Page 181 - GHES-3-3

Global Health Economics and
Sustainability
Transport and health of pregnant women

women, children, the elderly, and people with disabilities 2. Literature review
are more at risk of transport exclusion. Lack of adequate
and efficient access to transportation contributes to the 2.1. Social exclusion
marginalization of pregnant women, especially with regard Although there is no consensus on a definite definition
to access to health facilities (Carmien et al., 2005; Mishra, of the concept of social exclusion, various descriptions
2024; Seekins et al., 2007). Specifically, a lack of private have centered it around issues of deprivation and denial.
transportation options may make pregnant women more This leads to an inability to participate in activities such
dependent on alternate forms of transportation, reducing as economic, social, cultural, or political ones, ultimately
the frequency of health trips and access to clinics and other resulting in a diminished quality of life for individuals
health facilities. This issue is especially severe in resource- (Brady et al., 2021; Levitas et al., 2007). The term “social
poor nations like Nigeria, where infrastructural decadence, exclusion” originated in France in 1974 to describe limited
individual poverty, and lack of social support may limit access to resources, causing personal and physical harm
accessibility to effective modes of transport. (Sen, 2000). Cuesta et al. (2024) described social exclusion

Recent reports suggest that Nigeria has one of the as a key determinant of the well-being of individuals,
highest rates of infant and maternal mortality worldwide households, and communities arising from geographic,
(Nwanze, 2023; World Health Organization, 2019; economic, political, and social dynamism. Kenyon
United Nations Children’s Fund, 2020), though it remains (2006) perceives social exclusion as a multi-dimensional
unclear how much of this is attributable to transport concept resulting from the interplay of factors unique to
exclusion. While extensive research has explored transport- individuals or groups. These factors manifest as a denial of
related social exclusion in both developed and developing opportunities to participate in the economic, political, and
nations (Church et al., 2000; Lucas et al., 2009; Luke, 2024; social life of the community to which an individual belongs.
Schwanen et al., 2015), there is limited evidence addressing In another perspective, the concept of social exclusion is
its impact on diverse populations, specifically in Africa. In considered relative, meaning an individual can be socially
this context, male dominance in vehicle ownership and excluded only in comparison with other members of a
operations often creates an environment where women society (Bossert et al., 2007; Cuesta et al., 2024). Thus,
who need to travel must negotiate their journeys. Travel there is no “absolute” social exclusion, as an individual
is viewed by many women, especially young women, can only be declared socially excluded with respect to the
as a hazardous affair, with potential threats ranging society in which he is considered a member. This relative
from theft, molestation, and verbal/sexual harassment aspect presents the concept of social exclusion as one of
to actual physical harm. These challenges severely limit deprivation, supporting Levita et al.’s (2007) description of
women’s access to essential services and livelihoods while social exclusion as an issue of deprivation and denial. This
threatening their overall well-being (Adeola et al., 2024; idea arises from comparing one’s situation with those who
Porter et al., 2018). are better off (Varo, 2024; Runciman, 1966). This, however,
does not equate social exclusion with deprivation, as social
Despite these broader insights into transport
exclusion’s effects on women, little is known about the exclusion has important dynamic aspects. For instance,
an individual can be socially excluded if his condition of
risks of transport exclusion among pregnant women in deprivation is persistent or worsens over time. Therefore,
Nigeria, whose mobility may be greatly affected by their the measurement of exclusion requires time as an
vulnerable condition. Hence, this study aims to examine important variable (Ravallion & Chen, 2013). When an
the lived experiences of pregnant women in a selected individual experiences a continuous, uninterrupted level
part of southwestern Nigeria by identifying key factors of deprivation, they may be in a state of higher social
contributing to their transport exclusion. The overall exclusion than someone with periods of deprivation
objective is to provide insights into how transport barriers interrupted by periods of non-deprivation.
affect pregnant women’s mobility and well-being while
informing policy initiatives aimed at promoting inclusive From a social policy perspective, social exclusion is
transportation for pregnant women in the study area. driven by the values, processes, and actions of key delivery
Subsequent sections of this paper provide a review of agencies that are often designed to systematically exclude
social exclusion, the links between transport and social certain groups of individuals. This exclusion contributes
exclusion, and the effects of transport exclusion on to a range of social ills, including health disparities, low
healthcare. This is followed by this study’s methodology income, skills deficits, unemployment, poor housing, high
description, results, discussion, summary, conclusion, and crime rates, and family breakdown (Bhattacharjee, 2023;
policy implications. Social Exclusion Unit [SEU], 2004).

Volume 3 Issue 3 (2025) 173 https://doi.org/10.36922/ghes.5203