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Gender-related differences in care-seeking behaviour for newborns: a systematic review of the evidence in South Asia
  1. Sharif A. Ismail1,
  2. Amy McCullough2,3,
  3. Sufang Guo4,
  4. Alyssa Sharkey4,
  5. Sheeba Harma5,
  6. Paul Rutter5
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Portsmouth City Council, Portsmouth, UK
  3. 3Public Health Department, Southampton City Council, Southampton, UK
  4. 4UNICEF Regional Office of South Asia, Kathmandu, Nepal
  5. 5UNICEF Regional Office for South Asia, Kathmandu, Nepal
  1. Correspondence to Amy McCullough; amy.mccullough{at}nhs.net

Abstract

Introduction Data indicate substantial excess mortality among female neonates in South Asia compared with males. We reviewed evidence on sex and gender differences in care-seeking behaviour for neonates as a driver for this.

Methods We conducted a systematic review of literature published between January 1st, 1996 and August 31st, 2016 in Pubmed, Embase, Eldis and Imsear databases, supplemented by grey literature searches. We included observational and experimental studies, and reviews. Two research team members independently screened titles, abstracts and then full texts for inclusion, with disagreements resolved by consensus. Study quality was assessed using National Institute for Health and Care Excellence (NICE) checklists and summary judgements given using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were extracted into Microsoft Excel.

Results Of 614 studies initially identified, 17 studies were included. Low quality evidence across several South Asian countries suggests that care-seeking rates for female neonates are lower than males, especially in households with older female children. Parents are more likely to pay more, and seek care from providers perceived as higher quality, for males than females. Evidence on drivers of these care-seeking behaviours is limited. Care-seeking rates are suboptimal, ranging from 20% to 76% across male and female neonates.

Conclusion Higher mortality observed among female neonates in South Asia may be partly explained by differences in care-seeking behaviour, though good quality evidence on drivers for this is lacking. Further research is needed, but policy interventions to improve awareness of causes of neonatal mortality, and work with households with predominantly female children may yield population health benefits. The social, economic and cultural norms that give greater value and preference to boys over girls must also be challenged through the creation of legislation and policy that support greater gender equality, as well as context-specific strategies in partnership with local influencers to change these practices.

PROSPERO registration number

CRD42016052256.

  • neonatal
  • neonate
  • paediatric
  • mortality
  • morbidity
  • gender
  • equality
  • care-seeking
  • care utilisation
  • healthcare
  • South Asia
  • Afghanistan
  • Bangladesh
  • India
  • Nepal
  • Pakistan

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2018-001309

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors AM, SG, AS and SH conceived the study and devised the research questions. AM then developed the research protocol and identified keywords to support literature searches. AM and SI collated search results, and screened papers based on title and abstract, and ultimately full text—including quality assessment. SI performed the data extraction. All authors contributed to the first draft of the manuscript and to revisions in subsequent versions. AM completed the edit of the revised manuscript.

    • Funding This study was carried out independently by the authors without specific funding. SAI was supported by a National Institute of Health Research (NIHR) Academic Clinical Fellowship based at Imperial College London in the UK for part of the time that this study was conducted (Award no ACF-2015-21-024). The Newborn Health Specialist (SG) in Unicef’s Regional Office for South Asia was supported by funding from the Bill and Melinda Gates Foundation (Grant no SC140844).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval As this study was based purely on secondary analysis of data and involved no primary data collection involving patients or vulnerable groups, ethical approval was neither required nor sought.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data come from peer-reviewed and grey literature sources. Extracted data are available on request to the corresponding author.