Using intersectionality to identify gendered barriers to health-seeking for febrile illness in agro-pastoralist settings in Tanzania

Barasa, V. and Virhia, J. (2022) Using intersectionality to identify gendered barriers to health-seeking for febrile illness in agro-pastoralist settings in Tanzania. Frontiers in Global Women's Health, 2, 746402. (doi: 10.3389/fgwh.2021.746402) (PMID:35156085) (PMCID:PMC8835114)

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Abstract

Background: Research has shown that gender is a significant determinant of health-seeking behaviour around the world. Gender power relations and lay etiologies of illness can influence the distribution of household resources, including for healthcare. In some rural settings in Africa, gender intersects with multiple forms of health inequities, from proximal socio-cultural factors to more ‘upstream’ or distal health system determinants which can amplify barriers to health-seeking for specific groups in specific contexts. Aim: We used an intersectionality approach to determine how women in particular experience gendered barriers to accessing healthcare among Maa and non-Maa speaking agro-pastoralists in northern Tanzania. We also explored lay etiologies of febrile illness, perceptions of health providers and rural health-seeking behaviours in order to identify the most common barriers to accessing healthcare in these settings. Methods: Ethnographic approaches were used to collect data between 2016 and 2018 from four Maa-speaking and two Swahili-speaking agro-pastoralist villages in northern Tanzania. Data on health seeking behaviours was collected through semi-structured questionnaires, in-depth interviews, focus group discussions and participant observation. Findings: The results primarily focus on the qualitative outcomes of both studies. We found that febrile illness was locally categorised across a spectrum of severity ranging from normal and expected illness to serious illness that required hospital treatment. Remedial actions taken to treat febrile illness included attending local health facilities, obtaining medicines from drug sellers and use of herbal remedies. We found barriers to health-seeking played out at different scales, from the health system, community (inter-household decision making) and household (intra-household decision making). Gender-based barriers at the household had a profound effect on health-seeking. Younger women delayed seeking healthcare the most, as they often had to negotiate with husbands and extended family members, including co- wives and mothers-in-law who make the majority of health-related decisions. Conclusion: An intersectional approach enabled us to gain a nuanced understanding of determinants of health-seeking behaviour beyond the commonly assumed barriers such lack of public health infrastructure. We propose tapping into the potential of senior women involved in local therapy-management groups, to explore gender-transformative approaches to health-seeking, including tackling gender-based barriers at the community level.

Item Type:Articles
Additional Information:This research was funded by the Biotechnology and Biological Sciences Research Council, Department for International Development, the Economic and Social Research Council, the Medical Research Council, the Natural Environment Research Council and the Defense Science and Technology Laboratory, under the Zoonoses and Emerging Livestock Systems Associated Studentships (ZELS-AS) programme (BB/N503563/1).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Virhia, Miss Jennika
Authors: Barasa, V., and Virhia, J.
College/School:College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:Frontiers in Global Women's Health
Publisher:Frontiers Media
ISSN:2673-5059
ISSN (Online):2673-5059
Copyright Holders:Copyright © 2022 Barasa and Virhia
First Published:First published in Frontiers in Global Women's Health 2: 746402
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
171979Zoonoses and Emerging Livestock Systems ZELS Reducing the risk to livestock and people programme associated studentships - ZELS-ASSarah CleavelandBiotechnology and Biological Sciences Research Council (BBSRC)BB/N503563/1Institute of Biodiversity, Animal Health and Comparative Medicine