Intersectional Impact of Religion, Gender and Health Outcomes on Health Equity in Sub-Saharan Africa
Abstract
This scoping review examines the intersectional impact of religion and gender on health outcomes in sub-Saharan Africa, with particular attention to their combined implications for health equity. Despite notable improvements in healthcare systems across the region, substantial disparities persist, particularly among marginalized populations. Existing scholarship has largely analysed religion, gender, and health outcomes in isolation, overlooking the complex and mutually reinforcing dynamics that shape lived health experiences.
Drawing on intersectionality theory, this review synthesises peer-reviewed studies published between 2010 and 2023 to explore how religious beliefs, gender norms, and structural inequalities interact to influence health behaviours, access to care, and overall well-being. The findings indicate that religion plays a dual role, acting both as a facilitator and as a barrier to positive health outcomes. Religious doctrines and leadership structures significantly influence health-seeking behaviour, attitudes toward medical interventions, and community perceptions of illness. At the same time, entrenched gender norms and roles continue to shape differential access to healthcare services, decision-making power, and exposure to health risks.
The review highlights how individuals experiencing compounded vulnerabilities—particularly women in socioeconomically disadvantaged or religiously conservative contexts—face distinct and amplified health challenges. It further demonstrates the influential role of religious leaders in shaping community health practices and policy acceptance.
By offering an integrated and intersectional synthesis, this study contributes to the fields of Public Health, Global Health, Health Policy, and Gender Studies. It advances current knowledge by demonstrating how sociocultural and religious structures interact with gender to sustain or mitigate health inequities in sub-Saharan Africa. The findings underscore the importance of engaging religious actors in health policy processes and designing culturally responsive, gender-sensitive interventions aimed at reducing persistent health disparities across underserved populations.
Keywords: Intersectionality; Health equity; Religion and health; Gender norms; Health outcomes; Sub-Saharan Africa.
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ADEKOLA, A.P. (2024). An intersectional analysis of gender-specific barriers to adolescent health literacy in South Africa. Proceedings of The International Conference on Gender Studies and Sexuality, 1(1), 23–34. https://doi.org/10.33422/icgss.v1i1.192
ADEKOLA, A. P. & MOTHOAGAE I.D. (2023). Adolescents’ sexual health: Elucidating the paradoxical influence of Christian religion on sexuality education programmes in schools within the King Cetshwayo District, South Africa. Pharos Journal of Theology. 104(2). Available on https://doi.org/10.1007/s13178-021-00651-1
AGADJANIAN, V. (2013). Religious denomination, religious involvement, and modern contraceptive use in southern Mozambique. Studies in Family Planning, 44(3), 259–274. https://doi.org/10.1111/j.1728-4465.2013.00357.x
AGADJANIAN, V. (2005). Gender, religious involvement, and HIV/AIDS prevention in Mozambique. Social Science & Medicine, 61(7), 1529–1539. https://doi.org/10.1016/j.socscimed.2005.03.012
AGU, C. I., NWANKPA, O., EKWUEME, C. N., AGU, I. C., MBACHU, C. O., EZUMAH, N., & ONWUJEKWE, O. (2024). Intersectionality analysis of young people’s experiences and perceptions of discrimination in Primary Health Centers in Ebonyi State, Southeast Nigeria. International Journal for Equity in Health, 23(1). https://doi.org/10.1186/s12939-024-02192-6
ALEMIE, A. S., YESHITA, H. Y., ZELEKE, E. G., & MEKONNEN, B. D. (2023). Intimate partner violence and associated factors among HIV positive women attending antiretroviral therapy clinics in Gondar City, Northwest Ethiopia. BMC Women’s Health, 23(1). https://doi.org/10.1186/s12905-023-02193-7
ARKSEY, H., & O’MALLEY, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
AWOLOLA, O., & ILUPEJU, N. (2019). Female genital mutilation: culture, religion, and Medicalization, where do we direct our searchlights for its eradication: Nigeria as a case study. Tzu Chi Medical Journal, 31(1), 1. https://doi.org/10.4103/tcmj.tcmj_127_18
AZAD, A. D., CHARLES, A. G., DING, Q., TRICKEY, A. W., & WREN, S. M. (2020). The gender gap and healthcare: Associations between gender roles and factors affecting healthcare access in Central Malawi, June–August 2017. Archives of Public Health, 78(1). https://doi.org/10.1186/s13690-020-00497-w
AZIATO, L., ODAI, P. N., & OMENYO, C. N. (2016). Religious beliefs and practices in pregnancy and labour: An inductive qualitative study among post-partum women in Ghana. BMC Pregnancy and Childbirth, 16(1). https://doi.org/10.1186/s12884-016-0920-1
BASTIA, T., DATTA, K., HUJO, K., PIPER, N., & WALSHAM, M. (2022). Reflections on intersectionality: A journey through the worlds of Migration Research, Policy and Advocacy. Gender, Place & Culture, 30(3), 460–483. https://doi.org/10.1080/0966369x.2022.2126826
BERGEN, N., ZHU, G., YEDENEKAL, S. A., MAMO, A., ABEBE GEBRETSADIK, L., MORANKAR, S., & LABONTÉ, R. (2020). Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian Health Sector. Global Health Action, 13(1), 1704530. https://doi.org/10.1080/16549716.2019.1704530
COURTENAY, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine, 50(10), 1385–1401. https://doi.org/10.1016/s0277-9536(99)00390-1
CRENSHAW, K. (2018). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics [1989]. Feminist Legal Theory, pp. 57–80. https://doi.org/10.4324/9780429500480-5
DADA, D., ABU-BA’ARE, G. R., TURNER, D., MASHOUD, I. W., OWUSU-DAMPARE, F., APREKU, A., NI, Z., DJIADEU, P., AIDOO-FRIMPONG, G., ZIGAH, E. Y., NYHAN, K., NYBLADE, L., & NELSON, L. E. (2024). A scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa. BMJ Open, 14(2). https://doi.org/10.1136/bmjopen-2023-078794
EMBLETON, L., LOGIE, C. H., NGURE, K., NELSON, L., KIMBO, L., AYUKU, D., TURAN, J. M., & BRAITSTEIN, P. (2022). Intersectional stigma and implementation of HIV prevention and treatment services for adolescents living with and at risk for HIV: Opportunities for improvement in the HIV continuum in Sub-Saharan Africa. AIDS and Behavior, 27(S1), 162–184. https://doi.org/10.1007/s10461-022-03793-4
FRANCIS, J. M., MYERS, B., NKOSI, S., PETERSEN WILLIAMS, P., CARNEY, T., LOMBARD, C., NEL, E., & MOROJELE, N. (2019). The prevalence of religiosity and association between religiosity and alcohol use, other drug use, and risky sexual behaviours among grade 8-10 learners in Western Cape, South Africa. PLOS ONE, 14(2). https://doi.org/10.1371/journal.pone.0211322
GYIMAH, S. O., TAKYI, B. K., & ADDAI, I. (2006). Challenges to the reproductive-health needs of African women: On religion and maternal health utilization in Ghana. Social Science & Medicine, 62(12), 2930–2944. https://doi.org/10.1016/j.socscimed.2005.11.034
HABIB, M., ADEGNIKA, A. A., HONKPEHEDJI, J., KLUG, S. J., LOBMAIER, S., VOGG, K., BUSTINDUY, A. L., ULLRICH, A., REINHARD-RUPP, J., ESEN, M., & PRAZERES DA COSTA, C. (2021). The challenges for Women’s Health in sub-Saharan Africa: Lessons learned from an integrative Multistakeholder Workshop in Gabon. Journal of Global Health, 11. https://doi.org/10.7189/jogh.11.02002
ICHOKU, H. E., MOONEY, G., & ATAGUBA, J. E.-O. (2013). Africanizing the Social Determinants of Health: Embedded structural inequalities and current health outcomes in Sub-Saharan Africa. International Journal of Health Services, 43(4), 745–759. https://doi.org/10.2190/hs.43.4.i
IFEANYICHUKWU, C. D. (2020). Towards a healthy life for the sub-Saharan African (SSA) women. Empowering African Women for Sustainable Development, 61–71. https://doi.org/10.1007/978-3-030-59102-1_6
ILESANMI, O. S. (2014). Religiousity and risky sexual behaviour among undergraduates in SouthWest Nigeria. Mediterranean Journal of Social Sciences. https://doi.org/10.5901/mjss.2014.v5n23p2345
KOENIG, H. G., PETEET, J. R., & VANDERWEELE, T. J. (2024). Handbook of Religion and Health. Oxford University Press.
KOENIG, H. G. (2012). Religion, spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry, 2012, 1–33. https://doi.org/10.5402/2012/278730
LEWIS, K. A., JADWIN-CAKMAK, L., WALIMBWA, J., OGUNBAJO, A., JAUREGUI, J. C., ONYANGO, D. P., MOORE, D. M., JOHNSON, G. L., ODERO, W., & HARPER, G. W. (2023). “you’ll be chased away”: Sources, experiences, and effects of violence and stigma among gay and bisexual men in Kenya. International Journal of Environmental Research and Public Health, 20(4), 2825. https://doi.org/10.3390/ijerph20042825
MANDELBAUM, J. (2020). Advancing Health Equity by integrating intersectionality into epidemiological research: Applications and challenges. Journal of Epidemiology and Community Health, 74(9), 761–762. https://doi.org/10.1136/jech-2020-213847
MIKULAK, M., RYAN, S., MA, R., MARTIN, S., STEWART, J., DAVIDSON, S., & STEPNEY, M. (2021). Health professionals’ identified barriers to Trans Health Care: A qualitative interview study. British Journal of General Practice, 71(713). https://doi.org/10.3399/bjgp.2021.0179
MOCHACHE, V., WANJE, G., NYAGAH, L., LAKHANI, A., EL-BUSAIDY, H., TEMMERMAN, M., & GICHANGI, P. (2020). Religious, socio-cultural norms and gender stereotypes influence uptake and utilization of maternal health services among the Digo community in Kwale, Kenya: A qualitative study. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-00919-6
MOTHOAGAE, I. D., & MAVHANDU-MUDZUSI, A. (2021). The intersectionality of religion, race and gender at the time of the COVID-19 pandemic: A South African reflection. Religion, Ethics and Communication in the Era of the COVID-19 Pandemic, (102(2)). https://doi.org/10.46222/pharosjot.102.220
MÜLLER A. (2016). Health for All? Sexual Orientation, Gender Identity, and the Implementation of the Right to Access to Health Care in South Africa. Health and human rights, 18(2), 195–208.
MUTOWO, J., YAZBEK, M., VAN DER WATH, A., & MAREE, C. (2021). Barriers to using antenatal care services in a rural district in Zimbabwe. International Journal of Africa Nursing Sciences, 15, 100319. https://doi.org/10.1016/j.ijans.2021.100319
NWAKAMA, C., ABDULWAHAB, L., OREOLUWA, A., & OSASUMWEN, I. (2023). The practice of female genital mutilation in Africa and the challenges facing its eradication: Nigeria as a case study. International Journal Of Scientific Advances, 4(2). https://doi.org/10.51542/ijscia.v4i2.9
NYANCHOKA, L., TUDUR-SMITH, C., THU, V. N., IVERSEN, V., TRICCO, A. C., & PORCHER, R. (2019). A scoping review describes methods used to identify, prioritize and display gaps in Health Research. Journal of Clinical Epidemiology, 109, 99–110. https://doi.org/10.1016/j.jclinepi.2019.01.005
OGUNJIMI, L. O. (2012). Curbing maternal and child mortality: The Nigerian experience. International Journal of Nursing and Midwifery, 4(3). https://doi.org/10.5897/ijnm11.030
OLUDURO, O. (2017). The role of religious leaders in curbing the spread of HIV/AIDS in Nigeria. Potchefstroom Electronic Law Journal, 13(3), 207–236. https://doi.org/10.17159/1727-3781/2010/v13i3a2690
PARSITAU, D. S., & AURA, R. A. (2021). The role of religion and faith actors in violence against women and girls in Africa: Challenges, tensions, and promise. The Palgrave Handbook of African Women’s Studies, 2209–2232. https://doi.org/10.1007/978-3-030-28099-4_27
SEIDU, A.-A. (2020). Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-Saharan Africa: Insights from demographic and Health Surveys. PLOS ONE, 15(11). https://doi.org/10.1371/journal.pone.0241409
SEKONI, A. O., JOLLY, K., & GALE, N. K. (2020). Hidden Healthcare populations: Using intersectionality to theorise the experiences of LGBT+ people in Nigeria, Africa. Global Public Health, 17(1), 134–149. https://doi.org/10.1080/17441692.2020.1849351
SHABALALA, S. B., & CAMPBELL, M. M. (2023). The complexities of trans women’s access to healthcare in South Africa: Moving health systems beyond the gender binary towards gender equity. International Journal for Equity in Health, 22(1). https://doi.org/10.1186/s12939-023-02039-6
SUNDARARAJAN, R., YODER, L. M., KIHUNRWA, A., ARISTIDE, C., KALLUVYA, S. E., DOWNS, D. J., MWAKISOLE, A. H., & DOWNS, J. A. (2019). How gender and religion impact uptake of family planning: Results from a qualitative study in northwestern Tanzania. BMC Women’s Health, 19(1). https://doi.org/10.1186/s12905-019-0802-6
UMAR, A. S. (2017). The use of maternal health services in Nigeria: Does ethnicity and religious beliefs matter? MOJ Public Health, 6(6). https://doi.org/10.15406/mojph.2017.06.00190
UNAIDS (2022, March 7). Women and girls carry the heaviest HIV burden in sub-Saharan Africa. UNAIDS. https://www.unaids.org/en/resources/presscentre/featurestories/2022/march/20220307_women-girls-carry-heaviest-hiv-burden-sub-saharan-africa
UNAIDS. (2021). Global AIDS update 2021. https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_en.pdf
VALENTINE, S. E., & SHIPHERD, J. C. (2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clinical Psychology Review, pp. 66, 24–38. https://doi.org/10.1016/j.cpr.2018.03.003
WEINSTEIN, J. N., GELLER, A., NEGUSSIE, Y., & [45] BACIU, A. (2017). Communities in action: Pathways to health equity. The National Academies Press.
WONG, E. C., MAHER, A. R., MOTALA, A., ROSS, R., AKINNIRANYE, O., LARKIN, J., & HEMPEL, S. (2021). Methods for identifying health research gaps, needs, and priorities: A scoping review. Journal of General Internal Medicine, 37(1), 198–205. https://doi.org/10.1007/s11606-021-07064-1
WORLD HEALTH ORGANIZATION. (2013). Mental Health Action Plan 2013-2020. https://www.who.int/publications/i/item/9789241506021
ZINYEMBA, K. G., & HLONGWANA, K. (2022). Men’s conceptualization of gender-based violence directed to women in Alexandra Township, Johannesburg, South Africa. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-14616-5
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