Health-Seeking Behaviour of Rural Ethnic Women in Bangladesh: A Critical Analysis through an Intersectional Lens
Based on:
Journal Article (2023)
Investigating how intersecting factors of ethnicity, gender, socioeconomic status, and geography shape healthcare-seeking behaviours of rural ethnic women in northern Bangladesh, specifically among Santal communities.
Brief by:
Research collaborators:
In rural Bangladesh, healthcare access remains a critical challenge, especially for ethnic minority women who live in geographically isolated areas with limited health infrastructure. Rural ethnic women face unique and compounded barriers due to gender and socio-cultural expectations, economic hardships, and lower health literacy. For instance, women in the Santal community frequently face mobility constraints, often relying on male family members or community elders to approve healthcare visits and pay for medical expenses, which can delay or prevent access to needed services. Additionally, the influence of traditional beliefs and local healers, such as the baddya, often plays a larger role in these women’s healthcare choices than formal medical facilities.
The intersection of these factors means that healthcare solutions must address not just physical access but also socio-cultural dynamics within these communities. Existing studies have not adequately explored these intersections in Bangladesh’s northern regions, where ethnic communities like the Santal reside in lowland plains, comparatively near medical facilities, yet still face significant barriers tied to gender norms and socioeconomic conditions. This study fills a critical gap by providing evidence on how intertwined identities, including ethnicity, gender, economic status, and cultural beliefs, impact healthcare decisions for rural ethnic women in northern Bangladesh, which could inform more inclusive, community-tailored health policies.
Key findings
Intersectional identity exacerbates healthcare access barriers for rural ethnic women.
Evidence
Santal women experience compounding disadvantages in healthcare access due to their intersecting gender and ethnic identities, reinforcing patriarchal norms and economic hardship. In interviews, Santal women reported reliance on male family members for both healthcare decisions and financial support, limiting autonomy. For example, as one participant stated, ''I cannot make my healthcare seeking decision alone
What it means
The interaction of gender, ethnicity, and financial limitations creates a network of constraints that uniquely restricts Santal women's healthcare access, underscoring the need for policies that address these intersecting barriers.
Limited financial autonomy hinders access to healthcare.
Evidence
I need my husband to accompany me to the hospital'' (Interview with SWRH-3). Poverty also directly impacts decisions, with one respondent sharing, ''I need to borrow money from neighbours to afford the trip to the hospital.''
What it means
Financial dependency is a primary barrier, highlighting the necessity for accessible, affordable healthcare solutions that directly consider Santal women's financial realities and reliance on family support.
Traditional beliefs influence healthcare-seeking behaviour among rural ethnic women.
Evidence
Financial constraints heavily impact healthcare access, with Santal women often relying on community loans and male family members for transportation costs. As one respondent explained, ''My family could not afford the 150 BDT needed at the missionary hospital, and we had to borrow the money'' (Interview with SWL-7). The field study revealed that most Santal women are unable to cover out-of-pocket expenses, leaving 95% to rely on community or informal loans, as shown in observations.
What it means
Cultural beliefs profoundly shape Santal women's healthcare decisions, illustrating the need for culturally sensitive healthcare services that integrate traditional practices to improve trust and engagement with modern healthcare.
Community and family power dynamics significantly shape health decisions.
Evidence
Many Santal women prefer traditional healers, such as the baddya, due to longstanding beliefs in the supernatural's role in illness. One participant noted, ''We only go to baddya when someone behaves like crazy and unstable... [as] modern medicine cannot cure madness'' (Interview with SWRH-5). Despite increased access to clinics, reliance on spiritual practices and local knowledge persists due to distrust in formal healthcare.
What it means
The influence of community and family hierarchies restricts healthcare agency for Santal women, suggesting that policies supporting gender equity within communities could enhance women's healthcare autonomy.
Education and health literacy have mixed effects on healthcare-seeking behaviour.
Evidence
Santal women reported limited autonomy, requiring consent from male family members or elders to seek healthcare. A participant shared, ''I have never visited anywhere outside this village for healthcare
What it means
Education alone does not drive healthcare-seeking in Santal communities, indicating the need for broader, context-aware strategies that tackle economic and social barriers beyond health literacy alone..
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Health-Seeking Behaviour of Rural Ethnic Women in Bangladesh: A Critical Analysis through an Intersectional Lens
Cite this brief: Nawaz, Faraha. 'Health-Seeking Behaviour of Rural Ethnic Women in Bangladesh: A Critical Analysis through an Intersectional Lens'. Acume. https://www.acume.org/r/health-seeking-behaviour-of-rural-ethnic-women-in-bangladesh-a-critical-analysis-through-an-intersectional-lens/
Brief created by: Professor Faraha Nawaz | Year brief made: 2025
Original research:
- Bushra, A. N., & Nawaz, F., ‘Health-Seeking Behaviour of Rural Ethnic Women in Bangladesh: A Critical Analysis through an Intersectional Lens’ 15(2) (pp. 269–281) https://doi.org/10.38039/2214-4625.1029. – https://journals.usek.edu.lb/cgi/viewcontent.cgi?article=1029&context=aebj
Research brief:
Investigating how intersecting factors of ethnicity, gender, socioeconomic status, and geography shape healthcare-seeking behaviours of rural ethnic women in northern Bangladesh, specifically among Santal communities.
In rural Bangladesh, healthcare access remains a critical challenge, especially for ethnic minority women who live in geographically isolated areas with limited health infrastructure. Rural ethnic women face unique and compounded barriers due to gender and socio-cultural expectations, economic hardships, and lower health literacy. For instance, women in the Santal community frequently face mobility constraints, often relying on male family members or community elders to approve healthcare visits and pay for medical expenses, which can delay or prevent access to needed services. Additionally, the influence of traditional beliefs and local healers, such as the baddya, often plays a larger role in these women’s healthcare choices than formal medical facilities.
The intersection of these factors means that healthcare solutions must address not just physical access but also socio-cultural dynamics within these communities. Existing studies have not adequately explored these intersections in Bangladesh’s northern regions, where ethnic communities like the Santal reside in lowland plains, comparatively near medical facilities, yet still face significant barriers tied to gender norms and socioeconomic conditions. This study fills a critical gap by providing evidence on how intertwined identities, including ethnicity, gender, economic status, and cultural beliefs, impact healthcare decisions for rural ethnic women in northern Bangladesh, which could inform more inclusive, community-tailored health policies.
Findings:
Intersectional identity exacerbates healthcare access barriers for rural ethnic women.
Santal women experience compounding disadvantages in healthcare access due to their intersecting gender and ethnic identities, reinforcing patriarchal norms and economic hardship. In interviews, Santal women reported reliance on male family members for both healthcare decisions and financial support, limiting autonomy. For example, as one participant stated, ”I cannot make my healthcare seeking decision alone
The interaction of gender, ethnicity, and financial limitations creates a network of constraints that uniquely restricts Santal women’s healthcare access, underscoring the need for policies that address these intersecting barriers.
Limited financial autonomy hinders access to healthcare.
I need my husband to accompany me to the hospital” (Interview with SWRH-3). Poverty also directly impacts decisions, with one respondent sharing, ”I need to borrow money from neighbours to afford the trip to the hospital.”
Financial dependency is a primary barrier, highlighting the necessity for accessible, affordable healthcare solutions that directly consider Santal women’s financial realities and reliance on family support.
Traditional beliefs influence healthcare-seeking behaviour among rural ethnic women.
Financial constraints heavily impact healthcare access, with Santal women often relying on community loans and male family members for transportation costs. As one respondent explained, ”My family could not afford the 150 BDT needed at the missionary hospital, and we had to borrow the money” (Interview with SWL-7). The field study revealed that most Santal women are unable to cover out-of-pocket expenses, leaving 95% to rely on community or informal loans, as shown in observations.
Cultural beliefs profoundly shape Santal women’s healthcare decisions, illustrating the need for culturally sensitive healthcare services that integrate traditional practices to improve trust and engagement with modern healthcare.
Community and family power dynamics significantly shape health decisions.
Many Santal women prefer traditional healers, such as the baddya, due to longstanding beliefs in the supernatural’s role in illness. One participant noted, ”We only go to baddya when someone behaves like crazy and unstable… [as] modern medicine cannot cure madness” (Interview with SWRH-5). Despite increased access to clinics, reliance on spiritual practices and local knowledge persists due to distrust in formal healthcare.
The influence of community and family hierarchies restricts healthcare agency for Santal women, suggesting that policies supporting gender equity within communities could enhance women’s healthcare autonomy.
Education and health literacy have mixed effects on healthcare-seeking behaviour.
Santal women reported limited autonomy, requiring consent from male family members or elders to seek healthcare. A participant shared, ”I have never visited anywhere outside this village for healthcare
Education alone does not drive healthcare-seeking in Santal communities, indicating the need for broader, context-aware strategies that tackle economic and social barriers beyond health literacy alone..