Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index

Abstract

Reducing maternal mortality has been a crucial part of the global development agenda. According to modernisation theory, the effect of gender equality on maternal health may differ depending on a country's economic development status. We explored the correlation between the Global Gender Gap Index (GGI) provided by the World Economic Forum and the maternal mortality ratio (MMR) obtained from the World Development Indicators database of the World Bank. The relationships between each score in the GGI, including its four sub-indices (measuring gender gaps in economic participation, educational attainment, health and survival, and political empowerment), and the MMR were analysed. When the countries were stratified by gross national income per capita, the low and lower-middle-income countries had lower scores in the GGI, and lower scores in the economic participation, educational attainment, and political empowerment sub-indices than the high-income group. Among the four sub-indices, the educational attainment sub-index showed a significant inverse correlation with the MMR in low and lower-middle-income countries when controlling for the proportion of skilled birth attendance and public share of health expenditure. This finding suggests that strategic efforts to reduce the gender gap in educational attainment could lead to improvements in maternal health in low and lower-middle-income countries.

Composite measures of women’s empowerment and their association with maternal mortality in low-income countries

“…Our results replicate the previous finding by Choe et al [ 31 ] that GGI was not a significant predictor of maternal mortality after controlling for GDP per capita [ 31 ]. However, our results also suggest that GGI had less relationship to MMR than the other two gender indices when analyzing low-income countries from multiple regions.…”

“…Given the unexpected results of the Varkey et al [ 32 ] and Choe et al [ 31 ] studies, we wondered whether their conclusions that there were no macro-level associations between female empowerment and MMR could be related to methodological or measurement issues. We felt that their studies raised some critical questions.…”

“…Two studies examined the Human Development Index and found that it was linked to MMR [ 29 , 30 ], but they did not assess whether women’s empowerment was a factor. Another two studies specifically used a composite indicator of women’s empowerment [ 31 , 32 ] to assess if greater gender equity was linked to lower MMR. In the Varkey et al study [ 32 ], the authors employed the Gender Empowerment Measure (GEM) to examine the correlations between women’s empowerment and a range of health indicators, including maternal mortality, for the 75 countries in the 2006 Human Development Report.…”

“…After adjusting for gross domestic product (GDP) per capita, Varkey et al [ 32 ] found that the GEM was not correlated with maternal mortality, although it was associated with several other health indicators (low birth rate, fertility rate, infant mortality rate, and child mortality rate). In the Choe et al study [ 31 ], the authors used the Gender Gap Index (GGI) to assess the effects of gender equality on MMRs in 134 countries using 2010 data. The GGI was developed by the World Economic Forum and has four dimensions, namely education, economic, political, and health.…”

An Analysis of Inter-relationship between Maternal Mortality and Development in Low Human Development Countries

“…Khalid, A & Iqbal (2015) provided an analysis of GDI and its relationship to maternal mortality. It is found that there is two-way relationship between gender gap and maternal mortality (Seung-Ah Choe & Kim, 2016). Tim Ensor and Fitzmaurice (2010) have found that there is inverse relationship between GDP per capita and MMR.…”