“It is because we women do not have a voice to be heard” - perceptions of gender-based discrimination and its relevance to health: a qualitative study with women in Burkina Faso, Ghana and Tanzania

Abstract Background Gender-based discrimination (GBD) remains a pervasive determinant of health inequity for women globally, yet its systemic and culturally embedded forms in low- and middle-income countries are underexplored. This study explores women’s lived experiences of GBD in Burkina Faso, Ghana and Tanzania, highlighting how intersecting social and institutional norms influence access to health care, education, employment, financial resources and the resulting impacts on women’s health. Methods Between February and May 2022, 17 focus group discussions and 32 in-depth interviews were conducted with 167 women across twelve regions in the three countries. Thematic analysis was employed to identify core patterns in how women perceive and navigate GBD in their daily lives. Results Across all sites, participants conceptualized GBD as a normalized, systemic structure embedded in both public and private spheres. Women described GBD as omnipresent and internalized, upheld by cultural, religious, economic and educational norms that reinforced power imbalances, particularly in household decision-making. These structural constraints limited women’s access to education, employment, healthcare, and financial autonomy, and positioned them as both subjects of and gatekeepers to gendered hierarchies. GBD was identified as a key barrier to maternal care such as reproductive autonomy, with male dominance over contraceptive use, and pregnancy-related decisions. This lack of autonomy, compounded by institutional biases and sociocultural stigma, was perceived to contribute to delayed care, emotional distress, and adverse physical and mental health outcomes. Conclusion The findings underscore the need for multisectoral strategies to address women’s health inequities. Efforts must focus on dismantling entrenched gender norms, enhancing women’s decision-making power, and ensuring institutional accountability for gender equity within health systems – not only in Burkina Faso, Ghana, and Tanzania.