The Influence of Intrafamilial Power on Maternal Health Care in Mali: Perspectives of Women, Men And Mothers-in-Law

Abstract

Despite decades of policies and programs aimed at improving reproductive health worldwide, high maternal morbidity and mortality persist in many resource-poor settings, particularly in Sub-Saharan Africa. [1][2][3] The predominant approach to mitigating this problem has been to target the knowledge, attitudes and practices of women of reproductive age and to strengthen health service provision. Although educating and designing services for women is undoubtedly important, this focus assumes that women have control over their maternal health care decisions. Evidence from diverse settings, however, indicates that women often have only partial, if any, autonomy over their reproductive and sexual health. [4][5][6][7][8] Not only do husbands have a significant influence on the behavior and actions of their wife, 7,9,10 but other household members, especially mothers-in-law, also exert control over younger women. 5,[11][12][13] Maternal morbidity and mortality are largely preventable through the provision of antenatal care, institutional delivery and timely postnatal care. 8,[14][15][16][17] 7,12,23 in some settings, substantial gaps in coverage remain even after adjustment for the availability of services. Accordingly, researchers and program planners have begun to appreciate the complexity of contextual influences on maternal health practices, and have adopted an approach that recognizes that individual attitudes and behaviors are products of their social and cultural environments. 24,25 Still, most studies have focused exclusively on women as the target population, and have aimed to understand and influence barriers and facilitators from their perspective. This narrow focus is incongruent with a sociocultural context in which women hold low status and are subject to the preferences and beliefs of their husband and elder relatives. 26-28Interpersonal power, however, has proven difficult to measure, such that power dynamics within a household and how they influence decisions on maternal health are not fully understood. 6,[29][30][31] To address this gap, we explored the link between household power dynamics and the maternal health behaviors of married women in rural Mali. Specifically, this article examines the relative influence of the preferences and beliefs of women, their hus- METHODS Data and SettingData for this analysis were drawn from the Projet Espoir Baseline Survey (PEBS), which was conducted between June and July 2011 in Bandiagara and Bankass, two rural districts of central Mali's Mopti region. This article contributes to the project's larger goal of identifying and addressing underlying social determinants of poor maternal health in rural Mali. Ethical approval was obtained from the institutional review boards at Emory University and the Malian Ministry of Health. The Mopti region is predominantly rural and agricultural, and has the lowest levels of education in the country. 51Although men and women in the region have roughly equal educational profiles overall, among younger cohorts, educational attainm...

Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey

“…For instance, lower educational levels [9] and socioeconomic factors [2,7] are associated with poor ANC attendance in women in rural areas [2,10]. Spousal support and decisions concerning the use of maternal health services also influence women’s access to skilled care [11]. This could be attributed to the patriarchal system in place in Africa, in which men are usually the heads of households, with the power and authority to make decisions, including those concerning their wives’ use of maternal health services [12–16], for their family members [13].…”

Role of Men in Women’s Health Status in Rural Areas of Andhra Pradesh

“…Husbands' preferences and opinions were not associated with any outcome. [5] Our study found that 75% of men decided which hospital to go to and family size decision. This finding is close to the study done by Azuh D, Fayomi O and Ajayi which found that in family decision making power including that of health and treatment place, the patriarchal domination orchestrated by gender roles manifested prominently as husband exercises an overwhelming proportion (72.7%) or control in the affairs of his household activities.…”

“An Be Jigi”: Collective cooking, whole grains, and technology transfer in Mali

“…Daughters-in-law were not mentioned by these women, even though they typically lived together in the same household. This limitation of communication between mothers-in-law and daughters-in-law is part of the cultural rules that define their relationship and was to be expected (White et al 2013). Women from all age groups showed interest in attending the cuisines collectives.…”