Introduction
The importance of the status of female health cannot be overlooked and should be prioritized in order to balance gender equality and fulfil the unique medical needs of women. Female health status is often ignored, especially in developing countries, due to the disadvantaged conditions they face, created by discrimination which is deeply rooted in biological, socio-economic, cultural, political, and spiritual grounds [
1,
2]. To end this underprivileged situation, the United Nations Development Program (UNDP) focused on the sustainable development goals to reduce gender inequality and ensure better health facilities for females [
3,
4]. Despite numerous efforts to ensure more facilities, the health care access of females still remains a greater challenge in the contemporary world. Thus further research for identifying contributory factors to female health outcomes is quite appealing and crucial for policy makers.
Against this backdrop, our present study is an endeavour to probe the determining factors of female health in the selected 10 SAARC-ASEAN countries.
1 Having a GDP of US$ 436.491 billion, these countries belong to the group of those having a total population of 2.007 billion, out of whom 48.626% are female [
5]. The average life expectancy of females in these countries in 2018 was 73.985 years, where the highest life expectancy was in Thailand (80.704 years) and lowest was in Pakistan (68.109 years) [
5]. These figures are lower than some other regions of the world such as EU and North America where average female life expectancy of these two regions are 83.867 years and 81.405 years, respectively [
5]. In 2018, the average female adult mortality rate in these countries was 126.411 per 1,000 female adults (ages 15–60 years), where the highest mortality is experienced by Bhutan (194.721 per 1000 female adults) and the lowest mortality was in Sri Lanka (56.065 per 1000 female adults) [
5]. This is higher than some other regions of the world such as EU and North America where the average female adult mortality of these two regions was 52.251 and 81.935, respectively [
5]. The average rate of access to electricity, female education, immunization, and urbanization in these countries in 2018 were 90.611%, 90.500%, 39.150%, respectively [
5]. The average per capita public health expenditure in this region is US$119.279 [
5]. All these indicators need more careful attention for ensuring better health outcomes of female.
Some empirical studies can be found in the literature [
6‐
45,
61,
62,
72] that has endeavoured to uncover the determining elements of the health outcomes of people where inclusive health issues are rarely addressed. Female health outcomes have been analysed by some studies, but those studies failed to include some important factors like access to electricity, female education rate, immunization rate, economic growth rate, urbanization rate, and public health expenditure, all of which have important policy implications. Thus our main aim is to fill up the prevailing literary gaps in this current study, where we will thoroughly probe the effects of access to electricity, female education rate, public health expenditure, immunization rate, economic growth rate, and urbanization rate on female health outcomes in the SAARC-ASEAN countries.
The rationale for selecting the variables is that: (i) access to electricity ensures better health outcomes for females by providing health related facilities, like getting more health related knowledge from TV, Radio, etc. and become more health conscious, and receiving more medical benefits from electricity run appliances; (ii) female education creates awareness and provides proper guidelines about the healthy life to ensure better health for females; (iii) public health expenditure provides various medical facilities at a lower cost for the improvement of female health. (iv) economic growth ensures better living standards that facilitate improved female health; (v) a higher immunization rate generates protection against infectious diseases and safeguards female health; and (vi) urbanization creates different modern facilities that may positively affect female health. More rationalization of the selection of variables is provided in Sect.
3.1.
The major objectives of this study are:
(i)
To identify the impact of access to electricity, female education, public health expenditure economic growth, immunization rate, and urbanization on female health outcomes in the SAARC-ASEAN countries.
(ii)
To detect the causality between access to electricity, female education, public health expenditure, economic growth, immunization rate, urbanization, and female health outcomes.
The main contributions of this study are: (i) this is the first study in the literature, to the best of our knowledge, that identifies the impact of access to electricity, female education, public health expenditure, economic growth, immunization rate, and urbanization on female health outcomes in the context of SAARC-ASEAN countries; (ii) this study utilizes the updated available and inclusive data considering the period of 17 years (2002–2018); (iii) the outcomes are achieved by using robust econometric tools: cross-sectional dependence test, Modified Wald test, Wooldridge test, the Panel corrected standard error (PCSE) model, the Feasible generalized least square (FGLS) model, and the pair-wise Granger causality test; and (vi) the results will provide unique guidelines for policy makers to advance the improved health status of females by considering access to electricity, female education, public health expenditure, economic growth, immunization rate, and urbanization policies.
The study is aligned in the following order: following the introduction, Sect.
2 reviews the past literature; Sect.
3 describes the methods; Sect.
4 presents s the results; Sect.
5 discusses the results; and Sect.
6 displays the conclusion and policy implications.
Discussion
The outcomes of Tables
5 and
6 display the key determining factors of female life expectancy at birth and female adult mortality rate. We have found that access to electricity positively affects female life expectancy and negatively affects the female adult mortality rate due to the convenience of the operation of modern medical instruments and preservation of valuable medicines, drugs, and vaccination and receiving health related information from public media. Thus, more access to electricity enhances life extending facilities enough to reduce mortality rate and increase the life expectancy of female. These outcomes are in the line with the findings of Wang [
6], Chen et al. [
7], Adair-Rohani et al. [
11], Irwin et al. [
12], and Hernández [
14]. A higher female education rate increases life expectancy and decreases the female adult mortality rate because education creates and enhances awareness and consciousness among females to consume nutritious food, to maintain a healthy life for them and for their children. Moreover, the educated female can acquire better health related information to stay healthy and lead a safe life. This result is consistent with those of Rahman and Alam [
8], McAlister and Baskett [
16], Keats [
19], and Kanmiki et al. [
20]. Public health expenditure has significant and positive effect on female life expectancy, and negative impact on the female adult mortality rate, as it promotes different public hospitals, free of cost medicines, and lower cost medical facilities for people. Additionally, the more public health expenditure arranges better medical facilities (e.g. more hospitals, healthcare workers, medicines, etc.) for the poor and vulnerable portion of population including female. This outcome is similar to the findings of Rahman et al. [
9], Novignon and Lawanson [
10], Nicholas et al. [
23], Ahmad and Hasan [
24], and Behera and Dash [
72]. The immunization rate also improves female life expectancy and reduces female adult mortality. Vaccination creates herd immunity against infectious diseases, as a result children and adults become less affected by various types of infectious diseases, signifying an improved health status for females. Therefore, the availability of vaccination to the mass level including female can ensure better immunity that lengthens female life expectancy and reduces mortality rate This outcome is consistent with the results obtained by Pezzotti et al. [
32], Brisson et al. [
33], Owais et al. [
34], and Rodrigues and Plotkin [
61], considering health outcomes. The per capita GDP positively influences female life expectancy and negatively influences female adult mortality, because economic growth enables governments to spend more in the health sector, and ensures more medical facilities and better living standards for people, which significantly improves their health status. The higher growth rate makes family affluent; household head can spend more for the better health of family members including females. This finding is similar to those of Rahman and Alam [
8], Rahman et al. [
9], Wang et al. [
25], Mahyar [
35], and Shahbaz et al. [
36]. The urbanization rate has a positive effect on female life expectancy but an insignificant effect on the female adult mortality rate because of improved urban health facilities, access to information, better living standards, better employment resources and higher incomes for all people. The urban people also become more health conscious due to the availability of more urban facilities. Furthermore, in urban areas, most of the females are employed and can afford better health facilities and better food that enhance their life expectancy. This result is consistent with the results of Wang [
39], Amouzou et al. [
40] and Panahi and Aleemran [
41], but not consistent with the results of Rahman and Alam [
8], Adediran et al. [
42], and Torres et al. [
62].
Table 5
Feasible generalized least square (FGLS) model results
LNAEL | 0.010*** (2.82) | − 0.089** (− 2.41) |
LNFED | 0.024*** (5.14) | − 0.138*** (− 3.79) |
LNPUH | 0.004*** (3.31) | − 0.023** (− 2.34) |
LNGDP | 0.010*** (6.68) | − 0.060*** (− 5.04) |
LNIMM | 0.014*** (3.07) | − 0.090** (− 2.15) |
LNURB | 0.126*** (9.06) | 0.093 (1.27) |
_Constant | 3.334*** (70.12) | 7.570*** (22.96) |
Wald chi2 | 634.86 | 124.60 |
Probability | 0.000 | 0.000 |
N | 170 | 170 |
Table 6
Causality test results
LNFLE case |
LNAEL does not cause LNFLE | 0.010 | 0.991 | LNFLE → LNAEL (one-way causality) |
LNFLE does not cause LNAEL | 7.788*** | 0.001 |
LNFED does not cause LNFLE | 0.162 | 0.850 | LNFLE → LNFED (one-way causality) |
LNFLE does not cause LNFED | 4.654** | 0.011 |
LNPUH does not cause LNFLE | 0.775 | 0.463 | No causality |
LNFLE does not cause LNPUH | 0.199 | 0.819 |
LNGDP does not cause LNFLE | 2.512* | 0.085 | LNGDP → LNFLE (one-way causality) |
LNFLE does not cause LNGDP | 1.529 | 0.220 |
LNIMM does not cause LNFLE | 0.610 | 0.545 | LNFLE → LNIMM (one-way causality) |
LNFLE does not cause LNIMM | 2.948* | 0.056 |
LNURB does not cause LNFLE | 22.828*** | 0.000 | LNURB → LNFLE (one-way causality) |
LNFLE does not cause LNURB | 1.769 | 0.174 |
LNFAM case |
LNAEL does not cause LNFAM | 0.189 | 0.828 | LNFAM → LNAEL (one-way causality) |
LNFAM does not cause LNAEL | 5.038*** | 0.008 |
LNFED does not cause LNFAM | 0.162 | 0.851 | LNFAM → LNFED (one-way causality) |
LNFAM does not cause LNFED | 2.356* | 0.098 |
LNPUH does not cause LNFAM | 0.258 | 0.773 | No causality |
LNFAM does not cause LNPUH | 0.683 | 0.507 |
LNGDP does not cause LNFAM | 0.275 | 0.759 | No causality |
LNFAM does not cause LNGDP | 1.601 | 0.205 |
LNIMM does not cause LNFAM | 0.162 | 0.851 | LNFAM → LNIMM (one-way causality) |
LNFAM does not cause LNIMM | 3.826** | 0.024 |
LNURB does not cause LNFAM | 1.925 | 0.150 | No causality |
LNFAM does not cause LNURB | 0.330 | 0.719 |
Conclusion and policy implications
This paper has explored the nexus of access to electricity, female education, and public health expenditure with female health outcomes in the SAARC-ASEAN countries. Using the data of 2002–2018, and applying the cross-sectional dependence test, Modified Wald test, Wooldridge test, the PCSE model and the FGLS model, and the pair-wise Granger causality test, robust results have been obtained. Access to electricity, female education rate, public health expenditure, economic growth, and immunization rate have a positive effect on female life expectancy at birth, and a negative effect on the female adult mortality rate. The urbanization rate has a significant positive impact on female life expectancy at birth but an insignificant impact on the female adult mortality rate. A one-way causal relationship between the variables is also noted. All the results are logical and generate important milestones for the health sector. These results may be said to apply, not only for the regions studied but globally.
The important policy implications of the study are: the health status of females should be improved and protected by formulating effective policies on access to electricity, female education, public health expenditure, immunization, economic growth, and urbanization. In this context the following specific recommendations should be prioritized:
(i)
Ensuring more access to electricity: More electricity access plays role in increasing female life expectancy and reducing female mortality rate in the studied region. Electricity facility also helps females to be health conscious via electricity run devices and media by and also helps to take proper medical treatment with modern electricity led medications. It also helps female to get employment and thus discourages child marriages. Use of electricity facilitates easy access to print and electronic media that increases female awareness, which plays an important role in reducing early marriage related death and increasing life expectancy. For this reason, an effective and efficient policy formulation to ensure more electricity access should be formulated that will be conducive to female health.
(ii)
Spreading more female education: More education of female ensures more life expectancy and lower female mortality rate[
19,
20]). Thus, all types of barriers of education for female should be eradicated and priority should be given to a female friendly environment for spreading more female education, so that, among others, they will be more aware of about health issues. For this reason more female educational institutions, financial facilities by offering various scholarships, and a better educational environment are required which urge dynamic policy efforts.
(iii)
Greater public health expenditure: Our findings of public health expenditure on female life expectancy and female mortality rate plausible. More public health expenditure offers more medical facilities at no cost or minimum costs As a result, people including female can easily enjoy required health facilities which reduces mortality and lengthens female life expectancy.. Therefore, the governments of these countries should increase budget allocation for public health with priority for females’ health as women has unique health issues [
77]. In this regard, supplying more doctors specializing in female health, establishing more community clinics at the foundational level, more subsidies for medicines, and providing modern and improved medical equipment are essential.
(iv)
Larger coverage on immunization: As immunization builds herd immunity against different types of infectious diseases, a greater coverage of immunization may help females to achieve better health outcomes [
32,
33]. Necessary arrangements should be made in such a way that all people including female may get vaccinated. In this case, secular, unbiased, and gender friendly immunization policies should be formulated.
(v)
Sustainable economic growth policy Our findings of economic growth on health outcomes are consistent too because economic growth brings amenities and ensures modern types of different facilities for better health, which increases female life expectancy and declines female mortality rate. A sustainable and effective economic growth policy can ensure modern health facilities for females. Therefore, effective, efficient, updated, and health-focused economic growth policies should be pioneering across the regions for making sustainable future for ensuring better female health status.
(vi)
Planned urbanization As urbanization increases female life expectancy, the more panned urban facilities for female should also be ensured. Because unplanned urbanization may create detrimental consequences on human health through creating pollution, unhygienic water and sanitation facilities, congestion, and various socio-cultural mal-adjustments like slums [
8,
62]. A proficient, green, and sustainable well-organized and well-planned urbanization policy should be undertaken to ensure better health status for all people, but particularly for females.
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