The Influence of Intrafamilial Power on Maternal Health Care in Mali: Perspectives of Women, Men And Mothers-in-Law
Year: 2013
Type: article
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]4][15][16][17] Yet, in Sub-Saharan Africa, fewer than half of women receive the World Health Organization's recommended 18 four or more antenatal care visits from a skilled provider, the majority deliver in the home and few receive postnatal care.17,19 Limited access to preventive and curative services, 8,20 inadequate health infrastructure and personnel, 8,21,22 and inability to pay 8,21,22 have been recognized as formidable barriers to receipt of maternal health care.Recent research, however, indicates that supply side factors do not fully explain the variability in care-seeking practices; 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][27][28] Interpersonal 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-CONTEXT: Evidence from diverse settings suggests that women often have limited control over their own reproductive health decisions.To increase uptake of preventive services and behaviors, it is important to understand how intrafamilial power dynamics and the attitudes of women, their husband and their mother-in-law are associated with maternal health practices.METHODS: In 317 households in two rural districts of central Mali, women who had given birth in the previous year, their husband and their mother-in-law each completed a survey gauging their attitudes toward constructs of gender, power and health.Bivariate and multivariable logistic regression analyses were conducted to identify associations with four maternal health outcomes: antenatal care frequency, antenatal care timing, institutional delivery and postnatal care.RESULTS: In multivariable analyses, the preferences and opinions of mothers-in-law were associated with the maternal health behaviors of their daughters-in-law.Women's own perceptions of their self-efficacy, the value of women in society and the quality of services at the local health facility were also independently associated with their preventive and health-seeking practices.Husbands' preferences and opinions were not associated with any outcome.CONCLUSION: Interventions focusing on women or couples may be insufficient to advance women's reproductive health in patriarchal societies such as Mali.Future research and programmatic efforts need to address gender norms and consider the influence of other family members, such as mothers-in-law.
DOI: 10.1363/3905813
Institutions: CARE USA, Emory University, Care International
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Emory University, Tides Foundation
OpenAlex ID: W2039207024