Obstacles to women's access : issues and options for more effective interventions to improve women's health

Abstract

Few studies have attempted to document differential patterns of health service use between women and men, and thus the evidence demonstrating the magnitude and dimensions of gender-specific barriers to access is limited. Moreover, most studies that describe these barriers focus on maternal health services rather than a comprehensive view of women's health care. Nevertheless, the evidence on gender-specific differences in welfare suggests a general pattern of obstacles facing women. Barriers to access reduce the effectiveness or increase the cost of interventions beyond what they would be in the absence of such barriers. They reduce the effectiveness of facility-based interventions by restricting the number of patients served. In some settings, this may render outreach services a more cost-effective alternative. Where barriers are severe, additional resources must be used to provide access for hard-to-reach women. Thus, access barriers also increase the cost of interventions. The obstacles limiting women's use of health services are of several types, some of which are general (i.e., they also affect men) and others of which are gender-related. Intrahousehold obstacles to health inputs may arise from patterns of allocation of resources for food, education, and the financial means to access medical care services that discriminate against women and girls. Studies suggest that many households are less willing to commit resources for the health care of female household members, with the result that the costs of using health services often present a greater barrier for females than for males. Lack of education is itself an impediment to health service use, and cultural norms also limit women's access to care in some societies. Finally, shortcomings in the efficiency, equity, and quality of health services are general problems that combine to limit utilization below what would be possible if resources were allocated and used more efficiently. This paper examines barriers to women's access to health services and suggests options for addressing them. These options consist of measures that can be taken within the health sector to minimize the consequences of these barriers and thus improve the realized cost-effectiveness of interventions to improve women's health.

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