Barriers to healthcare access and women’s self-rated health in six sub-Saharan African countries

Achieving universal health coverage and gender equality remains a global priority, yet women in sub-Saharan Africa (SSA) continue to face barriers to healthcare access. However, evidence on the association between specific healthcare access barriers and self-rated health status (SRHS) among women in SSA remains limited. This study examined the association between barriers to healthcare access and SRHS among women aged 15–49 years in six SSA countries. We analysed Demographic and Health Survey data from six SSA countries: Côte d’Ivoire (2021), Burkina Faso (2021), Tanzania (2022), Mozambique (2022–2023), Kenya (2022), and Ghana (2022), comprising 92,741 women. Generalized ordered logistic regression models were used to examine associations between barriers to healthcare access and SRHS. Separate multivariable models assessed difficulty obtaining permission, money for treatment, distance to a health facility, not wanting to go alone, and the presence of at least one barrier. Difficulty obtaining money for treatment was associated with higher odds of poorer SRHS across all four thresholds (AORs: 1.26–1.95). Distance to a health facility was associated with higher odds of poorer SRHS at the very good, good, and moderate thresholds (AORs: 1.12–1.37). Not wanting to go alone was associated with higher odds of poorer SRHS at the good, moderate, and bad thresholds (AORs: 1.13–2.64). Difficulty obtaining permission was associated with poorer SRHS at the moderate threshold (AOR = 1.46, 95% CI: 1.25–1.71). Experiencing at least one barrier was consistently associated with poorer SRHS (AORs: 1.31–1.90). Healthcare access barriers were associated with poorer SRHS among women in the six countries studied. Addressing financial, geographical, and social barriers may contribute to improving women’s perceived health status.