Overall, the review identified several critical gender-related research gaps: 1) Data on barriers and delays at the provider/system levels; 2) study populations that include people with suspected TB who have not presented for care; 3) in-depth analyses of access to TB services for each step along the diagnostic and treatment continuum; 4) studies purposefully designed for gender analysis; and 5) standardised research tools to systematically collect and compare gender-related sociocultural variables across studies, which may help to identify both common and unique gender-related barriers.
Regarding financial barriers, the role as primary income earner in many households prevented men from leaving work to access TB services. This could be addressed by providing more flexible hours and locations for services. For women, financial dependence on spouses and families limited their access to TB services, which may be compounded by social norms that deprioritise women’s health care needs within the household. Because maternal health is prioritised by some families, integrating TB services with maternal health care may facilitate women’s improved access.
Regarding stigma, women were fearful of having a TB diagnosis disclosed to their spouse, family, or community and, when gender-related differences were found in studies, they experienced greater stigma than men. In addition to generating negative mental and social consequences, TB-related stigma may also serve as a financial barrier for women who depend on spouses and family for support and are faced with rejection.
This is particularly beneficial for women in rural areas, as studies revealed large gender disparities in TB-related health literacy in rural settings. Additional research, particularly qualitative studies, should be conducted to examine the combined effects of low literacy and poverty, as well as marital status and age, on TB-related health care seeking and access to services among women.
As with individual-level barriers, when gender disparities were reported in studies, women were more likely to face barriers and delays at the provider/system level to accessing TB services than men. Such barriers and delays can be minimised by acknowledging and planning for the different needs of men and women and unique barriers they face when designing and providing health services.
