Culturally Perceived Risks of Pregnancy: Correlations between early disclosure of pregnancy, gender and social norms, and positive maternal health program outcomes in Bankass and Bandiagara, Mali Open Access

Abstract

Background. Over 20 years after ICPD, uptake of essential reproductive and maternal health services remains slow in Sub-Saharan Africa. Frequently, social norms, cultural traditions, and gender roles are blamed for impeding access to crucial health care. Although current anthropological research highlights the need to address culturally perceived risks of pregnancy in current maternal health programming, no evidence addresses the impact of early disclosure of pregnancy on maternal health program outcomes. Objective. This study investigates the intersections of culturally perceived risks of pregnancy disclosure, social and gender norms, and maternal health program outcomes within the context of a community-based maternal health initiative in Mali, West Africa. Methods. In two rural districts of the Mopti region of central Mali, survey data were collected from women that gave birth within the past six months. Differences in socio-demographic characteristics, gender empowerment constructs, and health service utilization were analyzed between intervention and control districts and timing of pregnancy disclosure. The predictive value of early disclosure of pregnancy, the primary covariate of interest, on main maternal health program outcomes was assessed using multivariate modeling. Binomial logistic regression was performed to fit associative models with each of four maternal health program outcome variables including: current family planning use, complete package of WHO recommended antenatal care services, institutional delivery, and skilled postnatal care. Results. Unadjusted bivariate associations between positive maternal health program outcomes and the intervention district were significant. Women in the intervention district also reported statistically higher scores of gender empowerment than those in the control district. After adjusting for socio-demographic characteristics, gender empowerment indices, and exposure to the intervention, early disclosure of pregnancy remained a strong predictor of the receipt of the WHO recommended package of antenatal care services, institutional delivery, and skilled postnatal care. Discussion. This analysis substantiates the valor of community-based initiatives that catalyze dialogue about pregnancy at the community and household level and confront social and gender norms that impede women from accessing health services. The results from this analysis contribute to existing research by emphasizing the benefit of addressing culturally perceived risks of pregnancy to improve maternal health service utilization in Mali.

Table of Contents

I. Introduction 1

Research Objectives: 4

II. Literature Review 5

Diffusion of Innovation and Social Network Theory 5

Social Norms, Culture, Gender Roles, and Reproductive Health 7

Addressing the Gatekeepers of Maternal Health: Male Involvement 9

Culturally Perceived Risks of Pregnancy 11

III. Methodology 14

Population and Study Setting 15

Research design and sample 16

Measurements 18

Demographics 19

Women's Empowerment Indices 19

Other Indices 22

Validation of Indices 23

Analysis 23

IV. Results 26

Descriptive Statistics 26

Demographic variables 26

Discussion of Pregnancy 27

Gender Empowerment Constructs and Indices 29

Early Disclosure of Pregnancy 31

Maternal Health Program Outcomes 35

Early Disclosure and Maternal Health Program Outcomes 41

Family Planning Use 41

Antenatal Care 43

Institutional Delivery 46

Postnatal Care 48

Overview of Final Models 51

V. Discussion 52

Program Implications 60

Data limitations 61

VI. Conclusions 63

VII. Appendix I: Construction of Indices 64

VIII. References 74

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	pregnancy social norms antenatal care maternal health postnatal care family planning gender institutional delivery
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Committee Members	Weiss, Paul, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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