Having a modern cooking stove at the household level provides an incomplete measure of cooking energy access. This limitation has necessitated the introduction of a multi-tier framework (MTF) to provide a more nuanced assessment. Thus, this study examines the overall, gendered, and rural-urban effects of cooking energy access under the MTF on health and time allocation to various household activities. Using the 2018 World Bank/ESMAP MTF dataset on Zambia, the study applies inverse probability regression adjustment with generalized propensity score to estimate pairwise average treatment effect on treated, by categorising households to tiers (0–5) based on six primary cooking energy attributes. The findings reveal that as households move up the MTF tiers, improvements in outcomes – such as reduced respiratory illness and better time allocation – are generally observed, though the magnitude of benefits tends to taper at higher tiers. Furthermore, women experience greater improvements relative to men, particularly in lower-tier transitions.