Barriers to Care and Internalized Gender Stigma Among Women in Zambia: A DHS-Based Analysis of Psychosocial Vulnerability.

Background Structural and cultural determinants such as access barriers and gender-based stigma are key psychosocial stressors affecting women’s health in sub-Saharan Africa. While education and wealth are known to influence health access and gender norms, few studies have quantified these associations using nationally representative data. Objectives This study aimed to explore how sociodemographic factors relate to (1) reported challenges in accessing healthcare and (2) the belief that wife-beating is justified, among Zambian women aged 15–49 years, as indicators of underlying structural and cultural vulnerabilities. Methods A cross-sectional analysis was performed on responses from 13,683 women aged 15–49 years participating in the Zambia Demographic and Health Survey. Two outcomes were assessed: (1) reported barriers to accessing healthcare (distance, permission, cost, or not wanting to go alone), and (2) acceptance of wife-beating under specific circumstances, a proxy for internalized gender stigma. Key predictors in the model were women’s educational attainment, household economic status, and residential location (urban versus rural). Weighted logistic regression models were fitted to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results Barriers to care were more prevalent among rural women (53%) compared to urban women (25%). In adjusted models, women in the richest households had significantly lower odds of reporting care barriers (AOR: 0.22; 95% CI: 0.16–0.30) compared to the poorest. Rural residence increased the odds of barriers (AOR: 1.65; 95% CI: 1.28–2.12), while education was not independently significant. Women with higher educational attainment and greater household wealth were less likely to view wife-beating as acceptable. In comparison to women without formal education, those with higher education levels were 75% less likely to justify wife-beating (AOR: 0.25; 95% CI: 0.18–0.35). Beliefs justifying wife-beating were significantly less common among women in the highest wealth quintile, with an adjusted odds ratio of 0.34 (95% CI: 0.26–0.44). No statistically significant difference remained between urban and rural residence, after controlling for relevant factors. Conclusion Economic status and education strongly predict structural and cultural markers of psychosocial stress among Zambian women. Interventions addressing gender stigma and care access must integrate economic empowerment strategies and target rural populations. These findings support the need for gender-responsive, mental health–informed health policy in Zambia and similar contexts.