥20 years	1	1	1	1
Control over earnings
Yes	1	1	1	1
No	1.15 (0.69–1.89)	0.93 (0.34–2.53)	1.32 (1.09–1.58)	0.94 (0.53–1.68)
Relationship inequality
Age inequality
Younger than partner	0.85 (0.36–2.04)	0.58 (0.11–3.14)	1.24 (0.91–1.68)	1.09 (0.51–2.37)
Same age as partner	1	1	1	1
Older than partner	0.47 (0.15–1.53)	0.35 (0.06–2.21)	1.07 (0.69–1.66)	0.47 (0.16–1.39)
Education inequality
Less educated than partner	0.88 (0.63–1.24)	0.97 (0.41–2.29)	1.15 (0.99–1.32)	1.34 (0.84–2.13)
Same education as partner	1	1	1	1
More educated than partner	0.50 (0.34–0.74)	1.46 (0.56–3.79)	1.15 (0.95–1.39)	1.38 (0.69–2.78)
Earning inequality
Earns less than partner	1.15 (0.79–1.67)	1.35 (0.56–3.29)	0.99 (0.82–1.20)	0.92 (0.58–1.46)
Earns the same as partner	1	1	1	1
Earns more than partner	1.01 (0.61–1.67)	1.69 (0.49–5.75)	0.93 (0.72–1.21)	1.06 (0.47–2.40)
Age of respondent
15–24 years	0.38 (0.22–0.65)	0.26 (0.07–0.96)	0.43 (0.34–0.55)	0.46 (0.20–1.10)
25–34 years	0.69 (0.47–1.02)	0.45 (0.18–1.09)	0.59 (0.49–0.73)	0.60 (0.29–1.22)
≥35 years	1	1	1	1
Highest educational level
No education	0.11 (0.06–0.23)	0.19 (0.07–0.54)	0.42 (0.36–0.50)	0.42 (0.25–0.70)
Primary	0.48 (0.34–0.69)	0.60 (0.27–1.33)	0.62 (0.52–0.75)	0.63 (0.37–1.06)
Secondary or higher	1	1	1	1
Number of children ever born
1–2	1	1	1	1
3–4	0.58 (0.40–0.86)	0.43 (0.18–1.03)	0.37 (0.32–0.43)	0.32 (0.19–0.55)
≥5	0.34 (0.21–0.55)	0.22 (0.07–0.67)	0.20 (0.16–0.25)	0.44 (0.20–0.94)
Place of residence
Urban	1	1	1	1
Rural	0.36 (0.25–0.52)	0.22 (0.09–0.51)	0.47 (0.41–0.53)	0.38 (0.25–0.56)
Wealth index
Poor	0.36 (0.25–0.51)	0.22 (0.09–0.54)	0.26 (0.22–0.31)	0.35 (0.22–0.57)
Middle	0.81 (0.55–1.19)	0.49 (0.21–1.14)	0.52 (0.44–0.62)	0.36 (0.19–0.68)
Rich	1	1	1	1

Note: Bold figures indicate statistical significance.

Abbreviations: CI, confidence interval; OR, odds ratio.