Understanding barriers to healthcare services utilization among women in Mauritania: a socio-anthropological analysis

Persistent health inequities affecting women are exacerbated in contexts where weak institutional, sociopolitical, and health system responses intersect with structural barriers that limit the availability and accessibility of healthcare services. In Mauritania, gender discrimination remains pervasive and contributes to women's non-utilization or discontinuation of healthcare. This study examines the sociocultural barriers limiting healthcare utilization among Mauritanian women, particularly in relation to gender-based violence (GBV) and sexual and reproductive health (SRH), with attention to reliance on informal or alternative pathways, and discontinuation of formal care.

A qualitative study was conducted in Nouakchott, Mauritania, between August and October 2023, using a feminist, socio-anthropological approach. Thirty-three adult women participated, including 28 recruited through stratified purposive sampling to capture diversity in age, cultural background, and socioeconomic status. Data were collected through six participatory experiential workshops and five semi-structured individual interviews with key informants. A thematic analysis was conducted to examine how sociocultural norms and structural inequalities shape women's trajectories of access to GBV and SRH services.

Women's engagement with the healthcare system was constrained by entrenched social and cultural norms that normalize silence and endurance. GBV-related barriers included fear of disclosure, risk of social exclusion, and fear of legal repercussions, rooted in patriarchal expectations and internalized stigma. SRH-related barriers reflected shame and limited sexual health information sustained across the life course. Disengagement from the formal health system was further driven by institutional mistrust, discriminatory and racist practices against minority and migrant women, and procedural requirements such as police authorization for GBV care. Many women consequently relied on traditional practitioners or discontinued formal healthcare following negative experiences.

The convergence of systemic violence against women, restrictive sociocultural norms, and institutional failures undermines the utilization of essential healthcare services in Mauritania. These barriers intersect with racism and poverty, reinforcing structural exclusion and contributing to long-term adverse health outcomes. Addressing these interconnected barriers requires integrated legal and social protection measures, alongside rights-based health policies and culturally sensitive service delivery models that prioritize women's needs and voices.