Abstract
BackgroundThere is some evidence to suggest that within the household, family and community settings, women in sub-Saharan Africa often have limited autonomy and control over their reproductive health decisions. However, there are few studies that examine how intra-familial decision-making power may affect women’s ability to access and use maternal health services. The purpose of this paper is to examine how intra-familial decision-making affects women’s ability to access and use maternal health services.MethodsWe conducted 12 focus group discussions and 81 individual interviews with a total of 185 expectant and lactating mothers in six communities in Ghana. In addition, 20 key informant interviews were completed with healthcare providers. Attride-Stirling’s thematic network analysis framework was used to analyse the data.ResultsFindings suggest that decision-making regarding access to and use of skilled maternal healthcare services is strongly influenced by the values and opinions of husbands, mothers-in-law, traditional birth attendants and other family and community members, more than those of individual childbearing women. In 49.2 %, 16.2 %, and 12.4 % of cases in which women said they were unable to access maternal health services during their last pregnancy, husbands, mothers-in-law, and husband plus mothers-in-law, respectively, made the decision. Women themselves were the final decision-makers in only 2.7 % of the cases. The findings highlight how the goal of improving access to maternal healthcare services can be undermined by women’s lack of decision-making autonomy through complex processes of gender inequality, economic marginalisation, communal decision-making and social power.ConclusionInterventions to improve women’s use of maternity services should move beyond individual women to target different stakeholders at multiple levels, including husbands and mothers-in-law.
Highlights
There is some evidence to suggest that within the household, family and community settings, women in sub-Saharan Africa often have limited autonomy and control over their reproductive health decisions
Much progress has been made over the last several decades to improve maternal health worldwide. This progress notwithstanding, high maternal mortality persists in many resource-poor settings in sub-Saharan Africa [1]
The aim of this paper is to address this gap by exploring how intra-familial decision-making within the household, family and community affects women’s ability to access and use maternal health services in Ghana, focusing on communities in both southern and northern Ghana
Summary
There is some evidence to suggest that within the household, family and community settings, women in sub-Saharan Africa often have limited autonomy and control over their reproductive health decisions. There are few studies that examine how intra-familial decision-making power may affect women’s ability to access and use maternal health services. The purpose of this paper is to examine how intra-familial decision-making affects women’s ability to access and use maternal health services. Much progress has been made over the last several decades to improve maternal health worldwide This progress notwithstanding, high maternal mortality persists in many resource-poor settings in sub-Saharan Africa [1]. While facility births have gone up dramatically in some settings, some women still do not have access to health facilities and skilled birth attendants in many countries in the sub-Saharan African region where the burden of maternal mortality is relatively high [2,3,4,5,6]. Despite the fact that Ghana has since 2003 implemented a maternal healthcare policy that provides free maternity care services in all public and
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