A Policy Analysis of Gender, Medicine, and Healthcare Access in Madagascar

Gender is a critical social determinant of health, yet its integration into health policy and medical practice in Madagascar remains inconsistent. This analysis examines policies addressing gender perspectives in medicine and healthcare access, focusing on structural barriers and equity. This policy analysis aims to assess the incorporation of gender perspectives into national health policies and strategies in Madagascar. It seeks to identify key gaps, shifts in policy discourse, and implications for equitable healthcare delivery. A qualitative document analysis was conducted. This involved a systematic review of publicly available national health policy documents, strategic plans, and relevant legislative frameworks. A structured framework was used to evaluate explicit and implicit gender content, intentions, and proposed implementation mechanisms. The analysis reveals a progressive but uneven integration of gender considerations. A dominant theme is the persistent framing of women primarily through maternal health, often sidelining broader gender-based barriers to access. Policies increasingly recognise socio-cultural norms as barriers, with some explicitly linking gender-based violence to health outcomes. While policy recognition of gender as a social determinant of health has grown, operationalisation remains a challenge. Policies often lack specific, funded actions to address entrenched gender inequalities within the healthcare system and in community access. Future policies must move beyond maternal-centric frameworks to adopt intersectional gender analyses. Concrete recommendations include mandating gender audits of health facilities, integrating gender competency into medical training curricula, and establishing targeted programmes for marginalised gender groups. gender, health policy, healthcare access, maternal health, Madagascar, policy analysis, equity This analysis provides a consolidated critique of gender integration in Malagasy health policy, offering evidence to inform more equitable and effective policy design and implementation.