Excess female mortality in rural Somalia—Is inequality in the household a risk factor?

Gender differences in mortality risks in rural Somali communities were studied to assess their relation to literacy, marital status and family economy between January 1987 and December 1989. In all, 6947 person-years form the basis for the demographic analysis and estimations of mortality rates and survival. Both sexes showed similar mortality risks in infancy and early childhood, but females demonstrated a greater risk of dying during their reproductive life than males. Respiratory symptoms, diarrhoea, fever and jaundice dominated the symptoms prior to death. Illiteracy in women considerably increased the risk of dying from 15 years and onwards particularly when living with literate men. The life expectancy from 15 years was 58 for a literate male but only 42 years for an illiterate woman living with a literate head of household. Multivariate analyses showed after adjustment for marital status and literacy that an excess female mortality from 15 years, but especially from 45 years, was associated to a household situation, where the woman did not subside on farming but on other, mainly commercial, activities. This vulnerability of females was associated to the recession of the economy in the pre-war situation in Somalia, a backlash hitting women trying to earn their living. To conclude, gender differences in a number of factors in the household—literacy, marital status and especially source of income—were disadvantageous for the women, increasing the mortality risk in this setting.