The Influence of Interfamilial Power on Family Planning and Maternal Health Care in Mali: Perspectives of Women, Men, and Mothers-in-Law Open Access

Abstract

Abstract

Background. Despite decades of policies and programs designed to improve reproductive
health in the developing world, indicators of family planning and maternal health remain
poor, particularly in Sub-Saharan Africa. The typical approach to addressing these gaps
has focused exclusively on women, however evidence suggests that women often have
limited control over their own reproductive health.
Objective. This study explores interfamilial power dynamics and the relative influence of
women, their husbands, and their mothers-in-law on family planning and maternal health
care practices.
Methods. In two rural districts of the Mopti region of central Mali, survey data were
collected from women, their husbands, and their mothers-in-law. In addition to socio-
demographic questions, respondents were presented with eight sets of scale items
assessing agreement with various constructs of gender, power, and health. Based on
these items, the primary covariates for analysis comprised a series of indices constructed
using principal components analysis. Logistic regression was performed to fit associative
models for each of five outcome variables representing the index women's: current use of
family planning, antenatal care frequency, antenatal care timing, institutional delivery,
and postnatal care.
Results. Although the relevant constructs and the degree of influence of each respondent
group varied across the five outcomes, some overarching patterns emerged. After
adjusting for socio-demographic characteristics and other significant covariates,
husbands' preferences and opinions were not significantly associated with any of the
outcomes. In contrast, the preferences and opinions of mothers-in-law had strong effects
on the reproductive health behaviors of their daughters-in-law. From the perspective of
the index women, constructs related to self-efficacy, perceptions of the value of women,
and attitudes towards health services were independently associated with preventative
and health-seeking practices.
Discussion. These results indicate that interventions focusing only on women or at the
level of the couple are 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 mothers-in-law.

Table of Contents

Table of Contents
List of tables ....................................................................................................................... iii
Definition of key terms ...................................................................................................... vi
I. INTRODUCTION ........................................................................................................... 1
Background ..................................................................................................................... 2
II. LITERATURE REVIEW ............................................................................................... 8
Gender, power, and health............................................................................................... 8
Power and reproductive health: Evidence of association .............................................. 10
Measuring power ........................................................................................................... 12
Power and reproductive health in Mali ......................................................................... 19
III. METHODOLOGY ..................................................................................................... 24
Population and study setting ......................................................................................... 24
Sample and research design .......................................................................................... 25
Measurements................................................................................................................ 27
Analysis ......................................................................................................................... 39
IV. RESULTS ................................................................................................................... 40
Descriptive statistics ...................................................................................................... 40
Family planning use ...................................................................................................... 52
Antenatal care frequency ............................................................................................... 56
Antenatal care timing .................................................................................................... 61
Institutional delivery ..................................................................................................... 67
Postnatal care................................................................................................................. 72
Summary of associations ............................................................................................... 78
V. DISCUSSION .............................................................................................................. 80
Implications ................................................................................................................... 86
Limitations .................................................................................................................... 89
VI. CONCLUSION........................................................................................................... 92
REFERENCES ................................................................................................................. 93

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	Mali Maternal health Family planning Power Sub-Saharan Africa Reproductive Health Mothers-in-Law Gender
Committee Chair / Thesis Advisor	Stephenson, Robert, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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