A Case Study in Lesotho: Gendered Healthcare Access and Maternal Outcomes in a North African Context,

Gender norms influence healthcare access and utilisation, with documented impacts on maternal health. Lesotho presents a valuable case study for examining these dynamics within a broader North African sociocultural context, where patriarchal structures often mediate women's access to medical services. This study aimed to analyse how gendered social determinants shaped access to obstetric care in a specific North African setting, using Lesotho as an illustrative case, and to explore the subsequent impact on maternal health outcomes. A qualitative, instrumental case study design was employed. Data were collected via in-depth, semi-structured interviews with purposively selected female patients and healthcare providers. Archival policy documents and local health facility records were analysed thematically to triangulate findings. A primary theme was the critical role of male partner or family authorisation in seeking care, which frequently delayed emergency obstetric interventions. Analysis of facility records indicated that a notable proportion of antenatal clinic attendees reported needing to consult their husband before attending. This gatekeeping dynamic was a recurrent barrier to timely care. Gendered power structures, manifesting as required male permission, are a substantial barrier to timely maternal healthcare in this context, adversely affecting service utilisation and outcomes. The case underscores the need to view medical access through a gendered lens. Health education programmes should actively engage men and community leaders. Health policy must advocate for and implement gender-sensitive service protocols that support women's autonomous decision-making in seeking care. gender, maternal health, healthcare access, North Africa, qualitative research, obstetric care This case study provides a context-specific analysis of how gendered social dynamics directly impact clinical pathways and maternal health, offering practical insights for developing more equitable healthcare delivery in similar settings.