What Does Access to Medical Care Really Mean?
A woman has access to medical care if she can easily get to a medical facility, can afford medical care, and is permitted to access medical care by her family and society. The forms of access can be described as geographic access, financial access, and cultural access. (All of these factors affect men as well as women, but I am going to use pregnant women as my example when I discuss access.) They cannot be easily separated from each other - for example, transport to a health center may require both permission from a woman's mother-in-law and money for a taxi or bus.
In a discussion of access, even the most basic terms end up needing definitions. To qualify as a medical facility, the location must have trained health care providers and essential medicines. An empty or understaffed building a ten minute walk away does not qualify as access, even if it is always open and doesn't require any payment.
Geographic access requires that a woman be able to physically get to a health care provider. Most women in the developing world do not have access to vehicular transportation. Therefore, they must either walk or find a form of transport in order to get to medical facilities. One rule of thumb is that to qualify as accessible, a health care facility should be no more than two hours walk away. How far a woman can walk in two hours depends on landscape, roads, and weather.
The amount of time that a woman can spend travelling to get medical care also depends on her household duties - if she has children to care for, or meals she must prepare, she may not be able to spare much time to walk to a health facility. Geographic access is especially difficult for women in labor, who may not be able to walk easily.
Financial access depends on household resources, the cost of medical care, and women's' status. The basic out of pocket cost of medical care matters; that is the first and clearest obstacle to access. Health care may be fee for service, or it may provided free by the government but require under the table payments to health care providers. A woman needs sufficient resources to cover those costs. A household may have the savings to pay for medical care, but if her husband or mother-in-law decides that it isn't worth spending the money, then a woman lacks financial access.
Cultural Access is a result of the complication social interplay around health and health care. For a woman to have cultural access to health care, both she and the decision-makers in her family (if she is not permitted to make her own decisions) must value health care, and be willing to spend time and money on it. It also requires that the woman and her community must value women enough to commit resources to their health.
Cultural obstacles to accessing health care are many and powerful. Woman and girls are often sent to cheaper traditional healers rather than Western medical providers. They may be discourages or forbidden fro, leaving the house, even for medical care. They may not be allowed to see male health care providers, even if female providers are not available.
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