Abstract
BackgroundThis paper aims to provide insights into the role of traditional authorities in two maternal health programmes in Northern Malawi. Among strategies to improve maternal health, these authorities issue by-laws: local rules to increase the uptake of antenatal and delivery care. The study uses a framework of gendered institutions to critically assess the by-law content, process and effects and to understand how responsibilities and accountabilities are constructed, negotiated and reversed.MethodsFindings are based on a qualitative study in five health centre catchment areas in Northern Malawi. Data were collected using meeting observations and document search, 36 semi-structured individual interviews and 19 focus group discussions with female maternal health service users, male community members, health workers, traditional leaders, local officials and health committee members. A gender and power sensitive thematic analysis was performed focusing on the formulation, interpretation and implementation process of the by-laws as well as its effects on women and men.ResultsIn the study district, traditional leaders introduced three by-laws that oblige pregnant women to attend antenatal care; bring their husbands along and; and to give birth in a health centre. If women fail to comply with these rules, they risk being fined or denied access to maternal health services. The findings show that responsibilities and accountabilities are negotiated and that by-laws are not uniformly applied. Whereas local officials support the by-laws, lower level health cadres’ and some community members contest them, in particular, the principles of individual responsibility and universality.ConclusionsThe study adds new evidence on the understudied phenomenon of by-laws. From a gender perspective, the by-laws are problematic as they individualise the responsibility for maternal health care and discriminate against women in the definition and application of sanctions. Through the by-laws, supported by national policies and international institutions, women bear the full responsibility for failures in maternal health care, suggesting a form of ‘reversed accountability’ of women towards global maternal health goals. This can negatively impact on women’s reproductive health rights and obstruct ambitions to achieve gender inequality and health equity. Contextualised gender and power analysis in health policymaking and programming as well as in accountability reforms could help to identify these challenges and potential unintended effects.
Highlights
IntroductionScholars argue that traditional leaders, like families and religious institutions, remain the primary locus of political obligation and moral imperative in many communities in Africa [3]
This paper aims to provide insights into the role of traditional authorities in two maternal health programmes in Northern Malawi
Norms express particular values and relations of power, and they are gendered in the following ways: 1) in their formulation, they articulate societal expectations regarding the roles, behaviours and attitudes that are considered appropriate for men and women; they may privilege either men’s or women’s interests, such as in the case of male involvement or gender quota in local elections; 2) norms are always subject to interpretation and are developed, accepted, maintained, circumvented, manipulated or contested by actors who are operating according to hierarchical power relationships, based on gender; 3) in practice, they are applied differently to men and women, and different groups of women; and
Summary
Scholars argue that traditional leaders, like families and religious institutions, remain the primary locus of political obligation and moral imperative in many communities in Africa [3]. They have unique capacities in brokering relations of individual and collective responsibility and accountability in order to safeguard social norms and promote community mobilisation [3,4,5]. It examines how chiefs mediate and formalise the distribution of responsibilities and accountabilities in communities in efforts to increase the uptake of antenatal and maternal health care. It discusses the implications for the way in which we understand accountability and for the approaches used in policy-making and programming in the area of sexual and reproductive health
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
