Issue: Inequality in essential health coverage

Relevance and promising measurement approaches:

The quality of maternal healthcare and MMRs are higher for poorer women. Unequal access to essential health services also adds to the burden of unpaid work for women and girls who care for sick relatives. Lack of access to quality healthcare also hampers women’s ability to earn a livelihood and close the gap between the richest and poorest households. Research from India has found that unless explicit attention is paid to gender (and its intersectionality with other types of inequality), movement towards universal health coverage can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity.

To monitor where coverage in a given country is universal, the WHO and World Bank developed the Tracking Universal Health Coverage: 2017 Global Monitoring Report, which outlines gaps in essential health services across populations, as well as progress towards universal health coverage. Another promising new approach is the Healthcare Access and Quality (HAQ) Index, developed using the 2016 Global Burden of Diseases study, which aims to provide a stronger indication of personal healthcare access and quality across 195 countries and territories globally.

Issue: Mental health and suicide (girls and women)

Relevance and promising measurement approaches:

Women face specific pressures, including discrimination, disadvantage and gender-based violence (GBV). Sexual violence has a disproportionate impact on girls and women and significant effects on their mental health – often untreated due to stigma. It can trigger post-traumatic stress disorder, which affects more women worldwide than men. Unipolar depression, predicted to be the second leading cause of the global disability burden by 2020, is twice as common in women as in men. Yet, girls and women may need permission from a male household member to seek treatment for mental health issues, and many who seek treatment report discriminatory attitudes towards their mental health.

As of 2018, only 60 WHO member states had vital registration data of sufficient quality to be used to estimate suicide rates. The WHO suggests vital registration of suicides, hospital-based registries of suicide attempts and nationally representative surveys to collect information about mental health and self-reported suicide attempts to capture a global picture of mental health and suicide.

Issue: Age at first pregnancy

Relevance and promising measurement approaches:

The number of births in early adolescence (10-14 years) is a strong measure of the gender inequalities faced by girls. The WHO suggests that they are more likely in marginalized communities where poverty rates are high and girls have limited access to education and employment opportunities. Girls under the age of 15 are at a particularly high risk of complications during pregnancy and childbirth as a result of an underdeveloped pelvis, eclampsia, puerperal endometritis and systemic infections. According to research (2013), the MMR is 5 times higher for girls aged 10-14 than for women aged 20-24, and early adolescents are more likely to experience rapid repeat pregnancies.

We lack data for girls aged 10- 14 years. The missing data can be collected or derived retrospectively from census and survey data sources. Some organizations measure factors related to early pregnancy – for example, Girls Not Brides ranks countries on child marriage prevalence (the percentage of women 20-24 years old who were first married or in union before they were 15), based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other national surveys, which otherwise cover only those aged 15 and older.