The theoretical perspective on gender roles and relations

Many studies in the vast field of gender and health research on women’s lack of agency in rural sub-Saharan Africa (and elsewhere in the global south) have suggested various ways in which intra-household relations may affect women’s health. Sociocultural Aspects of Maternal and Child Essay. Evidence from diverse settings suggests that power relations are influenced by constructs at the interpersonal and societal levels [13, 14]. The manifestations of power are also shaped and in turn affected by social and normative prescriptions related to gender [15–18].

Drawing on these conceptual insights, this study employed the intra-household bargaining power theory pioneered by Sen (1990) and Agarwal (1997). In the context of “bargaining” and gender relations within the household, Agarwal [19] observed that the nature of gender relations–relations of power between women and men–is not easy to understand in its full complexity and that the complexity arise not least from the fact that gender relations (like all social relations) embody both the material and ideological, but are also revealed in the division of labor and resources between men and women. Based on these premises, Agarwal [19] observed that previous models of the household have paid inadequate or no attention to some critical aspects of intra-household gender dynamics such as: what factors (especially qualitative ones) affect bargaining power? What is the role of social norms and social perceptions in the bargaining process and how might these factors themselves be bargained? Are women less motivated than men by self-interest and might this affect bargaining outcomes?

As a demonstration of the useful of the intra-household bargaining power and gender relations, this study premised that gender related socio-cultural factors impinge intra-household bargaining power and retard maternal health care utilization.Sociocultural Aspects of Maternal and Child Essay.  The type of society (for example, patriarchic or traditional) a woman lives in and the gender norms and values within the society determine her status within the community and household, thereby inhibiting women access to health care [20]. The dynamics of the relationship between a woman and her partner can also influence access to and control over resources and decision on how to expend resources, which ultimately has implications for maternal health. Therefore, the aim of this study is to depict the gender dynamic in a rural Gambian context from the perspectives of women by exploring the social and cultural factors affecting maternal health. Our study findings contribute to the understanding of the gendered patterning embedded in interpersonal relations and have implications for reducing maternal mortality in resource poor settings.

Literature review

Maternal health improvement has attracted global attention at the 1987 Safe Motherhood Conference held in Nairobi, Kenya. Since then, improving women’s health issues pertaining to pregnancy and delivery has become the centerpiece of national development efforts in developing countries. However, despite this significant stride, there is little evidence to prove that maternal mortality has declined significantly in African countries, including The Gambia [21]. Review of related studies throws more light on why African countries are held back on maternal mortality reduction. Sociocultural Aspects of Maternal and Child Essay.

A study of Cameroonian women reported that although women were generally worried about their health, the cultural background of gender roles blinded them from recognizing their right to maintaining good health [22]. These women considered the right to good health as contingent on fulfilling their purpose of taking care of and meeting the needs of “others” (such as husbands) at the expense of their own physical health and well-being. There is a religious and socio-cultural dimension for this consideration. In a study among the Hausa of Northern Nigeria, Afonja [23] found that the most important factors contributing to maternal deaths include an Islamic culture that undervalues women; a perceived social needs for women’s reproductive health capacities to be under strict male control and the practice of purdah (wife seclusion), which restrict women’s medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic is complete and harmful traditional medical practices among others [24].

Dixon et al. [25] also found intra-household dynamics impact male/female enrolment in national health insurance in Ghana. In this case mothering often prevented women from enrolling. Similarly, another study in Mali found women’s own perceptions of their self-efficacy and the value of women in society as determinants for their preventive and health seeking behavior [18]. A study in Benin Republic also reported that factors like husbands’ approval and money for treatment had negative effects on maternal health seeking behavior [26]. This finding shows the lack of decision-making autonomy and economic independence of women.

Women’s decision-making autonomy may be explained in relation to their lack of education and limited influence over material resources [12]. Women’s land rights in particular have been a major focus of empowerment efforts [27], yet only in a few countries do women constitute even one-quarter of the landowners [28]. This gender disparity in land ownership impacts the economic status of women and further perpetuates a high level of dependency on their husbands, leading to male dominance [24]. Sociocultural Aspects of Maternal and Child Essay. Adding another voice to this discussion, Hansford et al. [29] observed that although women may have access to land or retain control over their own income, many have no influence on the use of their husband’s income. This may mean that women are particularly unlikely to make independent decisions about how money should be spent on high-expenditure items, including healthcare services.

The dynamics of the relationship between a woman and her husband can also determine a woman’s access to healthcare and can lead to varying levels of partner-controlling behaviors, such as gender-based violence [30], which studies have shown is associated with poor maternal health. A survey among antenatal care clinic attendees in The Gambia in 2011 revealed (61.8%) prevalence of intimate partner violence among study subjects, with 12% requiring medical care and 3% prevented from seeking healthcare as a result of such violence [31]. Another study in Matlab, Bangladesh, found that homicides and suicides that were motivated by stigma over unwanted pregnancy, beatings or dowries accounted for 6% of all maternal deaths in 1986 [32].

Other traditional practices based on patriarchal beliefs also affect women’s psychological and physical health [22]. Polygamy, a common marital practice in many African countries, is deeply engrained in Gambian culture, where multiple partners are considered part of Gambian masculinity [33]. This practice has resulted in men abandoning older wives for younger ones, leading to a vicious cycle of abuse toward women [33]. Many studies have shown that women in polygamous unions, especially senior wives, may suffer from more psychological disorders, as well as more familial and economic problems, compared to their counterparts in monogamous marriages [34, 35]. Sociocultural Aspects of Maternal and Child Essay.

Taken together, these issues highlight the consequences of women’s living conditions in relation to their disadvantaged experiences, which are also connected to the gendered effects of socio-cultural practices affecting maternal health. This underscores the significance of this study, whose objective was to depict the gender dynamic in a rural Gambian context from the perspectives of women by exploring the social and cultural factors affecting maternal health issues pertaining to pregnancy and delivery. A key focus of the study is on household dynamics.

Design

This study was based on a qualitative, exploratory research design and used focus group discussions and in-depth interviews as its primary data collection techniques.

Setting

We conducted focus group discussions and in-depth interviews in five rural communities (Makka Farafenni, Kerr Ardo, Kerr Gumbo, Mballow Omar and Bakindik) in the North Bank Region of The Gambia, where farming and animal rearing remain the mainstays of the local economy. The three main ethnic groups (Mandinka, Fula and Wolof) in the country reside in these communities. Our choice of these five rural communities was based on their long-standing history as locations of research intervention and continuous demographic surveillance [36]. In 1987, they were among the primary research sites for the field trial of the sisterhood method in The Gambia, which indicated a lifetime risk of maternal mortality of 0.0584, or 1 in 17 [37]. The sisterhood method is an indirect technique for deriving population-based estimates of maternal mortality [37].

It is also common to find women collaborating with research organizations in these five rural communities. This study partnered with the Agency for the Development of Women and Children (ADWAC) in order to secure entry points and easy access to the study communities and participants. Sociocultural Aspects of Maternal and Child Essay.

Data collection

The data collection involved women residing in the five rural communities (Makka Farafenni, Kerr Ardo, Kerr Gumbo, Mballow Omar and Bakindik). Participants in the study were recruited from women’s groups existing in the study communities. They were contacted by ADWAC field coordinators, who briefed them about the objective of the study and requested for their assistance in identifying potential subjects. Fifty eligible participants were then identified. The sample inclusion criteria include women of childbearing age (15–30 years) with at least one child. It was assumed that participants meeting these criteria would be able to provide current information about maternal health issues because they had recently entered their reproductive years or had given birth relatively recently. Therefore, they would be more likely to recall pregnancy and other related complications. These groups of women may also be more exposed to maternal health research or more informed about issues affecting their health and pregnancies than other local women who do not belong to any women’s groups.

A total of five focus group discussions (FGDs) that included fifty participants and six in-depth interviews (IDIs) were conducted. The FGDs were held in the morning before the women started their work in the field, and typically lasted for 70–90 minutes. Each focus group discussion was limited to ten participants for ease of management and was held in either the village health post or community development center to avoid noise and distraction.

Following the introduction and informed consent routines, participants were asked to discuss the difficulties they face in keeping themselves healthy and health-related problems they had experienced during pregnancy and delivery.Sociocultural Aspects of Maternal and Child Essay.  Based on the issues they raised, the researcher prompted them to describe their situations, how relevant decisions were made within their households, and how they managed to cope with difficulties. This discussion was supplemented by interactive questions about such topics as obtaining prenatal care, travel arrangements at the time of delivery and division of labor when they were pregnant. An interview guide mutually developed and agreed upon by the three authors (ML, DR and SLH) was used to facilitate the discussion. The interview guide was developed based on literature review of previous studies on women’s perceptions of maternal health issues [38], and on social and cultural barriers of maternity care [39, 40]. The interview guide was pilot tested with participants that have similar inclusion criteria as those that participated in the study and was ethically approved long before primary data was being collected and no change was made following ethical approval. It was designed to be open ended and contained specific questions, such as the following: “What are the obstacles pregnant women in your community face in seeking and receiving care?”; “Do any of you travel to a nearby place in anticipation of delivery?”; “Was this visit a burden to your family or yourself?”; “How were transportation arrangements made for you?”; “Who made the decision for you to seek care?”; and “Why was this person very important in your decision to seek care?”.

ORDER A PLAGIARISM-FREE PAPER NOW

In-depth interviews (IDIs) were also conducted with six traditional birth attendants (TBAs) to obtain in-depth information about maternal health issues in their communities. The traditional birth attendants were crucial to the data collection because they are considered part of the Gambian healthcare system [41]. TBAs have been practicing in the communities even before The Gambia adopted the primary healthcare program in 1978. They work (often in conjunction with village health workers), make referrals and attend all forms of illness in the village. Sociocultural Aspects of Maternal and Child Essay.

The in-depth interviews with TBAs were conducted to enrich data from the FGDs and to facilitate data triangulation [42]. The data collection was limited to five focus group discussions and six in-depth interviews because of the complexity of the data, which were time consuming in terms of collecting, and because the data aimed to provide rich insights to understand social phenomenon rather than statistical information. The number of focus group discussions and in-depth interviews were decided upon beforehand by the three authors (ML, DR, and SLH). The rationale for the use of these qualitative methods was to draw upon participants’ experiences and reactions in a way which would not be feasible using other methods [43].

The data collection process for both the FGDs and IDIs was based on the principle of saturation [44, 45] and was conducted during August and September 2012, with two research assistants recording all the discussions. The research assistants were a female nurse and a male community development worker who had mastery of the two local languages (Mandinka and Wolof) and had experience in data collection. Sociocultural Aspects of Maternal and Child Essay.