Grandmothers' influence in MCH decision-making : a metasynthis of qualitative research by the Grandmother Project Open Access

Peery, Brooke Elizabeth (2013)

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Background/Purpose: Improving the health of mothers and children in the developing world has been the objective of numerous public health programs during the past twenty years. Most maternal/child health programs based on individual behavior change paradigm narrowly focus on young mothers based on the assumption that if their knowledge and attitudes are changed they will automatically modify their own practices. Young mothers often defer to more senior women, who in large part direct and control their activities within the household, concerning diagnosis of illness and childcare decisions. To date, very few maternal/child health programs have included older experienced women or grandmothers in health interventions.

Objective: The objectives of this meta-synthesis are: 1) To identify household roles and decision-making around maternal/child health issues. 2) To clarify the role of grandmothers as advisors to younger women and as family caregivers.

Sample: From 1995 to 2013, the Grandmother Project conducted 9 studies in Laos, Djibouti, Senegal, Mali, Uzbekistan, Albania, Mauritania, and Sierra Leone. The approximate sample size for this meta synthesis is 2970 participants. The sample population included mothers, grandmothers, fathers, community members, traditional healers, village leaders, health care workers, and women of reproductive age.

Methods: A qualitative meta-synthesis methodology was used for the analysis of 9 studies conducted by the Grandmother Project. In each study, key metaphors, phrases, ideas, concepts, and relations were identified and translated using grounded theory.

Results: Five common themes emerged from these studies related to the social dynamics and decision-making within households and communities: distinct roles based on gendered experiences, collective decision making, the role of grandmothers as primary advisors in maternal/child health, the influence of female support systems in maternal/child health, and the conflicting paradigms of health care workers and grandmothers.

Discussion: Across the multiple contexts reviewed, families were consistently found to be multi-generational and hierarchically structured; roles and responsibilities were based on gendered experience. Grandmothers/mothers in law participate in informal social networks of communication and support, through which information is shared, advice is given, and problems are solved. Grandmothers are respected advisors on issues pertaining to maternal and child health; they contribute substantially to decision-making and implementation of decisions. This culturally assigned role of grandmothers creates conflict with health care workers, but despite this conflict they are open to learning and wish to be included in MCH activities.

Table of Contents

Table of Contents
Chapter 1: Introduction...1
Chapter 2: Literature Review...5
Chapter 3: Manuscript...20

Text Boxes...43

Chapter 4: Public Health Implications and Recommendations for Future Studies...55

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